Health Literacy,Health Inequality and a Just Healthcare System

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy.     

Preferences for Online Mental Health Services Among Australian and Indian Samples: A Cross-Cultural Comparison

Online mental health services provide a point-of-access to mental healthcare that may otherwise be unavailable or limited, particularly in developing countries. Nevertheless, there is a lack of research into individual differences between those who prefer online mental health services and those who prefer traditional in-person services, and whether these differences vary as a function of culture. This study investigated differences in preferences for online or in-person mental health services on e-health literacy, age, education level, and comfort using the internet in a general community sample recruited from Australia and India. A total of 487 participants (31.6% male; mean age?=?33.55, SD?=?12.20, range 18–78), 297 Australians and 190 Indians, completed an online or paper-and-pencil survey. A significant negative relationship between age and e-health literacy was found with younger ages associated with higher e-health literacy. Furthermore, e-health literacy scores were significantly higher for the Australian sample. Age, e-health literacy, country-of-residence, education level, and comfort in using the internet did not predict mental health service preference. The results suggest that preference for in-person or online mental healthcare is independent of demographic and cultural factors and indicate that online mental health services may be acceptable to Indian health service consumers.     

Quality and readability of internet information about stuttering

PurposeWe examined the quality and readability of English-language Internet information about stuttering and evaluated the results considering recommendations by experts in health literacy.MethodA search of Internet websites containing information about stuttering was conducted. Three key words (i.e., stuttering, stammering, speech disfluency) were entered into five country-specific versions of the most commonly used Internet search engine. A total of 79 websites were assessed. Their origin (commercial, non-profit, government, personal or university), quality [Health On the Net (HON) certification and DISCERN scores], and readability [Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG)] were assessed.ResultsOf the 79 websites, 38 % were of commercial, 42 % were of nonprofit organization, 15 % were of government and 5% were of university origins, respectively. Only 13 % had obtained HON certification and the mean DISCERN scores was 3.10 in a 5-point scale. The mean reading grade levels were at 13th and 14th grade and 100 % of the websites exceeded the recommended 5th to 6th reading grade level for health information.ConclusionsThe quality of Internet-based health information about the treatment of stuttering is generally adequate, but actual usability of the sites examined in this study may be limited due to poor readability levels. This is problematic in persons with poor literacy skills. Since the Internet can be readily accessed as a valuable consumer information resource, speech-language pathologists and other healthcare professionals have an opportunity to direct consumers to websites that provide readable information of good quality.     

The Associations of Patient Demographic Characteristics and Health Information Recall: The Mediating Role of Health Literacy

ABSTRACT

We examined the mediating role of health literacy in the relationships between participant demographic characteristics and health information recall. Baseline data from two studies that focused on hypertensive adults (N = 1190; M = 62.28 years, SD = 11.98; 35.5% female; 45.9% African-American) were analyzed. The final model, which adjusted for recruitment site, indicated that financial status, race, and education were indirectly related to health information recall through health literacy. Increasing education was also directly related to better health information recall. Increasing age was not related to health literacy, but was related to poorer health information recall. The final model fit the data very well, χ²(3) = 0.69, p = .36, RMSEA = .000 (90% CI = .000 to .024),CFI = 1.00. The results suggest that health literacy might be one of the mechanisms underlying the relationships between participant demographic characteristics and poor health outcomes due to inaccurate recall of instructions.     

Associations of Health-Related Quality of Life with Healthcare Utilization Status in Veterans

Evidence indicates that veterans using VA healthcare services have poor health-related quality of life (HRQOL). Little is known, however, about differences in HRQOL among those who only use VA services and those who also use non-VA services. We sought to evaluate differences in HRQOL among veterans who use: (1) only non-VA services (2) only VA services and (3) both VA and non-VA services (i.e., dual users). A cross-sectional study of 39,942 US veterans who completed the CDC’s 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was analyzed. Self-rated measures of global health status and the number of days per month that veterans were limited by physical or mental problems were extracted from BRFSS survey data as outcomes. Multivariate logistic regression demonstrated that, compared to those receiving all healthcare outside of VA, veterans receiving VA care were more likely to report poorer health outcomes, including worse global health status, greater impairments in physical functioning, and increased limitations regarding routine activities (p’s ≤ .05). Both exclusive and dual users of VA services reported poorer HRQOL than individuals not using VA services. More research is needed regarding veterans’ health status, particularly in the context of dual use.     

Reclaiming “Mydentity”: Counterstorytelling to challenge injustice for racially and economically marginalized emerging adults

Emerging adulthood is an important period for identity development, the development of sociopolitical beliefs, and establishment of social roles and responsibilities. As a part of this development, counterstorytelling—narrative processes that contrast and challenge dominant oppressive narratives—may be used within counterspaces to facilitate positive identity development and to challenge injustice. In this qualitative study, we analyse interviews with and poetry from 12 emerging adults who were facilitators within a youth critical literacy program to understand how counterstorytelling functions to both facilitate identity development and challenge injustice. We found evidence of two superordinate themes: reclaiming identity, taking ownership of identity through counterstorytelling; and co-creating a narrative community, collectively building community through counterstorytelling. Findings support counterstorytelling promotes emergent identity development and works as a strategy for challenging injustice and oppression for marginalized emerging adults. Implications for practitioners and future research are discussed.     

Specificity of Discrimination: Does It Matter From Whence It Comes?1

The negative effects of discrimination on those who are stigmatized are well documented. What is less clear, however, is whether the source of the discrimination has differential outcomes on the person being discriminated against. Survey results from 685 injecting drug users (IDUs) revealed that IDUs who experienced discrimination from healthcare workers had poorer physical health, whereas physical health was unrelated to experiences of discrimination by those outside the healthcare system (family, friends, and partners). In contrast, IDUs' mental health status was less sensitive to the source of discrimination. Discrimination by healthcare workers and by others outside the healthcare industry were both related to IDUs' mental health. Implications and limitations of this research are discussed.     

Promoting Mental Health Equity: The Role of Integrated Care

People suffering from mental illness experience poor physical health outcomes, including an average life expectancy of 25 years less than the rest of the population. Stigma is a frequent barrier to accessing behavioral health services. Health equity refers to the opportunity for all people to experience optimal health; the social determinants of health can enable or impede health equity. Recommendations from the U.S. government and the World Health Organization support mental health promotion while recognizing barriers that preclude health equity. The United States Preventive Services Task Force recently recommended screening all adults for depression. The Satcher Health Leadership Institute at the Morehouse School of Medicine (SHLI/MSM) is committed to developing leaders who will help to reduce health disparities as the nation moves toward health equity. The SHLI/MSM Integrated Care Leadership Program (ICLP) provides clinical and administrative healthcare professionals with knowledge and training to develop culturally-sensitive integrated care practices. Integrating behavioral health and primary care improves quality of life and lowers health system costs.     

Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33?years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.     

Exploring families’ experiences of health: contributions to a model of family health

Child health and developmental outcomes are influenced by the health of the family and the context created. Research suggests symptoms of poor family health (e.g. suboptimal family interactions, parenting stress) yet there is limited understanding of the factors which contribute to robust family health which may unveil opportunities for targeted intervention and family health promotion. The present study examined families’ experiences of family health and factors contributing to family health. We performed a qualitative study using constructivist grounded theory methods to guide our understanding of family health for families with typically developing children aged 5–18. Interviews were conducted in family homes and all members were invited to participate. Data from interviews were transcribed, coded, thematically analyzed, and verified with select families. Ten families, including 10 mothers, 8 fathers, and 15 children participated in the study. Participants described family health as a process of balance, living purposefully, and sharing experiences together in alignment with family identity. Mediating family health were processes of awareness and reflection, and adapting, adjusting, and changing in response to family life including external stress factors. Results highlight the possibility for healthcare practitioners to facilitate families’ self-reflection and awareness about their health in order to mediate family health development.     

The Development,Pilot, and Process Evaluation of a Parent Mental Health Literacy Intervention Through Community Sports Clubs

The mental health literacy of parents may be critical in facilitating positive child and adolescent mental health outcomes. The purpose of this study was to develop, pilot, and evaluate a targeted parent mental health literacy intervention through community sports clubs. Sixty six parents (M_age?=?44.86?±?5.2 years) participated in either a brief mental health literacy intervention workshop delivered through community sporting clubs (n?=?42) or a community-matched control group (n?=?24). Participants’ mental health literacy was assessed at baseline, post-intervention and at 1 month follow-up. A mixed methods process evaluation was conducted with intervention participants to determine the acceptability and feasibility of the intervention. Participants in the experimental group showed greater increases in depression literacy, anxiety literacy, knowledge of help seeking options and confidence to assist an adolescent experiencing a mental health disorder, compared to those in the control group. Post-intervention changes in the experimental group were maintained at 1 month follow-up. A mixed methods process evaluation revealed that parents found the intervention content engaging, relevant to their needs, and practically useful in terms of actively supporting adolescent mental health. Findings provide evidence that a brief, targeted intervention through community sports clubs might be a particularly useful method of improving parental mental health literacy and facilitating positive youth mental health outcomes.     

The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.     

The Influence of Perceived Injustice on the Endorsement of Political Leaders1

Recent public opinion polls have suggested that there is a striking lack of public support for national political leaders and institutions. The two studies discussed in this paper explore why public evaluations of political leaders and institutions are low. In particular, they examine the role of perceived injustice in creating dislike for and distrust of leaders and institutions. This focus upon justice is contrasted with the more traditional focus upon the level of outcomes received from the political system and upon congruence in citizen-leader policy preferences. The results strongly support a focus upon justice by showing that judgments of injustice exercise an influence upon leadership evaluations and in stitutional endorsements which is independent of beliefs about the level of outcomes the political system is providing to citizens or of public support for government policies. In fact, both studies suggest that judgments of justice or injustice have more influence upon the endorsement of political leaders and institutions than do outcome-related concerns.     

“What if There's Something Wrong with Her?”-How Biomedical Technologies Contribute to Epistemic Injustice in Healthcare

While there is a steadily growing literature on epistemic injustice in healthcare, there are few discussions of the role that biomedical technologies play in harming patients in their capacity as knowers. Through an analysis of newborn and pediatric genetic and genomic sequencing technologies (GSTs), I argue that biomedical technologies can lead to epistemic injustice through two primary pathways: epistemic capture and value partitioning. I close by discussing the larger ethical and political context of critical analyses of GSTs and their broader implications for just and equitable healthcare delivery.     

Comparing the Financial Literacy of Public School,Christian School,and Homeschooled Students

The 2008 recession underscored public concern that financial illiteracy has costs that are not limited to the individual who makes poor financial decisions. Considering that college students with limited financial experience are making legally binding decisions, this study explored the personal finance literacy and behavior of Christian college students. The research involved administering an objective item financial literacy and behavior survey. Findings showed a significant positive correlation between financial literacy and behavior. Furthermore, there was no significant difference among Christian college students based on their secondary education experience—Christian, public, or home school. This finding implies that students enter college with similar financial literacy levels, and senior students with inadequate financial literacy demonstrate poor personal financial behavior.     

Genetic Knowledge Among Participants in the Coriell Personalized Medicine Collaborative

Genetic literacy is essential for the effective integration of genomic information into healthcare; yet few recent studies have been conducted to assess the current state of this knowledge base. Participants in the Coriell Personalized Medicine Collaborative (CPMC), a prospective study assessing the impact of personalized genetic risk reports for complex diseases and drug response on behavior and health outcomes, completed genetic knowledge questionnaires and other surveys through an online portal. To assess the association between genetic knowledge and genetic education background, multivariate linear regression was performed. 4 062 participants completed a genetic knowledge and genetic education background questionnaire. Most were older (mean age: 50), Caucasian (90 %), female (59 %), highly educated (69 % bachelor’s or higher), with annual household income over $100 000 (49 %). Mean percent correct was 76 %. Controlling for demographics revealed that health care providers, participants previously exposed to genetics, and participants with ‘better than most’ self-rated knowledge were significantly more likely to have a higher knowledge score (p?<?0.001). Overall, genetic knowledge was high with previous genetic education experience predictive of higher genetic knowledge score. Education is likely to improve genetic literacy, an important component to expanded use of genomics in personalized medicine.     

A Brief Online Video-Based Intervention to Promote Mental Health Help-Seeking in the Context of Injuries for Athletes: A pilot study

In the athletic population, sports injuries are often associated with mental health decline. Despite the availability of services, athletes frequently do not seek help for mental health problems. A range of barriers to help-seeking in athletes have been proposed, including poor mental health literacy and limited help-seeking knowledge. To address this, the current study piloted a newly designed online intervention that aimed to increase help-seeking attitudes, intentions, and mental health literacy (specifically depression literacy) in an athletic population. Using a pre-test post-test design, a total of 207 athletes were recruited using online convenience sampling from across Australia. Athletes were from a range of sports and competition levels and were provided a brief online intervention comprising three short educational videos with content addressing: (1) the athlete’s response to injury; (2) help-seeking and social support; and (3) signs/symptoms of depression. Participants completed pre- and post-intervention surveys which measured attitudes and intentions towards mental health help-seeking, and depression literacy. Data were analysed using RM-MANOVA, which demonstrated significant within-group improvement from pre-to post-intervention for help-seeking intentions, particularly when seeking help from mental health professionals, F(1, 93) = 24.64, p < .001, and online/phone services, F(1, 93) = 29.75, p < .001. Two separate paired samples t-test demonstrated a significant increase from pre-to post-intervention for both help-seeking attitudes, t(206) = 9.04, p < .001, d = 0.628, and depression literacy, t(203) = 8.66, p < .001, d = 0.606. The current study shows promise for brief video-based interventions that provide information targeting help-seeking during times of injury. However, further research using a rigorous randomised controlled trial design is needed. Additionally, more work is required to explore if an improvement in attitudes or intentions corresponds with increased help-seeking behaviour.     

Emotional Reactions to Health Status Changes and Emotional Well-Being Among HIV-Positive Persons with Limited Reading Literacy

People living with HIV-AIDS experience emotional distress in response to negative changes in their health status. The current study hypothesized that individuals with poorer health literacy skills would evidence greater emotional distress in response to negative changes in health status compared to persons with higher health literacy skills. HIV positive persons (N = 294) completed anonymous surveys that included measures of depression and social support and a subset of 98 participants completed two experimental vignettes depicting a person receiving test results showing an increase in HIV viral load (negative health changes) followed by a vignette suggesting decreased viral load (improved health changes). Responses to affective reactions and coping strategies indicated that persons with lower health literacy skills more strongly endorsed negative affective states and maladaptive coping strategies compared to persons with higher health literacy skills. In addition, lower health literacy was associated with greater symptoms of affective depression and poorer social support, whereas higher literacy was associated with greater negativistic thinking. Findings suggest the need for patient education and counseling regarding changes in health status among people living with HIV-AIDS, particularly persons with limited health literacy skills.     

Sleep and Immunity: Cytokine Pathways Linking Sleep and Health Outcomes

ABSTRACT— The functions of sleep are enigmatic but are beginning to be delineated. Sleep has been long thought to be important for health, and poor sleep is prospectively associated with worsened health outcomes. Yet the mechanisms accounting for this are only partially understood. In this review, we suggest that the immune system plays a role in the relationship between sleep and health and that sleep processes and immunity show bidirectional interactions, as evidenced in both animal and human studies. Immunological signaling molecules, termed cytokines, are important in coordinating brain–immune system communication, and particular cytokines such as tumor necrosis factor, interleukin-1, and interleukin-6 play a crucial role in sleep regulation. Elevated levels of these cytokines are also associated with a number of chronic diseases and may provide a pathway linking poor sleep with health outcomes.     

Risk,Uncertainty, and Gender Stereotypes in Healthcare Decisions

Disparities in healthcare access, treatment, and outcomes are widely prevalent for women and minorities. At the same time, healthcare choices have become increasingly intricate and correspondingly uncertain. We review contemporary issues in healthcare for women, with emphasis on access to care and on healthcare disparities. In the belief that forewarned is forearmed, we review the role of sexism and the psychology of decision making in producing health disparities. In the face of this complexity, therapists can help women seek sound healthcare and make informed choices. Implications for feminist therapy are suggested that emphasize client empowerment and agency.