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This study designed and piloted an interactive measure to assess learning preferences of Latinos in the United States with diabetes and limited literacy. The measure utilized interactive learning activities to represent four learning styles: visual (seeing), kinesthetic (doing), affective (feeling/sensing), and cognitive (thinking), targeting four...
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Context 1
... total, 10 participants participated in 40 learning activities (Table 3). The easiest to understand activities (and frequencies) were kinesthetic (14), visual (4), affective (1), and cognitive (1). ...
Context 2
... approach is supported by literature on designing materials for low literacy patients. Namely, use of conversational language (see interview excerpts Table 3); minimizing the number of concepts presented and focusing on relevant concepts (diabetes behaviors); including practical information (understanding portion sizes, limiting fat, etc.); frequent summaries (included in interview script); use of visual clues and illustrations; and inviting interaction and feedback [18,21,22,30,50]. ...
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Continuous glucose monitoring (CGM) has the potential to provide useful data for behavioral interventions targeting non-insulin-using, sedentary individuals with type 2 diabetes mellitus (T2DM). The aims of this study were to describe CGM in terms of (1) feasibility and acceptability and (2) dietary- and exercise-teaching events.
Cross-sectional da...
Citations
... Despite anesthesia providers' efforts to deliver comprehensive explanations of anesthetic care plans, patient anxiety and time constraints can hinder the effective communication and assimilation of information [5]. Prior research has established a direct link between heightened patient knowledge of surgical information and reduced preoperative anxiety levels [6]. Alarmingly, a mere 32% of patients reported clear knowledge about anesthesia in a specific study, underscoring a significant knowledge gap likely rooted in an insufficient understanding of anesthesiologists' roles and anesthetic procedures [6]. ...
... Prior research has established a direct link between heightened patient knowledge of surgical information and reduced preoperative anxiety levels [6]. Alarmingly, a mere 32% of patients reported clear knowledge about anesthesia in a specific study, underscoring a significant knowledge gap likely rooted in an insufficient understanding of anesthesiologists' roles and anesthetic procedures [6]. Additionally, healthcare providers' perspectives might have a bigger impact on the informational quality and content shared with patients before surgery than the actual needs that patients perceive [7]. ...
Introduction: Health literacy significantly impacts healthcare outcomes, particularly in preoperative settings where patients' understanding of medical procedures, adherence to instructions, and surgical outcomes are influenced. Despite accessibility to medical information, challenges persist in comprehending healthcare details, affecting active patient participation in care. This study aims to assess health literacy among patients attending anesthesia outpatient clinics for preoperative evaluation and analyze associated factors.
Methods: A sample size of 240 patients was determined using power analysis. The inclusion criteria encompassed informed, consenting patients with adequate mental capacity and primary education, aged 18-65 years, according to the American Society of Anesthesiologists (ASA I-II). Data were collected through a descriptive characteristics form and the Health Literacy Scale (HLS).
Results: The mean health literacy score was 29.37±6.22, indicating a moderate level. Marital status, education level, employment status, book reading preference, comorbidities, and reason for clinic visits significantly influenced health literacy (p<0.001). Regression analysis revealed marital status (β=-1.915, p=0.047), employment (β=1.187, p=0.039), and book reading preference (β=3.76, p<0.001) as independent predictors of health literacy.
Discussion: Health literacy levels were associated with various socio-demographic and health-related factors. Notably, being single or divorced, employed, and enjoying reading predicted higher health literacy. This underscores the impact of social support, occupation, and reading habits on health literacy. However, longitudinal studies with objective measures are warranted to further explore these associations.
Conclusion: This study underscores the importance of addressing health literacy levels in anesthesia outpatient clinics, highlighting key predictors such as marital status, education, and employment. While contributing to our understanding of preoperative health literacy, further research using longitudinal designs and objective measures is essential. Bridging the health literacy gap is crucial for empowering patients, refining decision-making, and elevating the quality of overall surgical experiences.
... Within the cross-sectional studies, 10 used HL and numeracy as mediators or covariates [18,23,26,[28][29][30][31][32]36], 7 used HL and numeracy as the primary exposure [15,24,27,32,37,44,46], and 5 were validation studies [17,35,38,45,47,52]. All 9 intervention studies assessed diabetes education or care programs and collected baseline HL and numeracy [16,21,22,[39][40][41][42][43]. Both cohort studies examined HL and numeracy as the primary exposure [19,20]. ...
... All publications included Hispanic participants with T2DM. Five studies had 100% Hispanic participants [16,18,26,44,45], twenty had between 20% to 82%, and the remaining seven had 14% or less [19,20,25,[27][28][29]32,52]. Of the articles with 100% Hispanic participants, three had mostly Mexican nationality [18,44,45], while the other two predominantly had Puerto Rican and Dominican nationality [16,26]. ...
... Five studies had 100% Hispanic participants [16,18,26,44,45], twenty had between 20% to 82%, and the remaining seven had 14% or less [19,20,25,[27][28][29]32,52]. Of the articles with 100% Hispanic participants, three had mostly Mexican nationality [18,44,45], while the other two predominantly had Puerto Rican and Dominican nationality [16,26]. Of the remaining articles, 17 referred to participants as Hispanic [17,19,20,23,28,29,[31][32][33][34][35][36][40][41][42][43]47], 8 referred to participants as Latino [15,21,22,25,30,[37][38][39]46], and 2 used Hispanic/Latino [24,27]. ...
Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts.
... They did practical exercises, and the SMBG helped them to see effects of what they did. The importance of "doing" is supported by a small study among Latino people with diabetes and low literacy [44] and also, by the much sited article by of Trento and colleagues [45]. ...
... We identified 554 articles that were eligible for inclusion in this review (see Appendix 2 for summary of study selection process; see online Appendix 3 for full list of articles). Findings Studies that collect qualitative data directly related to an existing intervention or programme, in order to examine patient experiences and perceptions Study using in-depth interviews to explore the experiences of elderly patients who used a telemedicine case management intervention (Trief et al., 2008) Embedded experimental Studies designed with qualitative data collection both before and after an intervention or quantitative research component (a) Study that used both interviews and participant observation to first develop and later evaluate interactive learning activities (Carbone, Lennon, Torres, & Rosal, 2005) (b) Study that used multiple qualitative methods to develop, implement, and assess an integrated health care system approach to diabetes management (Nasmith et al., 2004) Substantive qualitative Studies that collect qualitative data alone and are not presented as part of a mixed-methods study; these studies explore participants' perceptions and experiences of diabetes without taking a formative, evaluative, or explanatory approach (a) Descriptive study that used in-depth interviews to identify cultural influences on the experience of diabetes among a Latin American population (Adams, 2003) (b) Study using in-depth interviews to explore perceptions of communication and interactions with general practitioners among Australian immigrants with diabetes (Kokanovic & Manderson, 2007) ...
We aimed to describe how qualitative methods are used in global research on diabetes and identify opportunities whereby qualitative methods could further benefit our understanding of the human experience of diabetes and interventions to address it. We conducted a systematic review of National Library of Medicine, EMBASE, and Web of Science electronic databases to identify original research articles that used qualitative methods to study diabetes between 1980 and 2011. We identified 554 eligible articles and categorised these by geographic region, year of publication, study population, study design, research question, qualitative data collection methods, and journal type. Results show low use of qualitative methods in diabetes research over the past 30 years. The majority of articles (75%) reported using substantive qualitative research, while mixed-methods research has remained underutilised. Eighty-five per cent of articles reported studies conducted in North America or Europe, with few studies in developing countries. Most articles reported recruiting clinic-based populations (58%). Over half (54%) of research questions focused on patient experience and 24% on diabetes management. Qualitative methods can provide important insights about socio-cultural aspects of disease to improve disease management. However, they remain underutilised for understanding the diabetes experience, especially in Africa and Asia and amongst non-clinic populations.
... This instrument has obtained a strong face and content validity as a result of the comprehensive initial validation process that included an extensive review of related instruments and questionnaires, a panel of experts that judged and proposed items, and cognitive interviews with patients. This last measure allowed to obtain direct patients' input to assess their underlying comprehension about each item and, above all, how their previous knowledge and information about foot self-care was represented in each item [24] Despite cognitive interviews has been used in different areas to develop PROs for people with chronic conditions and concretely in diabetic patients [10,34], some of the current instruments for evaluating foot self-care did not incorporate this methods during its development [12,27]. The definitive questionnaire showed an excellent overall internal consistency in a trifactorial structure that represents 60.88% of the total observed variance, indicating a good psychometric performance. ...
This paper assessed the reliability and construct validity of a tool to evaluate the foot self-care of diabetic patients.The education of diabetic patients about their foot care is a major issue to avoid complications like amputations and ulcers. Specific tools aimed to assess patient’s knowledge in this area are needed.The study had two phases: in Phase 1, item-generation was carried out through a literature review, expert review by a Delphi technique and cognitive interviews with diabetic patients for testing readability and comprehension. In Phase 2, diabetic patients participated in a cross-sectional study for a psychometric evaluation (reliability and construct validity) was carried out on a sample of type I and II diabetic patients. The study was conducted at the University of Malaga (Spain), podiatric clinics and a Diabetic Foot Unit between October 2012 and March 2013.After psychometric-test analyses on a sample of 209 diabetic patients, the questionnaire resulted in 16 questions. Cronbach’s alpha was 0.89 after removing 4 items because of their low reliability. Inter-item correlations gave a mean value of 0.34 (range: 0.06-0.74). The rotated solution showed a 3-factor structure (self-care, foot care, and footwear and socks) that jointly accounted for 60.88% of the variance observed. The correlation between the questionnaire scores and HbA1c was significant and inverse, (r = -0,15;p<0.01). The findings show that the questionnaire is a valid and reliable tool for evaluating foot self-care behaviour in diabetic patients.
... Research has also documented that hands on activities are often the preferred learning style for minority groups (e.g. Latina) for health information [28]. Because hands on activities elicit social interaction/group cooperation, this corresponds well with how Hmong women have traditionally learned. ...
Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants' perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants = 30 and female participants = 120). Teach-back method was used to assess the participants' understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants' perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants' responses. The three teaching techniques were helpful in increasing the Hmong people's understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.
... The education, psychology, and cognitive learning literature widely reflects the use of many different learning style assessments to evaluate individual preferences (Desmedt & Valcke, 2004;James & Blank, 1993) and how they can be used for personalized instruction. Although used extensively in general educational and biomedical research to measure student learning preferences, tools designed to assess learning styles have received little attention in clinical settings to inform health communication (Carbone, Lennon, Torres, & Rosal, 2005;Dinakar, Adams, Brimer, & Silva, 2005). Several investigators describe the need to assess learning styles for patient education, yet few implemented interventions that adapt material to specific learning modality preferences (Beagley, 2011;Cavanagh & Coffin, 2004;Inott & Kennedy, 2011). ...
Limited patient understanding of hypertension contributes to poor health outcomes. In 2 sequential randomized studies, the authors determined the impact of administering information tailored to health literacy level alone or in combination with preferred learning style on patients' understanding of hypertension. Patients with high blood pressure were recruited in an academic emergency department. In Experiment 1 (N = 85), the control group received only the routine discharge instructions; the intervention group received discharge instructions combined with information consistent with their health literacy level as determined by the Short Test of Functional Health Literacy. In Experiment 2 (N = 87), the information provided to the intervention group was tailored to both health literacy and learning style, as indicated by the VARK™ Questionnaire. To measure learning, the authors compared scores on a hypertension assessment administered during the emergency department visit and 2 weeks after discharge. Participants who received materials tailored to both health literacy level and learning style preference showed greater gains in knowledge than did those receiving information customized for health literacy level only. This study demonstrates that personalizing health information to learning style preferences and literacy level improves patient understanding of hypertension.
... Another study of Hispanic adults with type 2 diabetes and low literacy compares the preference for four learning styles, namely visual (seeing), kinesthetic (doing), affective (feeling/sensing), and cognitive (thinking). The results suggest that kinesthetic task to be the easiest to be understood by the subjects while cognitive tasks to be the most difficult 6 . There are quite a few studies evaluating the efficacy of different modalities in the Hispanic communities, e.g., education classes/workshops with Spanish-speaking instructors, promotores-led self-management programs, and printed materials [7][8][9][10] . ...
... All Internet studies focused solely on English language sites except the study by Berland and colleagues (39), which used validated English and Spanish versions of the Fry Readability Graph (49) and found that 100% of the English sites and 86% of the Spanish Web sites required a reading level of high school or greater. Of the 13 nutrition-related health literacy studies reviewed (Table 2), six were experimental (52)(53)(54)(55)(56)(57) and seven were nonexperimental, including four cross-sectional quantitative studies (58)(59)(60)(61), two qualitative studies (62,63), and one mixed methods study (64). Sample sizes of the six experimental studies ranged from 28 to 351 participants, and each implemented a low-literacy nutrition intervention by revising nutrition education materials to lower the readability level or by employing other design strategies primarily to enhance reading comprehension. ...
... Findings further indicated that participants in federal food assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children program (58) and the Expanded Food and Nutrition Education Program (59) have compromised health literacy status, and that years of schooling or education is not an appropriate proxy for health literacy status. Through the application of qualitative research methods, three studies provided evidence that the unique learning needs of individuals with limited literacy skills should be considered when developing nutrition materials and educational techniques (62)(63)(64). ...
Health literacy is defined as the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Although the field has grown during the past decade, most health literacy research does not explicitly focus on food or nutrition, and dietetics practitioners often remain unaware of patients' health literacy level. The purpose of this systematic review was to summarize the literature on nutrition and health literacy to enhance dietetics practitioners' awareness of the importance of health literacy in practice and research. Of the 33 studies reviewed, four focused on measurement development, 16 on readability assessments, and 13 on individual literacy skills assessments. Collective evaluation revealed four noteworthy gaps, including the need to use more comprehensive assessment approaches that move beyond readability and numeracy to address the full spectrum of health literacy factors; the need to apply more robust experimental studies to examine the effectiveness of health literacy interventions among individuals, communities, health care providers, and health care systems; the need to explore the moderating and mediating roles of an individual's health literacy status on nutrition outcomes; and the need to examine long-term effects of health literacy interventions on nutrition outcomes. This article defines health literacy gaps and opportunities in nutrition research and practice, and calls for continued action to elevate the role of dietetics practitioners in addressing health literacy.
... There were no significant differences in experiential activities relative to program delivery variables (instructional setting and language of lesson delivery). This is unfortunate in that previous research suggests that Spanish-speaking groups (i.e., Latinos, Mexican-Americans) are kinesthetic, or experiential, learners (Carbone, Lennon, Torres, & Rosal, 2005;Ewing, 1992), and would likely benefit from the use of experiential activities. Future training should promote the use of the experiential activities, particularly among the Spanish-speaking participants. ...
Use of qualitative research methods to evaluate nutrition education programs is limited. Structured observations and focus groups, qualitative research methods, were conducted to examine use of theory-based learning strategies and participant experiences in a nutrition education program. Theory-based learning strategies included use of open-ended questions, visual aids, and experiential learning activities. Open-ended questioning and some experiential activities were used less often than desired. Language of lesson delivery and instructional setting appear to influence the use of learning strategies. Lesson delivery and instructional setting may be relevant for preferred learning styles of different cultures.
