Dataset Information

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.

ABSTRACT:

Background

Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.

Objective

To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).

Design

Secondary analysis of a randomized controlled trial.

Participants

Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly.

Methods

A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy.

Results

The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04).

Conclusions

We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.

Gov identifier

NCT01828567.

SUBMITTER: Nouri SS

PROVIDER: S-EPMC6445901 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.

Nouri Sarah S SS Damschroder Laura J LJ Olsen Maren K MK Gierisch Jennifer M JM Fagerlin Angela A Sanders Linda L LL McCant Felicia F Oddone Eugene Z EZ

Journal of general internal medicine 20190212 4

<h4>Background</h4>Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.<h4>Objective</h4>To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).<h4>Design</h4>Secon ...[more]

PMID: 30756302

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Project description:BackgroundThe health literacy and numeracy skills of women in Pakistan are very low compared to other low- and middle-income countries.ObjectiveThe aim of this study was to improve the health literacy and numeracy skills of unschooled women in Northern Pakistan by developing a Maternal and Child Health Calendar (MCHC). The MCHC utilizes locally contextualized icons to promote and enhance service utilization and maternal and child health (MCH) outcomes.MethodsWe conducted a qualitative exploratory study design to understand the experiences and usefulness of the MCHC among women. We recruited the participants using purposive sampling. Using a semi-structured interview guide, we conducted individual interviews with nine Key informants, that is, Agha Khan Rural Support Staff and Community-based savings group staff and five focus group discussions with unschooled women. We followed Braun and Clarke's steps to conduct an inductive thematic data analysis.ResultsThe findings of our study are categorized into the following themes: (1) the benefits of using MCHC, (2) the usefulness of the MCHC in women's healthcare decision-making, (3) empowerment of poorly schooled women, (4) enabling numeracy and record-keeping skills, (5) MCHC implementation challenges, and (6) participants suggestions to improve the MCHC. Our findings revealed that the MCHC improved the health literacy and numeracy of illiterate or less educated women by using localized images to help them comprehend their own and their children's health. Additionally, it effectively empowered these women in their healthcare decision-making, such as discussing family planning with their husbands. Women also suggested modifying some images in the MCHC to enhance their clarity and usefulness.ConclusionThe MCHC has the potential to safely and sustainably build basic MCH literacy and numeracy skills among both literate and illiterate women in Northern Pakistan. Further research is needed to assess its potential as a stand-alone intervention to improve MCH outcomes.

Project description:BACKGROUND:Health literacy and numeracy influence many health-related behaviors and outcomes. Health literacy and numeracy have been assessed objectively and subjectively, but interrelationships among the measures and the consistency of their association with health knowledge have not been examined. OBJECTIVE:To increase understanding of the structure and interrelations among objective and subjective health literacy and numeracy and how these constructs relate to knowledge of risk factors of two major diseases. DESIGN:Secondary analysis of cross-sectional survey data, weighted to be representative of the general US population of non-institutionalized adults. PARTICIPANTS:Participants (N = 1005, 55.2% response rate) were recruited from GfK KnowledgePanel. The unweighted sample included 52% women, 26% racial/ethnic minorities, and 37% with no college experience. MAIN MEASURES:Objective health literacy, subjective health literacy, objective numeracy, subjective numeracy. Objective and perceived knowledge of diabetes and colon cancer risk factors were also assessed. KEY RESULTS:Confirmatory factor analyses indicated that a model with correlated (r = 0.16-0.56) but separate factors for each of the four literacy/numeracy constructs best fit the data (RMSEA = 0.055 (95% CI 0.049-0.061), CFI = 0.94). Consistency between measures in classifying people as having adequate or limited health literacy or numeracy was 60.9-77.1%, depending on the combination of measures. All four literacy/numeracy constructs were independently associated with objective diabetes knowledge and objective colon cancer knowledge (all ps < .04). Subjective (but not objective) literacy and numeracy measures were associated with diabetes perceived knowledge (all ps < .02). No literacy/numeracy measures were associated with perceived colon cancer knowledge. CONCLUSIONS:We identified objective and subjective health literacy and numeracy as four distinct but related concepts. We also found that each construct accounts for unique variance in objective (but not subjective) disease knowledge. Until research uncovers what psychological processes drive subjective measures (e.g., motivation, self-efficacy), research investigating the relationship between health literacy and health outcomes should consider assessing all four measures.

Dataset Information

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.

Background

Objective

Design

Participants

Methods

Results

Conclusions

Gov identifier

Publications

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.

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