Advertisement

Health literacy of critical care patients in a remote area health service: A cross-sectional survey

Published:September 28, 2022DOI:https://doi.org/10.1016/j.aucc.2022.08.007

      Abstract

      Background

      Lower life expectancy, higher rates of chronic disease, and poorer uptake of health services are common in remote patient populations. Patients with poor health literacy (HL) are less likely to attend appointments, adhere to medications, and have higher rates of chronic illness. Evidence underpinning the relationship between HL and inequity in remote critical care populations is sparse.

      Objectives

      The primary study aim was to explore a multidimensional HL profile of patients requiring critical care in a remote area health service. Secondary aims were to explore HL in subgroups of the sample and to explore associations between HL and emergency department representation and discharge against medical advice.

      Methods

      This was a cross-sectional study of consecutive eligible patients admitted to the Mount Isa hospital intensive care unit. The Health Literacy Questionnaire was administered in a semistructured interview.

      Results

      In a 5-month period, there were 141 patient admissions to the five-bed intensive care unit, 67 patients (47.5%) met inclusion criteria and were not discharged prior to recruitment, and 37 (26.2%) agreed to participate. Participants felt understood and supported by healthcare providers, had sufficient information to manage their health, proactively engaged with healthcare providers, and had strong social supports. More challenging was their capacity to advocate on their own behalf, to explore and appraise information and to navigate healthcare systems. Patients who represented to the emergency department (n = 8, 21.6%) felt more empowered to seek healthcare advice. Of the 11 patients that discharged against medical advice, only one participated in the study.

      Conclusion

      Trends in the data showed that Aboriginal and Torres Strait Islander participants were marginally less likely to be information explorers and to understand all written information. Findings provide guidance for the development of interventions to progress a reduction in health disparities experienced by this population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Australian Institute of Health and Welfare
        Rural and remote health.
        AIHW, Canberra2017
        • MacLeod S.
        • Musich S.
        • Gulyas S.
        • Cheng Y.
        • Tkatch R.
        • Cempellin D.
        • et al.
        The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults.
        Geriatr Nurs. 2017; 38: 334-341https://doi.org/10.1016/j.gerinurse.2016.12.003
        • World Health Organisation
        Health literacy: the solid facts.
        WHO, Copenhagen2013
        • Nutbeam D.
        Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century.
        Health Promot Int. 2000; 15: 259-267https://doi.org/10.1093/heapro/15.3.259
      1. (Australian Commission on Safety and Quality in Health Care)Health literacy: taking action to improve safety and quality. ACSQHC, Sydney2014 (Retrieved from)
        • Australian Bureau of Statistics
        Health Literacy, Australia.
        ABS, Canberra2009 (Retrieved from)
        • Beauchamp A.
        • Buchbinder R.
        • Dodson S.
        • Batterham R.W.
        • Elsworth G.R.
        • McPhee C.
        • et al.
        Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ).
        BMC Public Health. 2015; 15: 1-13https://doi.org/10.1186/s12889-015-2056-z
        • Nash S.
        • Arora A.
        Interventions to improve health literacy among Aboriginal and Torres Strait Islander peoples: a systematic review.
        BMC Public Health. 2021; 21: 2-15https://doi.org/10.1186/s12889-021-10278-x
        • Harfield S.
        • Davy C.
        • Kite E.
        • McArthur A.
        • Munn Z.
        • Brown N.
        • et al.
        JBI Database Syst Rev Implement Rep. 2015; 13: 43-51https://doi.org/10.11124/jbisrir-2015-2474
        • Flabouris A.
        • Hart G.K.
        • Nicholls A.
        Accessibility of the Australian population to an ICU, and ICUs to each other.
        Crit Care Resusc. 2012; 14: 177-184
        • Osborne R.H.
        • Batterham R.W.
        • Elsworth G.R.
        • Hawkins M.
        • Buchbinder R.
        The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ).
        BMC Public Health. 2013; 13: 1-17
        • North West Hospital and Health Service
        North West Hospital and Health Service Annual Report 2018/2019.
        2019 (Retrieved from)
        • McGill K.
        • Kennedy B.
        Are Indigenous admitted patients more likely to discharge against medical advice than non-Indigenous patients?.
        (Retrieved from)
        • Dodson S.
        • Beauchamp A.
        • Batterham R.W.
        • Osborne R.
        About the Health Literacy Questionnaire (HLQ).
        Deakin University, Melbourne, Vic2015 (Retrieved from)
        • Jessup R.L.
        • Osborne R.H.
        • Beauchamp A.
        • Bourne A.
        • Buchbinder R.
        Health literacy of recently hospitalised patients: a cross-sectional survey using the Health Literacy Questionnaire (HLQ).
        BMC Health Serv Res. 2017; 17: 1-12https://doi.org/10.1186/s12913-016-1973-6
        • Australian Bureau of Statistics
        National Health Survey: Health Literacy.
        ABS, Canberra2019 (Retrieved from)
        • Garvey D.
        A review of the social and emotional wellbeing of Indigenous Australian peoples - considerations, challenges and opportunities.
        Australian Indigenous Health Bulletin. 2008; 8: 1-29
        • Australian Institute of Health and Welfare
        Older Australians.
        AIHW, Canberra2021 (Retrieved from)
        • Cooke M.
        • Mitrou F.
        • Lawrence D.
        • Guimond E.
        • Beavon D.
        Indigenous well-being in four countries: an application of the UNDP's human development index to Indigenous peoples in Australia, Canada, New Zealand, and the United States.
        BMC Int Health Hum Rights. 2007; 7https://doi.org/10.1186/1472-698X-7-9
        • Rosenstock A.
        • Mukandi B.
        • Zwi A.B.
        • Hill P.S.
        Closing the Gaps: competing estimates of Indigenous Australian life expectancy in the scientific literature.
        Aust N Z J Public Health. 2013; 37: 356-364https://doi.org/10.1111/1753-6405.12084
        • Gador-Whyte A.P.
        • Wakerman J.
        • Campbell D.
        • Lenthall S.
        • Struber J.
        • Hope A.
        • et al.
        Cost of best-practice primary care management of chronic disease in a remote Aboriginal community.
        Med J Aust. 2014; 200: 663-666https://doi.org/10.5694/mja13.11183
        • Teng T.-H.K.
        • Katzenellenbogen J.M.
        • Thompson S.C.
        • Sanfilippo F.M.
        • Knuiman M.
        • Geelhoed E.
        • et al.
        Incidence of first heart failure hospitalisation and mortality in Aboriginal and non-Aboriginal patients in Western Australia, 2000-2009.
        Int J Cardiol. 2014; 173: 110-117https://doi.org/10.1016/j.ijcard.2014.02.020
        • Australian Institute of Health and Welfare
        The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2015.
        AIHW, Canberra2015 (Retrieved from)
        • Australian Health Ministers’ Advisory Council
        Aboriginal and Torres Strait Islander Health Performance Framework.
        AHMAC, Canberra2015 (Retrieved from)
        • Australian Commission on Safety and Quality in Health Care
        Consumer health information needs and preferences: perspectives of culturally and linguistically diverse and Aboriginal and Torres Strait Islander people.
        ACSQHC, Sydney2017 (Retrieved from)
        • Fraser S.D.S.
        • Roderick P.J.
        • Casey M.
        • Taal M.W.
        • Yuen H.M.
        • Nutbeam D.
        Prevalence and associations of limited health literacy in chronic kidney disease: a systematic review.
        Nephrol Dial Transplant. 2012; 28: 129-137https://doi.org/10.1093/ndt/gfs371
        • Ghisi G.L.d.M.
        • Chaves G.S.d.S.
        • Britto R.R.
        • Oh P.
        Health literacy and coronary artery disease: a systematic review.
        Patient Educ Couns. 2018; 101: 177-184https://doi.org/10.1016/j.pec.2017.09.002
        • Green J.A.
        • Mor M.K.
        • Shields A.M.
        • Sevick M.A.
        • Palevsky P.M.
        • Fine M.J.
        • Weisbord S.D.
        Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis.
        Clin J Am Soc Nephrol. 2011; 6: 1354-1360https://doi.org/10.2215/CJN.09761110
        • Baquet C.R.
        • Commiskey P.
        • Mullins D.
        • Mishra S.I.
        Recruitment and participation in clinical trials: socio-demographic rural/urban and health care access predictors.
        Cancer Detect Prev. 2006; 30: 24-33https://doi.org/10.1016/j.cdp.2005.12.001
        • Rheault H.
        • Coyer F.
        • Jones L.
        • Bonner A.
        Health literacy in Indigenous people with chronic disease living in remote Australia.
        BMC Health Serv Res. 2019; 19: 1-10https://doi.org/10.1186/s12913-019-4335-3
        • Queensland Government
        Performance indicators in Aboriginal and Torres Strait Islander Health.
        2017 (Retrieved from)