Effective Intervention Strategies to Improve Health Outcomes for Cardiovascular Disease Patients with Low Health Literacy Skills: A Systematic Review

다국어 초록 (Multilingual Abstract)

Purpose: Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills.
Methods: This study employs the following criteria recommended by Khan Kunz, Keijnen, and Antes (2003) for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies.
Results: Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes.
Conclusion: With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes.

참고문헌 (Reference)

1 유정옥, "인터넷 커뮤니티가 고혈압 근로자의 지식, 자기효능감, 자가간호행위에 미치는 효과" 한국간호과학회 35 (35): 1258-1267, 2005

2 김선호, "노인 대상의 고혈압 비약물 중재 프로그램에 관한 국내외 논문 분석 연구" 노인간호학회 10 (10): 152-163, 2008

3 Richardson, W., "The wellbuilt clinical question: a key to evidence based decisions" 123 (123): A12-A13, 1995

4 Bosworth, H. B., "Take control of your blood pressure study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control" 70 : 338-347, 2008

5 Khan, K. S., "Systematic reviews to support evidence-based medicine: How to review and apply findings of healthcare research" The Royal Society of Medicine Press 2003

6 Loke, Y. K., "Systematic review of consistency between adherence to cardiovascular or diabetes medication and health literacy" 46 : 863-872, 2012

7 Scottish Intercollegiate Guidelines Network, "Sign 50: A guideline developer’s handbook"

8 Parikh, N. S., "Shame and health literacy: the unspoken connection" 27 : 33-39, 1996

9 Davis, T. C., "Rapid estimate of adult literacy in medicine: a shortened screening instrument" 25 : 391-395, 1993

10 Shieh, C., "Printed health information materials: evaluation of readability and suitability" 25 (25): 73-90, 2008

11 Murray, M. D., "Pharmacist intervention to improve medicine adherence in heart failure" 146 : 714-725, 2007

12 Wolf, M. S., "Patients’ shame and attitudes toward discussing the results of literacyscreening" 12 : 721-732, 2007

13 Morrow, D. G., "Patients’ health literacy and experience with instructions: influence preferences for heart failure medication instructions" 19 : 575-593, 2007

14 Kumanyika, S. K., "Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level" 99 : 1380-1391, 1999

15 Ammerman, A. S., "Nutrition education for cardiovascular disease prevention among low income populations description and pilot evaluation of a physician-based model" 19 : 5-18, 1992

16 Bosworth, H. B., "Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention" 57 : 5-14, 2005

17 Agency for Healthcare Research and Quality, "Literacy and health outcomes.(AHRQ No. 04-E007-2). Research Triangle Institute International-University ofNorth Carolina Evidence Based Practice Center"

18 Glynn, L. G., "Interventions used to improve control of blood pressure in patients with hypertension" 2 : CD005182-, 2010

19 Pignone, M., "Interventions to improve health outcomes for patients with low literacy: a systematic review" 20 : 185-192, 2005

20 Schaefer, C. T., "Integrated review of health literacy interventions" 27 : 302-316, 2008

21 National Health and Medical Research Council, "How to review the evidence: systematic identification and review of the scientific literature" National Health and Medical Research Council 2000

22 Speros, C., "Health literacy: concept analysis" 50 : 633-640, 2005

23 Institute of Medicine, "Health literacy: a prescription to end confusion" National Academics Press 2004

24 Gazmarian, J. A., "Health literacy and knowledge of chronic disease" 51 : 267-275, 2003

25 Amin, F., "Enhanced external counterpulsation for chronic angina pectoris" 2 : CD007219-, 2010

26 Echeverry, D., "Efforts to improve subsequent treatment of cardiovascular risk factorsin older patients with diabetes hospitalized for a cardiac event" 11 : 758-764, 2005

27 Lee, T. W., "Effects of motivational interviewing for low literacy elderly with hypertension in the community: randomized control trial" 2009

28 Baker, D. W., "Development of a brief test to measure functional health literacy" 38 : 33-42, 1999

29 DeWalt, D. A., "Development and pilot testing of a disease management program forlow literacy patients with heart failure" 55 : 78-86, 2004

30 Bryant, P. K., "Congestive heart failure performance project" 7 : 152-162, 2002

31 Schillinger, D., "Closing the loop: Physician communication with diabetic patients who have low literacy" 163 : 83-90, 2003

32 Korea National Statistics Bureau, "Cause of death statistics for 2007"

33 United States National Center for Education Statistics, "Adult literacy in America: a first look at the findings of the National Adult Literacy Survey (NCES publication No. 1993-275)" United States National Center for Education Statistics 2006

34 Fry, E., "A readability formula that saves time" 11 : 513-578, 1968

35 Flesch, R., "A new readability yardstick" 32 : 221-233, 1948

36 DeWalt, D. A., "A heart failure self-management program for patients of all literacy levels: a randomized controlled trial" 6 : 30-, 2006