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Biomedical subjects

Terry C Davis

Publications and source records attributed to Terry C Davis.

At least 19 recordsLinked to original sources
PubMed2006

Literacy and misunderstanding prescription drug labels.

BACKGROUND: Health literacy has increasingly been viewed as a patient safety issue and may contribute to medication errors. OBJECTIVE: To examine patients' abilities to understand and demonstrate instructions found on container labels of common prescription medications. DESIGN: Cross-sectional study using in-person, structured interviews. SETTING: 3 primary care clinics serving mostly indigent populations in Shreveport, Louisiana; Jackson, Michigan; and Chicago, Illinois. PATIENTS: 395 English-speaking adults waiting to see their providers. MEASUREMENT: Correct understanding of instructions on 5 container labels; demonstration of 1 label's dosage instructions. RESULTS: Correct understanding of the 5 labels ranged from 67.1% to 91.1%. Patients reading at or below the sixth-grade level (low literacy) were less able to understand all 5 label instructions. Although 70.7% of patients with low literacy correctly stated the instructions, "Take two tablets by mouth twice daily," only 34.7% could demonstrate the number of pills to be taken daily. After potential confounding variables were controlled for, low (adjusted relative risk, 2.32 [95% CI, 1.26 to 4.28]) and marginal (adjusted relative risk, 1.94 [CI, 1.14 to 3.27]) literacy were significantly associated with misunderstanding. Taking a greater number of prescription medications was also statistically significantly associated with misunderstanding (adjusted relative risk, 2.98 [CI, 1.40 to 6.34] for > or =5 medications). LIMITATIONS: The study sample was at high risk for poor health literacy and outcomes. Most participants were women, and all spoke English. The authors did not examine the association between misunderstanding and medication error or evaluate patients' actual prescription drug-taking behaviors. CONCLUSIONS: Lower literacy and a greater number of prescription medications were independently associated with misunderstanding the instructions on prescription medication labels.

Adult↗
PubMed2006

Literacy, self-efficacy, and HIV medication adherence.

OBJECTIVE: We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. METHODS: Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days. RESULTS: Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen (p < 0.001). Patients' self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7-12.5). CONCLUSION: While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship. PRACTICE IMPLICATIONS: Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules.

Adult↗
PubMed2006

A critical review of FDA-approved Medication Guides.

OBJECTIVE: To investigate whether consumer-directed, FDA-approved Medication Guides issued for potentially harmful medications are likely to be useful to patients with limited literacy. METHODS: Lexile analysis and the suitability assessment of materials (SAM) were conducted on the 40 currently issued Medication Guides to evaluate reading difficulty, content, and format. Structured interviews with a literacy assessment were also conducted among 251 primary care patients at a public hospital clinic in Louisiana to determine if patients directed attention to Medication Guides and other accompanying patient information materials. RESULTS: The average Lexile score estimated an 11th-12th grade reading level for the guides (M=1223, S.D.=200). None of the 40 Medication Guides met federal recommendations (6th-8th grade level). Most Medication Guides were deemed unsuitable because they did not provide a summary of content (90.0%) or limit the scope of information (77.5%). Only 23.0% of patients reported having looked at Medication Guides or accompanying patient information materials; patients with low literacy were less likely to have looked at them (16.7% versus 32.9%, p=0.03). CONCLUSION: Medication Guides in their current form are not likely to be useful to patients with limited literacy skills. PRACTICE IMPLICATIONS: Reading level of text in Medication Guides should be reduced, summaries or "highlights" provided, and the scope of information limited to increase the likelihood of use among individuals with limited literacy. Consumers should be involved in their development.

Adult↗
PubMed2006

Vaccine risk/benefit communication: effect of an educational package for public health nurses.

The purpose of this study was to determine whether an in-service for public health nurses (PHNs) and accompanying educational materials could improve vaccine risk/benefit communication. The content and timing of vaccine communication were recorded during 246 pre-and 217 postintervention visits in two public health immunization clinics. Pre-/postintervention comparisons showed PHN communication of severe side effects (13% vs. 44%, p < .0001) and their management (29% vs. 60%, p < .0001) increased. There was no significant change in discussion of vaccine benefits (48% vs. 51%) or common side effects (91% vs. 92%),screening for contraindications (71% vs. 77%), or distribution of written information (89% vs. 92%). More parents initiated vaccine questions postintervention (27% vs. 39%,p < .01) and were more satisfied with vaccine-risk communication (8.1 vs. 8.9 on a 10-point scale, p < .01). Average vaccine communication time increased from 16 to 22 seconds (p < .01).

Child, Preschool↗
PubMed2006

Misunderstanding of prescription drug warning labels among patients with low literacy.

PURPOSE: The common causes for misunderstanding prescription drug warning labels (PWLs) among adults with low literacy were studied. METHODS: A total of 74 patients reading at or below the sixth-grade level and receiving care at the primary care clinic at the Louisiana State University Health Sciences Center in Shreveport were recruited to participate in structured interviews. Patients were asked to interpret and comment on eight commonly used warning labels found on prescription medications. Correct interpretation was determined by expert panel review of patients' verbatim responses. Qualitative methods were employed to code responses and generate themes regarding the misunderstanding of these PWLs. RESULTS: Among this sample of patients with low literacy skills, rates of correct interpretation for the eight warning labels ranged from 0% to 78.7%. With the exception of the most basic label, less than half of all patients were able to provide adequate interpretations of the warning label messages. Five themes were derived to describe the common causes for misunderstanding the labels: single-step versus multiple-step instructions, reading difficulty of text, use of icons, use of color, and message clarity. Labels were at greater risk for being misunderstood if they included multiple instructions, had a greater reading difficulty, included unfamiliar terms, or used confusing icons that were discordant with text messages. Participants also frequently imposed an incorrect meaning on label colors, which led to further confusion. CONCLUSION: Patients with low literacy skills demonstrated a lower rate of correct interpretation of the eight most commonly used PWLs than did those with higher literacy skills. Multiple-step instructions, reading difficulty of text, the use of icons, the use of color, and message clarity were the common causes of label misinterpretation.

Adult↗
PubMed2006

Social stigma concerns and HIV medication adherence.

The threat of social stigma may prevent people living with HIV from revealing their status to others and serve as a barrier to HIV treatment adherence. We evaluated the effect of such concerns on self-reported treatment adherence using a short, three-item measure among 204 people living with HIV. Overall, the mean age of participants was 40.1 years, 45% were African American, and 80% were male. People with high HIV stigma concerns were 2.5 times less likely to define and interpret the meaning of CD4 count correctly and 3.3 times more likely to be nonadherent to their medication regimen than those with low concerns. Concern over revealing HIV status was the only statistically significant, independent predictor of adherence in multivariate analysis. Clinical care directed to individuals living with HIV should therefore include considerations for patient sensitivity to social stigma, such as modifications to medication schedules and referrals for counseling prior to enrollment in antiretroviral therapies.

Adult↗
PubMed2006

Patient understanding and use of oral contraceptive pills in a southern public health family planning clinic.

OBJECTIVE: To assess patient understanding and use of oral contraceptive pills (OCPs) and determine if these are associated with literacy. METHODS: Four hundred OCP users from a southern public health family planning clinic were orally tested post visit for literacy, demographics, contraceptive knowledge, OCP use, side effects, and adherence. RESULTS: Patients were predominately African American (86%); 78% had completed high school and 42% read below a 9th grade level. Most (94%) understood what to do when they missed one pill, yet few knew the correct action to take after missing two or three pills (19% and 3% respectively); 33% reported missing one or more pills in the past 2 weeks. Literacy was not associated with OCP use, knowledge, or adherence. CONCLUSION: Patients of all literacy levels had limited understanding of OCP side effects and what to do about multiple missed pills. This puts them at risk for misuse.

Adolescent↗
PubMed2006

Low literacy impairs comprehension of prescription drug warning labels.

BACKGROUND: Adverse events resulting from medication error are a serious concern. Patients' literacy and their ability to understand medication information are increasingly seen as a safety issue. OBJECTIVE: To examine whether adult patients receiving primary care services at a public hospital clinic were able to correctly interpret commonly used prescription medication warning labels. DESIGN: In-person structured interviews with literacy assessment. SETTING: Public hospital, primary care clinic. PARTICIPANTS: A total of 251 adult patients waiting for an appointment at the Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) Primary Care Clinic. MEASUREMENTS: Correct interpretation, as determined by expert panel review of patients' verbatim responses, for each of 8 commonly used prescription medication warning labels. RESULTS: Approximately one-third of patients (n=74) were reading at or below the 6th-grade level (low literacy). Patient comprehension of warning labels was associated with one's literacy level. Multistep instructions proved difficult for patients across all literacy levels. After controlling for relevant potential confounding variables, patients with low literacy were 3.4 times less likely to interpret prescription medication warning labels correctly (95% confidence interval: 2.3 to 4.9). CONCLUSIONS: Patients with low literacy had difficulty understanding prescription medication warning labels. Patients of all literacy levels had better understanding of warning labels that contained single-step versus multiple-step instructions. Warning labels should be developed with consumer participation, especially with lower literate populations, to ensure comprehension of short, concise messages created with familiar words and recognizable icons.

Adolescent↗
PubMed2006

Assessment of newborn screening parent education materials.

OBJECTIVE: The purpose of this study was to measure the readability and user-friendliness (clarity, complexity, organization, appearance, and cultural appropriateness of materials) of parent education brochures on newborn screening. METHODS: We studied English-language versions of the brochures that state newborn screening programs prepare and distribute. We obtained brochures from 48 states and Puerto Rico. We evaluated each brochure for readability with the Flesch reading ease formula. User-friendliness of the brochures was assessed with an instrument we created that contained 22 specific criteria grouped into 5 categories, ie, layout, illustrations, message, manageable information, and cultural appropriateness. RESULTS: Most current newborn screening brochures should be revised to make them more readable and user-friendly for parents. Ninety-two percent of brochures were written at a reading level that is higher than the average reading level of US adults (eighth-grade level). In most brochures, the essential information for parents was buried. Although all brochures were brief and focused on the newborn screening tests being performed, 81% needed improvement in getting to the point quickly and making it easy for parents to identify what they needed to know or to do. None of the brochures scored high in all 22 criteria on the user-friendliness checklist. CONCLUSIONS: Parent education materials about newborn screening should be revised to be easier to read and more user-friendly, by lowering the reading difficulty to eighth-grade level and focusing on issues such as layout, illustrations, message, information, and cultural appropriateness. It is important that state newborn screening programs and organizations work with parents to develop and to evaluate materials to ensure that they are user-friendly.

Adult↗
PubMed2006

Recommendations for effective newborn screening communication: results of focus groups with parents, providers, and experts.

OBJECTIVES: The aims of this study were to determine parent and provider knowledge and awareness of newborn screening; to gather opinions from parents, providers, and newborn screening professionals about the content and timing of newborn screening education; and to use consensus data to formulate recommendations and to develop educational materials for parents and providers. METHODS: We conducted 22 focus groups and 3 individual interviews between October 2003 and May 2004, with English- and Spanish-speaking parents of infants <1 year of age who had experience with initial testing, retesting, or false-positive screenings; health professionals who provide prenatal care or health care for newborns; and state newborn screening program health professionals. RESULTS: Parents and providers had limited knowledge and awareness about newborn screening practices. Parents wanted brief to-the-point information on newborn screening and its benefits, including the possible need for retesting and the importance of returning promptly for retesting if initial results are abnormal. Parents wanted the information orally from the primary care provider. Parents, providers, and newborn screening professionals all thought that an accompanying concise, easy-to-read brochure with contact information would be helpful. All focus group participants thought that parents should receive this information before the birth of the infant, preferably in the third trimester of pregnancy. Providers wanted a brief checklist of information and resources to prepare them to educate parents effectively. CONCLUSIONS: We recommend prenatal and primary care providers be more involved in educating parents about newborn screening. Professional societies and state health officials should work together to encourage parent and provider education. User-friendly patient and provider education materials, such as those we developed, could form the basis for this educational approach.

Adult↗
PubMed2006

Infant hearing screening: stakeholder recommendations for parent-centered communication.

OBJECTIVES: The purpose of this study was to identify what stakeholders considered best practices for parent-provider communication regarding newborn hearing screening and diagnosis. We used consensus data to develop educational materials for parents. METHODS: We conducted 29 focus groups and 23 individual interviews between October 2003 and May 2004. Participants included (1) English- and Spanish-speaking parents of infants <18 months of age who had experience with hospital-based newborn hearing screening; (2) parents of children with hearing loss; (3) primary care providers who provide prenatal care or care for newborns; and (4) audiologists, audiology technicians, and hospital nurses. RESULTS: Communication to parents about hospital-based newborn hearing screening was limited. Most parents first learned about the screening in the hospital, but all stakeholders thought a more opportune time for education was before the birth. For parents of infants who did not pass the newborn hearing screening, stakeholders recommended direct communication about the urgency of diagnostic testing. They also indicated that primary care providers needed current information regarding hearing screening, diagnostic testing, and early intervention. All stakeholders thought that a brief brochure for parents to take home would be helpful for hospital-based screening and, if necessary, subsequent diagnostic testing. Primary care providers requested basic, to-the-point information. CONCLUSIONS: The most opportune time to begin discussion of newborn hearing screening is before the birth. Providers need up-to-date information on current standards of hearing screening, diagnosis, and intervention. User-friendly patient education materials, such as those we developed, could assist providers in educating parents.

Adult↗
PubMed2006

Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): a tool to screen adolescents for below-grade reading in health care settings.

OBJECTIVE: The magnitude and consequences of low literacy in adolescent health and health care are unknown. The purpose of this study was to validate the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen), a word-recognition test in English that can be used as a brief literacy-screening tool in health care settings. PATIENTS AND METHODS: A total of 1533 adolescents aged 10 to 19 years attending 1 of 5 middle schools, 3 high schools, 1 pediatric clinic, or 2 summer programs in Louisiana and North Carolina participated in face-to-face interviews. Demographic information was solicited, and participants were administered a battery of reading tests, including the REALM-Teen, Wide Range Achievement Test-Revised (WRAT-3), and Slosson Oral Reading Test-Revised (SORT-R). Internal consistency for the REALM-Teen was determined using Cronbach's alpha, and criterion validity was established through correlations with both the WRAT-R and SORT-R. Using reading below grade level (according to SORT-R scores) as an outcome, instrument accuracy and corresponding cutoff scores were calculated by plotting receiver operating characteristic curves and stratum-specific likelihood ratios. RESULTS: Participants were 50% black and 53% female; 34% were enrolled in middle school and 66% in high school. The average time required to administer the REALM-Teen was 3 minutes. Internal consistency was excellent, as was test-retest reliability. The REALM-Teen is strongly correlated with both the WRAT-R and SORT-R. Five reading level categories were identified: 3rd grade and below, 4th to 5th grade, 6th to 7th grade, 8th to 9th grade, and 10th grade and above. Forty-six percent of participants were reading below grade level according to the SORT-R and 28% had repeated at least 1 grade. CONCLUSION: The REALM-Teen is a brief, reliable instrument for assessing adolescent literacy skills and reading below grade level.

Adolescent↗
PubMed2005

Development of a brief survey on colon cancer screening knowledge and attitudes among veterans.

INTRODUCTION: Poor knowledge of and negative attitudes toward available screening tests may account in part for colorectal cancer screening rates being the lowest among 17 quality measures reported for the Department of Veterans Affairs health care system, the largest integrated health system in the United States. The purpose of this study was to develop a brief assessment tool to evaluate knowledge and attitudes among veterans toward colorectal cancer screening options. METHODS: A 44-item questionnaire was developed to assess knowledge, attitudes, and beliefs about colorectal cancer and screening and was then administered as part of an ongoing randomized controlled trial among 388 veterans receiving care in a general medicine clinic. Sixteen candidate items on colorectal cancer knowledge, attitudes, and beliefs were selected for further evaluation using principal components analysis. Two sets of items were then further analyzed. RESULTS: Because the Cronbach alpha for beliefs was low (alpha = 0.06), the beliefs subscale was deleted from further consideration. The final scale consisted of seven items: a four-item attitude subscale (alpha = 0.73) and a three-item knowledge subscale (alpha = 0.59). Twelve-month follow-up data were used to evaluate predictive validity; improved knowledge and attitudes were significantly associated with completion of flexible sigmoidoscopy (P = .004) and completion of either flexible sigmoidoscopy or colonoscopy (P = .02). CONCLUSION: The two-factor scale offers a parsimonious and reliable measure of colorectal cancer screening knowledge and attitudes among veterans. This colorectal Cancer Screening Survey (CSS) may especially be useful as an evaluative tool in developing and testing of interventions designed to improve screening rates within this population.

Aged↗
PubMed2005

Health care provider-directed intervention to increase colorectal cancer screening among veterans: results of a randomized controlled trial.

PURPOSE: Colorectal cancer screening is the most underused cancer screening tool in the United States. The purpose of this study was to test whether a health care provider-directed intervention increased colorectal cancer screening rates. PATIENTS AND METHODS: The study was a randomized controlled trial conducted at two clinic firms at a Veterans Affairs Medical Center. The records of 5,711 patients were reviewed; 1,978 patients were eligible. Eligible patients were men aged 50 years and older who had no personal or family history of colorectal cancer or polyps, had not received colorectal cancer screening, and had at least one visit to the clinic during the study period. Health care providers in the intervention firm attended a workshop on colorectal cancer screening. Every 4 to 6 months, they attended quality improvement workshops where they received group screening rates, individualized confidential feedback, and training on improving communication with patients with limited literacy skills. Medical records were reviewed for colorectal cancer screening recommendations and completion. Literacy level was assessed in a subset of patients. RESULTS: Colorectal cancer screening was recommended for 76.0% of patients in the intervention firm and for 69.4% of controls (P = .02). Screening tests were completed by 41.3% of patients in the intervention group versus 32.4% of controls (P = .003). Among patients with health literacy skills less than ninth grade, screening was completed by 55.7% of patients in the intervention group versus 30% of controls (P < .01). CONCLUSION: A provider-directed intervention with feedback on individual and firm-specific screening rates significantly increased both recommendations and colorectal cancer screening completion rates among veterans.

Colorectal Neoplasms↗
PubMed2005

Colorectal cancer screening among African-American and white male veterans.

BACKGROUND: Population-based studies from Medicare and privately insured individuals have consistently identified lower rates of colorectal cancer-screening tests among African-American versus white individuals. The purpose of this study was to evaluate whether, at a Veterans Affairs (VA) medical center, similar racial/ethnic differences in colorectal cancer screening could be identified. METHODS: Study participants were male veterans, aged > or =50, attending a general medicine clinic in a VA hospital, who had not had either a fecal occult blood test (FOBT) within the past year or a flexible sigmoidoscopy/colonoscopy within the past 5 years. Based on review of electronic medical records, rates of physician recommendation for FOBT, flexible sigmoidoscopy, or colonoscopy, and patient completion of these tests were obtained and compared by race/ethnicity. RESULTS: Sixty percent of 1599 veterans had not undergone recent colorectal cancer screening. Physicians recommended colorectal screening tests equally among African-American and white patients (71.0% vs 68.2%, p=0.44). African-American patients were 1.3 times more likely than white patients to receive colorectal screening procedures (36.3% vs 28.9%, p=0.03). CONCLUSIONS: In contrast to other settings, in a general medicine clinic at a VA hospital, rates of colorectal cancer-screening tests were not lower for African-American patients compared to white patients.

Black or African American↗
PubMed2005

A qualitative study of literacy and patient response to HIV medication adherence questionnaires.

The purpose of this study was to elicit patient feedback regarding the perceived clarity and level of difficulty associated with self-report human immunodeficiency virus (HIV) medication adherence measurement tools. HIV-infected patients from clinics in Shreveport, Louisiana, and Chicago, Illinois, were recruited to participate in four focus group discussions. Three groups consisted of patients with limited literacy skills (< ninth-grade reading ability), and one group contained patients with adequate literacy skills (> or = ninth-grade reading ability). Five themes emerged: (1) respondent understanding of the term "adherence," (2) recall, (3) question format, (4) visual aids, and (5) instrument administration. Participants struggled to define adherence, relied on visual cues to identify medications, and had a short recall time frame for missed doses (< or =3 days). Most preferred simple question formats and for their physician to assess adherence orally. Patients receiving treatment for HIV infection, especially those with limited literacy skills, may find it difficult to respond to existing HIV medication adherence questionnaires.

Adult↗
PubMed2005

Tipping the scales: the effect of literacy on obese patients' knowledge and readiness to lose weight.

OBJECTIVES: The purpose of this study was to determine the association between the literacy level of overweight/obese patients and their weight-loss knowledge, attitudes, and readiness. METHODS: Structured patient interviews and a literacy screening instrument were administered in two primary care clinics at a university-based public hospital. RESULTS: A convenience sample of 210 overweight or obese adult outpatients (body mass index > or =25 kg/m2 or > or =30 kg/m2, respectively) were enrolled. Mean respondent age was 52 years; 74% were female, and 76% were black. Two thirds of patients read below a 9th grade level. Half of patients across all literacy levels reported currently attempting weight loss. There was a significant relation between literacy level and weight-loss knowledge, attitudes, and readiness (P < 0.05). CONCLUSIONS: Patients with low literacy were significantly less likely to understand the adverse health consequences of obesity and the need to lose weight and to report being ready to lose weight. Patient education and counseling for weight loss should be tailored for patients with low literacy skills.

Adult↗