Longitudinal studies, the gold standard for measuring intra-individual trajectories of change over time, provide crucial information about human aging through the repeated observation of developmental trends. Knowing the extent to which cross-sectional data from a longitudinal sample relates to data from a one-time measurement sample is essential to data interpretation and application in clinical trials, treatment decisions, and health policy for older adults. However, when participants are rigorously screened at enrollment and attrition is high, longitudinal participants may become increasingly select over time, limiting the generalizability of findings. Individuals enrolled with exceptional health or who received repeated health evaluations while continuing in a study may have better physical and cognitive function than individuals who lack these characteristics and experiences.
BACKGROUND
The factors influencing medication adherence have not been fully elucidated. Inadequate health literacy skills may impair comprehension of medical care instructions, and thereby reduce medication adherence.
OBJECTIVES
To examine the relationship between health literacy and medication refill adherence among Medicare managed care enrollees with cardiovascular-related conditions.
RESEARCH DESIGN
Prospective cohort study.
SUBJECTS
New Medicare enrollees from 4 managed care plans who completed an in-person survey and were identified through administrative data as having coronary heart disease, hypertension, diabetes mellitus, and/or hyperlipidemia (n=1,549).
MEASURES
Health literacy was determined using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Prospective administrative data were used to calculate the cumulative medication gap (CMG), a valid measure of medication refill adherence, over a 1-year period. Low adherence was defined as CMG≥20%.
RESULTS
Overall, 40% of the enrollees had low refill adherence. Bivariate analyses indicated that health literacy, race/ethnicity, education, and regimen complexity were each related to medication refill adherence (P<.05). In unadjusted analysis, those with inadequate health literacy skills had increased odds (odds ratio [OR]=1.37, 95% confidence interval [CI]: 1.08 to 1.74) of low refill adherence compared with those with adequate health literacy skills. However, the OR for inadequate health literacy and low refill adherence was not statistically significant in multivariate analyses (OR=1.23, 95% CI: 0.92 to 1.64).
CONCLUSIONS
The present study suggests, but did not conclusively demonstrate, that low health literacy predicts poor refill adherence. Given the prevalence of both conditions, future research should continue to examine this important potential association.
Background: Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. Methods: Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. Results: Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. Conclusions: Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.
Background. The Body Position Spatial Task (BPST) is a novel measure of whole-body spatial cognition involving multidirectional steps and turns. Individuals with Parkinson disease (PD) are affected by motor and cognitive impairments, particularly in spatial function, which is important for mental imagery and navigation. Performance on the BPST may inform understanding of motor-cognitive and spatial cognitive function of individuals with PD. Objectives. We conducted this study to determine feasibility and validity of the BPST with standard, validated, and reliable measures of spatial cognition and motor-cognitive integration and to compare BPST performance in adults with and without PD. Methods. A total of 91 individuals with mild-moderate PD and 112 neurotypical (NT) adults of similar age were recruited for the study to complete the BPST and other measures of mobility and cognition. Correlations were used to determine construct and concurrent validity of BPST with valid measures of spatial cognition and motor-cognitive integration. Performance was compared between PD and NT adults using independent t-tests. Results. BPST was feasible to administer. Analyses show evidence of construct validity for spatial cognition and for motor-cognitive integration. Concurrent validity was demonstrated with other tests of mobility and cognition. Relationships were stronger and more significant for individuals with PD than for NT individuals. BPST performance was not significantly different between groups. Conclusion. Tests that integrate cognitive challenge in mobility contexts are necessary to assess the health of spatial cognitive and motor-cognitive integration. The BPST is a feasible and valid test of whole-body spatial cognition and motor-cognitive integration in individuals with PD.