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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review

Authors: Ana Cristina Cabellos-García, Antonio Martínez-Sabater, Enrique Castro-Sánchez, Mari Kangasniemi, Raul Juárez-Vela, Vicente Gea-Caballero

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Oral anticoagulants (OAC) are widely used in patients with cardiovascular diseases. However, for optimal OAC self-care patients must have skills, among which health literacy (HL) is highlighted. We aimed to describe the relation between HL and self-care in cardiovascular patients on OAC treatment.

Methods

Electronic searches were carried out in the PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, SciELO, IME-Biomedicina, CUIDEN Plus and LILACS databases, limited to Spanish and English language and between January 2000–December 2016. Papers reported on adults older than 18 years, taking OAC by themselves for at least three months. PRISMA guidelines were used for paper selection.

Results

We identified 142 articles and finally included 10; almost all of them about warfarin. Our results suggest that in patients taking OAC treatments there is a positive relationship between HL and the level of knowledge. In addition, a small percentage of participants on the selected papers recognized the side effects and complications associated with OAC treatment. Lower HL level was associated with greater knowledge deficits and less adherence to treatment.

Conclusion

There is a paucity of research evaluating the effect of HL on diverse aspects of OAC treatments. There is a need to expand the evidence base regarding appropriate HL screening tools, determinants of adequate knowledge and optimal behaviours related to OAC self-management.
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Literature
1.
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):1.CrossRef
2.
Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation--developed with the special contribution of the European heart rhythm association. Europace. 2012;14(10):1385–413.CrossRef
3.
Boned-Ombuena A, Pérez-Panadés J, López-Maside A, Miralles-Espí M, Guardiola Vilarroig S, Adam Ruiz D, et al. Prevalencia de la anticoagulación oral y calidad de su seguimiento en el ámbito de la atención primaria: estudio de la Red Centinela Sanitaria de la Comunitat Valenciana. Aten Primaria. 2017;49(9):534–48.CrossRef
4.
Gómez-Doblas JJ, Muñiz J, Martin JJA, Rodríguez-Roca G, Lobos JM, Awamleh P, et al. Prevalencia de fibrilación auricular en España. Resultados del estudio OFRECE. Rev Esp Cardiol. 2014;67(04):259–69.CrossRef
5.
Esmerio FG, Souza EN, Leiria TL, Lunelli R, Moraes MA. Uso crónico de anticoagulante oral: implicaciones para el control de niveles adecuados. Arq Bras Cardiol. 2009;93(5):549–54.CrossRef
6.
Navarro JL, Cesar JM, Fernández MA, Fontcuberta J, Reverter JC, Gol-Freixa J. Morbilidad y mortalidad en pacientes con tratamiento anticoagulante oral. Rev Esp Cardiol. 2007;60(12):1226–32.CrossRef
7.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962.CrossRef
8.
Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. EP Europace. 2018;20(8):1231–42. https://​doi.​org/​10.​1093/​europace/​euy054.CrossRef
9.
Matsuoka S, Tsuchihashi-Makaya M, Kayane T, Yamada M, Wakabayashi R, Kato NP, et al. Health literacy is independently associated with self-care behavior in patients with heart failure. Patient Educ Couns. 2016;99(6):1026–32.CrossRef
10.
Chen AMH, Yehle KS, Plake KS, Murawski MM, Mason HL. Health literacy and self-care of patients with heart failure. J Cardiovasc Nurs. 2011;26(6):446–51.CrossRef
11.
Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.CrossRef
12.
Peerson A, Saunders M. Health literacy revisited: what do we mean and why does it matter? Health Promot Int. 2009;24(3):285–96.CrossRef
13.
Berkman ND, Davis TC, McCormack L. Health literacy: what is it? J Health Commun. 2010;15(Suppl 2):9–19.CrossRef
14.
Altin SV, Finke I, Kautz-Freimuth S, Stock S. The evolution of health literacy assessment tools: a systematic review. BMC Public Health. 2014;14:1207.CrossRef
15.
Jordan JE, Osborne RH, Buchbinder R. Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol. 2011;64(4):366–79.CrossRef
16.
McCormack L, Bann C, Squiers L, Berkman ND, Squire C, Schillinger D, et al. Measuring health literacy: a pilot study of a new skills-based instrument. J Health Commun. 2010;15(Suppl 2):51–71.CrossRef
17.
Reading SR, Go AS, Fang MC, Singer DE, Liu IA, Black MH, et al. Health literacy and awareness of atrial fibrillation. J Am Heart Assoc. 2017;6(4):1–11.CrossRef
18.
Davis TC, Wolf MS. Health literacy: implications for family medicine. Fam Med. 2004;36(8):595–8.PubMed
19.
Parker RM, Ratzan SC, Lurie N. Health literacy: a policy challenge for advancing high-quality health care. Health Aff (Millwood). 2003;22(4):147–53.CrossRef
20.
Davis TC, Wolf MS, Bass PF, Middlebrooks M, Kennen E, Baker DW, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006;21(8):847–51.CrossRef
21.
Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002;92(8):1278–83.CrossRef
22.
Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, et al. Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med. 2006;21(8):806–12.CrossRef
23.
Howard DH, Sentell T, Gazmararian JA. Impact of health literacy on socioeconomic and racial differences in health in an elderly population. J Gen Intern Med. 2006;21(8):857–61.CrossRef
24.
Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ. 2012;344:e1602.CrossRef
25.
DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes. J Gen Intern Med. 2004;19(12):1228–39.CrossRef
26.
Parker R. Health literacy: a challenge for American patients and their health care providers. Health Promot Int. 2000;15(4):277–83.CrossRef
27.
Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503–9.CrossRef
28.
Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51(3):267–75.CrossRef
29.
Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002;40(5):395–404.CrossRef
30.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.CrossRef
31.
Zingg W, Castro-Sanchez E, Secci FV, Edwards R, Drumright LN, Sevdalis N, et al. Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). Public Health. 2016;133:19–37.CrossRef
32.
Mueller M, D'Addario M, Egger M, Cevallos M, Dekkers O, Mugglin C, et al. Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations. BMC Med Res Methodol. 2018;18(1):44.CrossRef
33.
Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, et al. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control. 2017;6:6.CrossRef
34.
Dolor RJ, Ruybalid RL, Uyeda L, Edson RG, Phibbs C, Vertrees JE, et al. An evaluation of patient self-testing competency of prothrombin time for managing anticoagulation: pre-randomization results of VA cooperative study #481--the home INR study (THINRS). J Thromb Thrombolysis. 2010;30(3):263–75.CrossRef
35.
Estrada CA, Martin-Hryniewicz M, Peek BT, Collins C, Byrd JC. Literacy and numeracy skills and anticoagulation control. Am J Med Sci. 2004;328(2):88–93.CrossRef
36.
Diug B, Evans S, Lowthian J, Maxwell E, Dooley M, Street A, et al. The unrecognized psychosocial factors contributing to bleeding risk in warfarin therapy. Stroke. 2011;42(10):2866–71.CrossRef
37.
Oramasionwu CU, Bailey SC, Duffey KE, Shilliday BB, Brown LC, Denslow SA, et al. The association of health literacy with time in therapeutic range for patients on warfarin therapy. J Health Commun. 2014;19(Suppl 2):19–28.CrossRef
38.
Wilson FL, Racine E, Tekieli V, Williams B. Literacy, readability and cultural barriers: critical factors to consider when educating older African Americans about anticoagulation therapy. J Clin Nurs. 2003;12(2):275–82.CrossRef
39.
Fang MC, Panguluri P, Machtinger EL, Schillinger D. Language, literacy, and characterization of stroke among patients taking warfarin for stroke prevention: implications for health communication. Patient Educ Couns. 2009;75(3):403–10.CrossRef
40.
Wilson FL, Templin TN, Nordstrom CK, Carter JM, Baker L, Kinney T, et al. Psychometric properties and construct validity of the knowledge information profile–Coumadin. J Pharm Technol. 2015;31(1):20–8.CrossRef
41.
Fang MC, Machtinger EL, Wang F, Schillinger D. Health literacy and anticoagulation-related outcomes among patients taking warfarin. J Gen Intern Med. 2006;21(8):841–6.CrossRef
42.
Schillinger D, Machtinger EL, Wang F, Palacios J, Rodriguez M, Bindman A. Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment. J Health Commun. 2006;11(7):651–64.CrossRef
43.
Schillinger D, Wang F, Rodriguez M, Bindman A, Machtinger EL. The importance of establishing regimen concordance in preventing medication errors in anticoagulant care. J Health Commun. 2006;11(6):555–67.CrossRef
44.
Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med. 2013;28(3):444–52.CrossRef
45.
Aronis KN, Edgar B, Lin W, Martins MAP, Paasche-Orlow MK, Magnani JW. Health literacy and atrial fibrillation: relevance and future directions for patient-centred care. Eur Cardiol. 2017;12(1):52–7.CrossRef
46.
Hassali MA, Lim CJ, Rajah R. Health literacy-related knowledge, attitude, and perceived barriers: a cross-sectional study among physicians, pharmacists, and nurses in public hospitals of Penang, Malaysia. Front Public Health. 2017;5:281.CrossRef
47.
Alphonsa A, Sharma KK, Sharma G, Bhatia R. Knowledge regarding oral anticoagulation therapy among patients with stroke and those at high risk of thromboembolic events. J Stroke Cerebrovasc Dis. 2015;24(3):668–72.CrossRef
48.
Chenot J, Hua TD, Abu Abed M, Schneider-Rudt H, Friede T, Schneider S, et al. Safety relevant knowledge of orally anticoagulated patients without self-monitoring: a baseline survey in primary care. BMC Fam Pract. 2014;15:104–12.CrossRef
49.
Mavri A, Ostasevski Fernandez N, Kramaric A, Kosmelj K. New educational approach for patients on warfarin improves knowledge and therapy control. Wien Klin Wochenschr. 2015;127(11–12):472–6.CrossRef
50.
Michal M, Prochaska JH, Ullmann A, Keller K, Gobel S, Coldewey M, et al. Relevance of depression for anticoagulation management in a routine medical care setting: results from the ThrombEVAL study program. J Thromb Haemost. 2014;12(12):2024–33.CrossRef
51.
Schwartz L, Mazzola N, Hoffman RS, Howland MA, Mercurio-Zappala M, Nelson LS. Evaluating Patients' understanding of printed warfarin medication information. J Pharm Pract. 2015;28(6):518–22.CrossRef
52.
Bas Sarmiento P, Fernández Gutiérrez M, Poza Méndez M, Pelicano PN. Propuestas de evaluación de la Alfabetización en Salud. Psychologia Latina. 2015;6(1):1–11.
53.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRef
54.
Martins MAP, Costa JM, Mambrini JV d M, Ribeiro ALP, Benjamin EJ, Brant LCC, et al. Health literacy and warfarin therapy at two anticoagulation clinics in Brazil. Heart. 2017;103(14):1089–95.CrossRef
55.
Tang EOYL, Lai CSM, Lee KKC, Wong RSM, Cheng G, Chan TYK. Relationship between patients' warfarin knowledge and anticoagulation control. Ann Pharmacother. 2003;37(1):34–9.CrossRef
56.
Keller DL, Wright J, Pace HA. Impact of health literacy on health outcomes in ambulatory care patients: a systematic review. Ann Pharmacother. 2008;42(9):1272–81.CrossRef
57.
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475–82.CrossRef
58.
Muir KW, Santiago-Turla C, Stinnett SS, Herndon LW, Allingham RR, Challa P, et al. Health literacy and adherence to glaucoma therapy. Am J Ophthalmol. 2006;142(2):223–6.CrossRef
Metadata
Title
Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review
Authors
Ana Cristina Cabellos-García
Antonio Martínez-Sabater
Enrique Castro-Sánchez
Mari Kangasniemi
Raul Juárez-Vela
Vicente Gea-Caballero
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6070-9

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