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A systematic review of the prevalence and associations of limited health literacy in CKD

A systematic review of the prevalence and associations of limited health literacy in CKD
A systematic review of the prevalence and associations of limited health literacy in CKD
Background and objectives: The self-management and decision-making skills required to manage CKD successfully may be diminished in those with low health literacy. A 2012 review identified five papers reporting the prevalence of limited health literacy in CKD, largely from United States dialysis populations. The literature has expanded considerably since. 
Design, setting, participants, & measurements: We used systematic review, pooled prevalence analysis, metaregression, and exploration of heterogeneity in studies of patients with CKD (all stages). 
Results: From 433 studies, 15 new studies met the inclusion criteria and were analyzed together with five studies from the 2012 review. These included 13 cross-sectional surveys, five cohort studies (using baseline data), and two using baseline clinical trial data. Most (19 of 20) were from the United States. In total, 12,324 patients were studied (3529 nondialysis CKD, 5289 dialysis, 2560 transplant, and 946 with unspecified CKD; median =198.5; IQR, 128.5–260 per study). Median prevalence of limited health literacy within studies was 23% (IQR, 16%–33%), and pooled prevalence was 25% (95% confidence interval, 20% to 30%) with significant between-study heterogeneity (I2=97%). Pooled prevalence of limited health literacy was 25% (95% confidence interval, 16% to 33%; I2=97%) among patients with CKD not on dialysis, 27% (95% confidence interval, 19% to 35%; I2=96%) among patients on dialysis, and 14% (95% confidence interval, 7% to 21%; I2=97%) among patients with transplants. A higher proportion of nonwhite participants was associated with increased limited health literacy prevalence (P=0.04), but participant age was not (P=0.40). Within studies, nonwhite ethnicity and low socioeconomic status were consistently and independently associated with limited health literacy. Studies were of low or moderate quality. Within-study participant selection criteria had potential to introduce bias. 
Conclusions: Limited health literacy is common in CKD, especially among individuals with low socioeconomic status and nonwhite ethnicity. This has implications for the design of self-management and decision-making initiatives to promote equity of care and improve quality. Lower prevalence among patients with transplants may reflect selection of patients with higher health literacy for transplantation either because of less comorbidity in this group or as a direct effect of health literacy on access to transplantation.
1555-9041
1070-1084
Taylor, Dominic M.
d5431234-2e04-4888-b61f-d86b01b65679
Fraser, Simon D. S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Bradley, J. Andrew
b4741218-b899-4a19-a9a3-4ad41969e81f
Bradley, Clare
35f55ae9-4f28-4c20-9266-a8640c6406fa
Draper, Heather
d3efb1a7-0556-4685-8c4b-482a29de0f96
Metcalfe, Wendy
dcad3fd9-b47d-415a-aeca-97db8d212b88
Oniscu, Gabriel C.
1f47eec9-c622-477e-8cf0-e26c05e93fea
Tomson, Charles R. V.
d9044890-5faf-4d0c-b685-5cfa41929c44
Ravanan, Rommel
478a10c3-977c-448e-8551-1437edba2acd
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
on behalf of ATTOM investigators
Taylor, Dominic M.
d5431234-2e04-4888-b61f-d86b01b65679
Fraser, Simon D. S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Bradley, J. Andrew
b4741218-b899-4a19-a9a3-4ad41969e81f
Bradley, Clare
35f55ae9-4f28-4c20-9266-a8640c6406fa
Draper, Heather
d3efb1a7-0556-4685-8c4b-482a29de0f96
Metcalfe, Wendy
dcad3fd9-b47d-415a-aeca-97db8d212b88
Oniscu, Gabriel C.
1f47eec9-c622-477e-8cf0-e26c05e93fea
Tomson, Charles R. V.
d9044890-5faf-4d0c-b685-5cfa41929c44
Ravanan, Rommel
478a10c3-977c-448e-8551-1437edba2acd
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a

on behalf of ATTOM investigators (2017) A systematic review of the prevalence and associations of limited health literacy in CKD. Clinical Journal of the American Society of Nephrology, 12 (7), 1070-1084. (doi:10.2215/CJN.12921216).

Record type: Article

Abstract

Background and objectives: The self-management and decision-making skills required to manage CKD successfully may be diminished in those with low health literacy. A 2012 review identified five papers reporting the prevalence of limited health literacy in CKD, largely from United States dialysis populations. The literature has expanded considerably since. 
Design, setting, participants, & measurements: We used systematic review, pooled prevalence analysis, metaregression, and exploration of heterogeneity in studies of patients with CKD (all stages). 
Results: From 433 studies, 15 new studies met the inclusion criteria and were analyzed together with five studies from the 2012 review. These included 13 cross-sectional surveys, five cohort studies (using baseline data), and two using baseline clinical trial data. Most (19 of 20) were from the United States. In total, 12,324 patients were studied (3529 nondialysis CKD, 5289 dialysis, 2560 transplant, and 946 with unspecified CKD; median =198.5; IQR, 128.5–260 per study). Median prevalence of limited health literacy within studies was 23% (IQR, 16%–33%), and pooled prevalence was 25% (95% confidence interval, 20% to 30%) with significant between-study heterogeneity (I2=97%). Pooled prevalence of limited health literacy was 25% (95% confidence interval, 16% to 33%; I2=97%) among patients with CKD not on dialysis, 27% (95% confidence interval, 19% to 35%; I2=96%) among patients on dialysis, and 14% (95% confidence interval, 7% to 21%; I2=97%) among patients with transplants. A higher proportion of nonwhite participants was associated with increased limited health literacy prevalence (P=0.04), but participant age was not (P=0.40). Within studies, nonwhite ethnicity and low socioeconomic status were consistently and independently associated with limited health literacy. Studies were of low or moderate quality. Within-study participant selection criteria had potential to introduce bias. 
Conclusions: Limited health literacy is common in CKD, especially among individuals with low socioeconomic status and nonwhite ethnicity. This has implications for the design of self-management and decision-making initiatives to promote equity of care and improve quality. Lower prevalence among patients with transplants may reflect selection of patients with higher health literacy for transplantation either because of less comorbidity in this group or as a direct effect of health literacy on access to transplantation.

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SR HL final manuscript cJASN v5 - Accepted Manuscript
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Accepted/In Press date: 7 April 2017
e-pub ahead of print date: 9 May 2017
Published date: 12 July 2017
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 410709
URI: http://eprints.soton.ac.uk/id/eprint/410709
ISSN: 1555-9041
PURE UUID: 33528a7e-5445-4f9d-9fd3-f4995188873e
ORCID for Simon D. S. Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 09 Jun 2017 09:24
Last modified: 16 Mar 2024 03:58

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Contributors

Author: Dominic M. Taylor
Author: J. Andrew Bradley
Author: Clare Bradley
Author: Heather Draper
Author: Wendy Metcalfe
Author: Gabriel C. Oniscu
Author: Charles R. V. Tomson
Author: Rommel Ravanan
Corporate Author: on behalf of ATTOM investigators

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