The University of Southampton
University of Southampton Institutional Repository

Health literacy and its relationship with process and outcome in advanced kidney disease

Health literacy and its relationship with process and outcome in advanced kidney disease
Health literacy and its relationship with process and outcome in advanced kidney disease
Introduction: Management of Chronic Kidney Disease (CKD) aims to reduce the risk of kidney failure and cardiovascular disease and, if appropriate, prepare patients for renal replacement therapy: dialysis or kidney transplantation. Kidney transplantation is superior to dialysis in terms of survival and quality of life, but donor organs are a limited resource. CKD care pathways are complex, and shared decision-making and self-care activities are promoted. Health literacy is an attribute facilitating access, understanding, appraisal and use of health-related information. Socioeconomic disparities exist in CKD care and outcomes. Low health literacy is associated with both low socioeconomic status (SES) and poorer health outcomes, so is hypothesised to mediate pathways which promote health inequity.

Aims/Methods: This thesis investigates:
• The prevalence of limited health literacy at different treatment stages of CKD, and associations with demographics and SES (systematic review and meta-analysis).
• Associations between low health literacy and CKD outcomes (systematic review)
• The prevalence and associations of limited health literacy in UK patients with advanced CKD in the Access to Transplant and Transplant Outcome Measures (ATTOM) study
• Associations between limited health literacy and clinical outcomes, including deceasedand living-donor kidney transplantation, using prospective data from the ATTOM study.
• Health literacy as a mediator in the relationship between low educational level and time to transplant wait-listing and deceased- or living-donor kidney transplantation

Results: The pooled prevalence of limited health literacy among people with CKD was 25%. Prevalence was lower among transplanted patients compared to those with non-dialysis or dialysis CKD. Limited health literacy was consistently, independently associated with low SES and non-white ethnicity. Current evidence from peer-reviewed literature for associations between low health literacy and clinical outcomes was limited. In the ATTOM study, limited health literacy was independently associated with low socioeconomic status and increased comorbidity. Prevalence of limited health literacy was significantly lower among transplant recipients compared to dialysis or wait-listed patients, after adjustment for comorbidity. Limited health literacy was associated with reduced chance of transplant wait-listing, living-donor transplant or transplantation from any donor at 2 years from dialysis start. In mediation analysis, health literacy mediated 25-30% of the total effect of low educational level on increased time to deceased-donor transplant wait-listing, living-donor transplantation or transplantation from any donor type.

Conclusions: A quarter or more of patients with CKD have limited health literacy, so are unlikely to be able to fully understand or appraise health-related information or navigate care pathways if standard communication methods are used. By mediating the relationship between low socioeconomic status and access to transplantation, health literacy differences may promote inequity. Interventions which successfully reduce these effects could improve patients’ understanding, reduce inequity and improve outcomes.
University of Southampton
Taylor, Dominic M.
d5431234-2e04-4888-b61f-d86b01b65679
Taylor, Dominic M.
d5431234-2e04-4888-b61f-d86b01b65679
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Ravanan, Rommel
478a10c3-977c-448e-8551-1437edba2acd

Taylor, Dominic M. (2018) Health literacy and its relationship with process and outcome in advanced kidney disease. University of Southampton, Doctoral Thesis, 264pp.

Record type: Thesis (Doctoral)

Abstract

Introduction: Management of Chronic Kidney Disease (CKD) aims to reduce the risk of kidney failure and cardiovascular disease and, if appropriate, prepare patients for renal replacement therapy: dialysis or kidney transplantation. Kidney transplantation is superior to dialysis in terms of survival and quality of life, but donor organs are a limited resource. CKD care pathways are complex, and shared decision-making and self-care activities are promoted. Health literacy is an attribute facilitating access, understanding, appraisal and use of health-related information. Socioeconomic disparities exist in CKD care and outcomes. Low health literacy is associated with both low socioeconomic status (SES) and poorer health outcomes, so is hypothesised to mediate pathways which promote health inequity.

Aims/Methods: This thesis investigates:
• The prevalence of limited health literacy at different treatment stages of CKD, and associations with demographics and SES (systematic review and meta-analysis).
• Associations between low health literacy and CKD outcomes (systematic review)
• The prevalence and associations of limited health literacy in UK patients with advanced CKD in the Access to Transplant and Transplant Outcome Measures (ATTOM) study
• Associations between limited health literacy and clinical outcomes, including deceasedand living-donor kidney transplantation, using prospective data from the ATTOM study.
• Health literacy as a mediator in the relationship between low educational level and time to transplant wait-listing and deceased- or living-donor kidney transplantation

Results: The pooled prevalence of limited health literacy among people with CKD was 25%. Prevalence was lower among transplanted patients compared to those with non-dialysis or dialysis CKD. Limited health literacy was consistently, independently associated with low SES and non-white ethnicity. Current evidence from peer-reviewed literature for associations between low health literacy and clinical outcomes was limited. In the ATTOM study, limited health literacy was independently associated with low socioeconomic status and increased comorbidity. Prevalence of limited health literacy was significantly lower among transplant recipients compared to dialysis or wait-listed patients, after adjustment for comorbidity. Limited health literacy was associated with reduced chance of transplant wait-listing, living-donor transplant or transplantation from any donor at 2 years from dialysis start. In mediation analysis, health literacy mediated 25-30% of the total effect of low educational level on increased time to deceased-donor transplant wait-listing, living-donor transplantation or transplantation from any donor type.

Conclusions: A quarter or more of patients with CKD have limited health literacy, so are unlikely to be able to fully understand or appraise health-related information or navigate care pathways if standard communication methods are used. By mediating the relationship between low socioeconomic status and access to transplantation, health literacy differences may promote inequity. Interventions which successfully reduce these effects could improve patients’ understanding, reduce inequity and improve outcomes.

Text
Thesis Jan 2018 Final - Version of Record
Available under License University of Southampton Thesis Licence.
Download (9MB)

More information

Published date: August 2018

Identifiers

Local EPrints ID: 417995
URI: http://eprints.soton.ac.uk/id/eprint/417995
PURE UUID: 660baffa-0af0-4a4c-8446-d9eda5b482b0
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406

Catalogue record

Date deposited: 20 Feb 2018 17:30
Last modified: 14 Mar 2019 01:52

Export record

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×