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Understanding of Key Obstetric Quality Terminology by Asian and Pacific Islander Subgroups: Implications for Patient Engagement and Health Equity

  • Mary Guo
  • Michelle Quensell
  • Ann Chang
  • Jill Miyamura
  • Tetine Sentell
From the Field

Abstract

Introduction Comprehension of healthcare terminology across diverse populations is critical to patient education and engagement. Methods Women in Oahu, Hawai‘i with a recent delivery were interviewed about their understanding of ten common obstetric terms. Health literacy was assessed by the rapid estimate of adult literacy in medicine (REALM). Multivariable models predicted total terms comprehended by demographic factors. Results Of 269 participants, self-reported primary race was 20.5% Japanese, 19.0% Native Hawaiian, 19.0% White, 16.7% Filipino, 11.5% other Asian, 9.7% other Pacific Islander, and 3.7% other race/ethnicity; 12.7% had low health literacy. On average, participants understood 6.0 (SD: 2.2) of ten common obstetric terms. Comprehension varied by term, ranging from 97.8% for “Breastfeeding” to 27.5% for “VBAC routinely available.” Models showed (1) being Filipino, Japanese, Native Hawaiian, or other Pacific Islander (vs. white); (2) having low (vs. adequate) health literacy; (3) having a high school (vs. a college) degree; and (4) being under 25-years-old (vs. 35 +) were significantly associated with less comprehension. Discussion Participants were unfamiliar with common obstetrics terminology. Comprehension struggles were more common among populations with maternal health disparities, including Asian and Pacific Islander subgroups, and those with low health literacy.

Keywords

Patient communication Obstetrics Pacific Islanders Asians Health disparities 

Notes

Acknowledgements

This project was supported by Agency for Healthcare Research and Quality (AHRQ) Grant R21 HS021903.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10995_2018_2597_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 KB)

References

  1. Abbott, D., Atere-Roberts, N., Williams, A., Oteng-Ntim, E., & Chappell, L. (2010). Obstetric anal sphincter injury. British Medical Journal.  https://doi.org/10.1136/bmj.c4256.Google Scholar
  2. Albright, C., Steffen, A., Novotny, R., Nigg, C., Wilkens, L., Saiki, K., et al. (2012). Baseline results from Hawaii’s Nā Mikimiki project: A physical activity intervention tailored to multiethnic postpartum women. Women & Health, 52, 265–291.  https://doi.org/10.1080/03630242.2012.662935.CrossRefGoogle Scholar
  3. Baby Center (2017). Choosing a hospital. Resource document. Retrieved from http://www.babycenter.com/0_choosing-a-hospital_1148.bc.
  4. Becerra, M. B., Becerra, B. J., Daus, G. P., & Martin, L. R. (2015). Determinants of low helath literacy among Asian American and Pacific Islanders in California. Journal of Racial and Ethnic Health Disparities, 2(2), 267–273.CrossRefPubMedGoogle Scholar
  5. Bennett, I., Chen, J., Soroui, J., & White, S. (2009). The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. The Annals of Family Medicine, 7, 204–211.CrossRefPubMedGoogle Scholar
  6. Bryant, A., Worjoloh, A., Caughey, A., & Washington, A. (2010). Racial/ethnic disparities in obstetric outcomes and care: Prevalence and determinants. American Journal of Obstetrics & Gynecology, 202, 335–343.CrossRefGoogle Scholar
  7. Center for Plain Language. (2016). What is plain language?. Center for Plain Language. Retrieved from http://centerforplainlanguage.org.
  8. Chang, A., Hurwitz, E., Miyamura, J., Kaneshiro, B., & Sentell, T. (2015). Maternal risk factors and perinatal outcomes among Pacific Islander groups in Hawaii: A retrospective cohort study using statewide hospital data. BMC Pregnancy and Childbirth, 15, 239.  https://doi.org/10.1186/s12884-015-0671-4.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Chew, L. D., Bradley, K. A., & Boyko, E. J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36(8), 588–594.PubMedGoogle Scholar
  10. Davis, T., Long, S., Jackson, R., Mayeaux, E., George, R., Murphy, P., & Crouch, M. (1993). Rapid estimate of adult literacy in medicine: A shortened screening instrument. Family Medicine, 25, 391–395.PubMedGoogle Scholar
  11. Fuller, S., Koester, K., Guinness, R., & Steward, W. (2017). Patients’ perceptions and experiences of shared decision-making in primary HIV care clinics. Journal of the Association of Nurses in AIDS Care, 28, 75–84.  https://doi.org/10.1016/j.jana.2016.08.010.CrossRefPubMedGoogle Scholar
  12. Goetz, M., Müller, M., Matthies, L. M., Hansen, J., Doster, A., Szabo, A., et al. (2017). Perceptions of patient engagement applications during pregnancy: A qualitative assessment of the patient’s perspective. JMIR mHealth and uHealth, 5(5), e73.  https://doi.org/10.2196/mhealth.7040.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Gün, İ, Doğan, B., & Özdamar, Ö (2016). Long- and short-term complications of episiotomy. Turkish Journal of Obstetrics and Gynecology, 13(3), 144–148.  https://doi.org/10.4274/tjod.00087.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Henkemans, B.O.A., Rogers, W., Fisk, A., Neerincx, M., Lindenberg, J., & van der Mast, C. (2008). Usability of an adaptive computer assistant that improves self-care and health literacy of older adults. Methods of Information in Medicine, 47, 82–88.Google Scholar
  15. Hughes, D. L. (2002). Quality of health care for Asian Americans. Pub #525. The Commonwealth Fund. Accessed from http://www.commonwealthfund.org/~/media/files/publications/other/2002/mar/quality-of-health-care-for-asian-americans--a-fact-sheet/hughes_factsheetasam-pdf.pdf.
  16. Kelly, P., & Haidet, P. (2007). Physician overestimation of patient literacy: A potential source of health care disparities. Patient Education and Counseling, 66, 119–122.CrossRefPubMedGoogle Scholar
  17. Kickbusch, I., Pelikan, J., Apfel, F., & Tsouros, A. (Eds.). (2013). Health literacy—The solid facts. Resource document. World Health Organization. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf.
  18. Kilbridge, K., Fraser, G., Krahn, M., Nelson, E., Conaway, M., Bashore, R., et al. (2009). Lack of comprehension of common prostate cancer terms in an underserved population. Journal of Clinical Oncology, 27, 2015–2021.  https://doi.org/10.1200/JCO.2008.17.3468.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Kilfoyle, K. A., Vitko, M., O’Conor, R., & Bailey, S. C. (2016). Health literacy and women’s reproductive health: A systematic review. Journal of Women’s Health, 25(12), 1237–1255.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Koh, H. (2010). National action plan to improve health literacy. Resource document. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from https://health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf.
  21. Mazor, K., Calvi, J., Cowan, R., Costanza, M., Han, P., Greene, S., et al. (2010). Media messages about cancer: What do people understand. Journal of Health Communication, 15, 126–145.  https://doi.org/10.1080/10810730.2010.499983.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Moy, E., Greenberg, L., & Borsky, A. (2008). Community variation: Disparities in health care quality between Asian and white Medicare beneficiaries. Health Affairs, 27, 538–549.CrossRefPubMedGoogle Scholar
  23. Revicky, V., Muralidhar, A., Mukhopadhyay, S., & Mahmood, T. (2012). A case series of uterine rupture: Lessons to be learned for future clinical practice. Journal of Obstetrics and Gynaecology of India, 62(6), 665–673.  https://doi.org/10.1007/s13224-012-0328-4.CrossRefPubMedGoogle Scholar
  24. Robinson, L., Calmes, D., & Bazargan, M. (2008). The impact of literacy enhancement on asthma-related outcomes among underserved children. Journal of the National Medical Association, 100, 892–896.CrossRefPubMedGoogle Scholar
  25. Ryan, C., & Bauman, K. (2015). Educational attainment in the United States: 2015. U.S. Department of Commerce, United States Census Bureau. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2016/demo/p20-578.pdf.
  26. Seidman, J. (2010). Health literacy & meaningful use of health IT. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology. Retrieved from http://www.nationalacademies.org/hmd/~/media/1973CA1C16614BA3A213C78F40E61CFA.ashx.
  27. Sentell, T., Baker, K., Onaka, A., & Braun, K. (2011). Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai’i. Journal of Health Communication, 16, Suppl 3.  https://doi.org/10.1080/10810730.2011.604390.
  28. Sentell, T., & Braun, K. (2012). Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of Health Communication, 17(Suppl 3), 82–99.  https://doi.org/10.1080/10810730.2012.712621.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Shen, J., Tymkow, C., & MacMullen, N. (2005). Disparities in maternal outcomes among four ethnic populations. Ethnicity & Disease, 15, 492–497.Google Scholar
  30. Shieh, C., Mays, R., McDaniel, A., & Yu, J. (2009). Health literacy and its association with the use of information sources and with barriers to information seeking in clinic-based pregnant women. Health Care for Women International, 30, 971–988.CrossRefPubMedGoogle Scholar
  31. StataCorp. (2011). Stata statistical software: Release 12. College Station: StataCorp LP.Google Scholar
  32. The American College of Obstetricians and Gynecologists. (2016). ACOG Committee Opinion No. 585: Health literacy. Obstetrics and Gynecology, 123(2), 380–383.  https://doi.org/10.1097/01.AOG.0000443277.06393.32.Google Scholar
  33. The Center for Medicaid & CHIP Services. (2017). 2018 Core set of maternal and perinatal health measures for Medicaid and CHIP (Maternity Core Set). Centers for Medicare & Medicaid Service. Accessed from https://www.medicaid.gov/medicaid/quality-of-care/downloads/performance-measurement/2018-maternity-core-set.pdf.
  34. Weiss, B., Hart, G., McGee, D., & d’Estelle, S. (1992). Health status of illiterate adults: Relation between literacy and health status among persons with low literacy skills. The Journal of the American Board of Family Medicine, 5, 257–264.Google Scholar
  35. Wolf, M., Davis, T., Tilson, H., Bass, P., & Parker, R. (2006). Misunderstanding of prescription drug warning labels among patients with low literacy. American Journal of Health-System Pharmacy, 63, 1048–1055.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mary Guo
    • 1
  • Michelle Quensell
    • 1
  • Ann Chang
    • 2
  • Jill Miyamura
    • 3
  • Tetine Sentell
    • 1
  1. 1.Office of Public Health StudiesUniversity of Hawai’i at ManoaHonoluluUSA
  2. 2.Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of MedicineUniversity of Hawai’iHonoluluUSA
  3. 3.Hawaii Health Information CorporationHonoluluUSA

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