Characteristics of studies included in the review
Study/Reference/Year/Location/N | Median Age, yr [Mean] | Men, % | CKD Stage | Aim | Design | Setting and Recruitment Method | Participants | Exclusion Criteria | Health Literacy Measure | Outcome Variables Tested | Prevalence of Limited Health Literacy, % |
---|---|---|---|---|---|---|---|---|---|---|---|
Adeseun (34) | [52] | 68 | Incident dialysis (HD or PD) | Examine relationship between health literacy and CV disease risk factors | Cohort (baseline data) | Adults from transplant evaluation clinics taking part in the Dialysis Heart and Bone Study | 100% with limited health literacy were black compared with 50% of those with adequate health literacy | Previous coronary revascularization, cardiac devices, or weight >350 lb | STOFHLA | BP, lipid profile, waist-to-hip ratio, BMI, tobacco use | 21 |
2012 | |||||||||||
US | |||||||||||
72 | |||||||||||
Boulware (35) | 60 | 40 | Nondialysis CKD 3–5 | Compare the effectiveness of educational interventions on preemptive living donor kidney transplantation | Cohort (baseline data) | Nephrology clinics | 46% White, 47% black,<1% Hispanic | <18 or >70 yr old, non-English speaking, previous transplant, cancer, heart failure, severe liver disease, PVD, HIV, unstable coronary artery disease | REALM | — | 25 |
2013 | |||||||||||
US | |||||||||||
130 | |||||||||||
Brice (24) | — | — | Prevalent HD | Validate TILS and SILS against STOFHLA | Cross-sectional | Adults from seven HD centers | English (96%) and Spanish speakers (4%) | <18 yr old, unable to speak English or Spanish, mental impairment defined by dialysis staff, poor vision | STOFHLA, SILS and TILS (English or Spanish) | — | 45 (STOFHLA),22 (SILS) |
2014 | |||||||||||
US | |||||||||||
277 | |||||||||||
Cavanaugh 1 (21)a | 62 | 56 | Incident HD | Measure the prevalence and associations of limited health literacy and risk of all-cause mortality | Cohort | Adults “eligible for a patient education program” from 77 dialysis units, health literacy measured if low literacy was suspected by case manager | 52% White, 50% diabetic | <18 yr old, patients on nonpermanent dialysis, known cognitive impairment, non-English speakers, nursing home residents | REALM | Mortality | 32 |
2010 | |||||||||||
US | |||||||||||
480 | |||||||||||
Cavanaugh 2 (23) | [52] | 51 | Prevalent HD | Validate BHLS against REALM and STOFHLA | Cross-sectional | Adults from four dialysis units | 73% Black | <18 or >80 yr old, dialysis initiation <1 mo, non-English speakers, cognitive impairment | BHLS (0–15), REALM, and STOFHLA | — | 23 (BHLS) 27 (REALM) 8 (STOFHLA) |
2015 | |||||||||||
US | |||||||||||
143 | |||||||||||
Dageforde 1 (36) | [48] | 64 | Incident transplant | Compare health literacy between live and deceased donor kidney transplant recipients and live kidney donors | Retrospective chart review | Transplant recipients and donors at single transplant center surveyed for health literacy preoperatively | 65% White LDR (n=103) DDR (n=152) | <18 yr old, no recorded answer to BHLS | BHLS (0–15) | Donor type, education, and demographics | 12 (LDRs: 9%; DDRs: 14%) |
2014 | |||||||||||
US | |||||||||||
255 | |||||||||||
Dageforde 2 (37) | [53] | 61 | Dialysis (n=14) and nondialysis CKD (n=90) | Characteristics of attenders versus absentees for kidney transplant evaluation appointments | Cross-sectional | Convenience sample of patients scheduled for initial evaluation for kidney transplant at a single center | 46% White | <18 yr old, non-English speakers, cognitive impairment | BHLS (0–15) | Attendance versus nonattendance | 23 (14% dialysis; 24% CKD) |
2015 | |||||||||||
US | |||||||||||
104 | |||||||||||
Devraj (38) | 45% over 60 yr old | 47 | Nondialysis CKD 1–4 | Relationship between health literacy and eGFR | Cross-sectional | Adults attending follow-up nephrology outpatient appointments at a single center, given a $20 merchandise card to participate | 40% White, 41% Hispanic | <21 yr old, non-English speaking, AKI, cognitive impairment defined by medical notes or if less than four on cognition screening test, poor visual acuity | NVS | eGFR (MDRD formula) | 63 |
2015 | |||||||||||
US | |||||||||||
150 | |||||||||||
Foster (39) | [58] | 54 | Prevalent dialysis (HD or PD) | Assess disaster preparedness in patients on dialysis | Cross-sectional | Adults approached during dialysis at six dialysis units | 57% Black, 6% Spanish speaking, 94% English speaking | <18 yr old, unable to understand consent process | STOFHLA (English or Spanish) | Disaster preparedness | 49.5 |
2011 | |||||||||||
US | |||||||||||
238 | |||||||||||
Gordon (18)a | [47] | 57 | Transplant | Relationship between health literacy, transplant knowledge, and graft function | Cross-sectional | Sequential transplant recipients from a single center recruited at post-transplant clinic visit for 30-min interview | <18 yr old, non-English-speaking, visually impaired, too unwell to participate | STOFHLA and REALM-T | Demographics and graft function | 9 | |
2011 | |||||||||||
US | |||||||||||
124 | |||||||||||
Green (19)a | 64 | 57 | Prevalent HD | Describe prevalence and associations of limited health literacy | Cohort (baseline data) | Patients from nine dialysis units included in an RCT of strategies for managing pain, sexual dysfunction, and depression | 40% Black | <18 yr old, less than thrice-weekly dialysis, non-English speakers, cognitive impairment, considering switch to PD or transplantation | REALM | Demographics, SES, comorbidity | 16 |
2011 | |||||||||||
US | |||||||||||
260 | |||||||||||
Grubbs (20)a | [52] | 66 | Prevalent HD | Association of poor health literacy with access to transplantation | Cross-sectional | Adults approached during dialysis session in five dialysis units | 73% Black | <18 or >75 yr old, ethnicity other than black or white, <9 mo on dialysis, previous transplant, cognitive impairment | STOFHLA | Referral for transplant evaluation, wait listing, or transplantation | 32 |
2009 | |||||||||||
US | |||||||||||
62 | |||||||||||
McNaughton (40) | 55 | 57 | CKD 3–5, including dialysis or transplant if eGFR<60 ml/min per 1.73 m2 | Relationship between limited health literacy and BP at ED presentation | Cross-sectional | Adults attending ED at a large quaternary hospital screened for health literacy as part of admission nursing assessment | Study included 31,902 patients, of whom 851 (3%) had kidney disease, 60% white | <18 yr old, nursing assessment or health literacy measure not completed, admitted with preeclampsia or alcohol withdrawal | BHLS (0–15) | BP at hospital presentation (in all ED attenders) | 26b |
2014 | |||||||||||
US | |||||||||||
851b | |||||||||||
Miller-Matero (41) | — | — | Referred for transplantation (dialysis or advanced CKD) | Assess health literacy of patients referred for solid organ transplantation | Cross-sectional | Patients considered for solid organ transplantation at a single center | — | — | REALM | Demographics, cognitive impairment, reading ability, numeracy (in all organ transplant recipients) | 37.8 |
2015 | |||||||||||
US | |||||||||||
95 | |||||||||||
Ricardo (42) | [58] | 54 | Nondialysis CKD 1–4 | Association of limited health literacy with kidney function and CV risk factors | Cross-sectional | Adults with CKD recruited from seven clinical centers | 52% White, 48% black | <21 or >74 yr old, polycystic kidney disease (43), Hispanic ethnicity | STOFHLA | eGFR (MDRD formula), BP, LDL cholesterol <100 mg/dl, HbA1c<7%, self-reported CV disease | 16 (Black, 28%; white, 5%) |
2014 | |||||||||||
US | |||||||||||
2340 | |||||||||||
Robinson (43) | [50] | 59 | Prevalent transplant | Validate a sun-protection education program | RCT (baseline data) | Adults from two transplant programs | 35% Black, 28% Hispanic, 36% white | <2 or >24 mo after transplant, non-Spanish speakers, <18 or >70 yr old, poor vision, ethnicity other than black, white, or Hispanic | STOFHLA (English or Spanish) | — | 36 (Black, 58%; Hispanic, 54%;white, 0%) |
2015 | |||||||||||
US | |||||||||||
170 | |||||||||||
Taylor (44) | 54 | 62 | Incident dialysis (HD or PD), incident transplant and transplant waitlisted (prevalent dialysis and nondialysis CKD) | Describe prevalence and associations of limited health literacy | Cohort (baseline data) | Adults approached for notes review and survey from all 71 United Kingdom renal units | Representative nationwide sample, 79% white, patients with CKD not on dialysis were all preemptively waitlisted for transplant | <18 or >75 yr old or unable to provide informed consent | SILS | Demographics, SES, comorbidity | 16 (Dialysis, 18%; CKD wait listed, 9%; incident transplant, 12%) |
2015 | |||||||||||
UK | |||||||||||
5520 | |||||||||||
Weng (45) | [55] | 60 | Prevalent transplant | Prevalence and correlates of medication nonadherence | Cross-sectional | Adults approached during a transplant clinic visit at a single center, offered $15 | 58% White, 27% black, median 2.9 yr post-transplant | <6 mo Post-transplant, <18 yr old, non-English speakers, unable to consent, dual organ transplant | STOFHLA | Medication nonadherence | 2.4 |
2013 | |||||||||||
US | |||||||||||
252 | |||||||||||
Wright (47)a | 58 | 53 | Nondialysis CKD 1–5 | Measure awareness and knowledge of CKD to develop a CKD knowledge survey | Cross-sectional | Adults attending a follow-up nephrology clinic appointment at a single center, offered $10 | 83% White | <18 yr old, non-English speakers, kidney transplant or dialysis, vision or cognitive impairment | REALM | Kidney disease knowledge | 18 |
2011 | |||||||||||
US | |||||||||||
401 | |||||||||||
Wright-Nunes (46) | 58 | 54 | Nondialysis CKD 1–5 | Assess feasibility and effect of a physician-delivered education tool to increase CKD knowledge | Clinical trial, (baseline data) | Adults at single center asked to complete a survey (written or read aloud), offered monetary compensation | 77% White, 78% CKD 3–5 | <18 yr old, non-English speakers, kidney transplant or dialysis, vision or cognitive impairment | REALM | — | 22 |
2013 | |||||||||||
US | |||||||||||
154c |
Outcome variables are listed only if statistical models included health literacy as an exposure variable. US, United States; HD, hemodialysis; PD, peritoneal dialysis; CV, cardiovascular; STOFHLA, Short Test of Functional Health Literacy in Adults; BMI, body mass index; PVD, peripheral vascular disease; REALM, Rapid Evaluation of Adult Literacy in Medicine; —, data unavailable or no outcomes tested; TILS, Two-Item Literacy Screener; SILS, Single-Item Literacy Screener; BHLS, Brief Health Literacy Screener; LDR, live donor recipient; DDR, deceased donor recipient; NVS, Newest Vital Sign; MDRD, Modification of Diet in Renal Disease; REALM-T, transplant-specific version of the Rapid Estimate of Adult Literacy in Medicine; RCT, randomized controlled trial; ED, emergency department; HbA1c, hemoglobin A1c;UK, United Kingdom; SES, socioeconomic status.
↵a Studies included in the 2012 review by Fraser et al. (17).
↵b Frequencies from personal communication with the authors (C. McNaughton).
↵c After excluding 401 from ref. 48.