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      Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women

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          Abstract

          Objectives

          Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations.

          Setting

          University hospital in Valencia (Spain).

          Participants

          119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment.

          Primary and secondary outcome measures

          HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination.

          Results

          119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R 2=0.22, p=0.014) and Newest Vital Sign (adjusted R 2=0.258, p=0.001) scores. Depending on the scale, 56%–85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information.

          Conclusions

          Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.

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          Most cited references23

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          The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability

          Nancy Morris, Charles MacLean, Lisa Chew … (2006)
          Background Reading skills are important for accessing health information, using health care services, managing one's health and achieving desirable health outcomes. Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener (SILS) to identify limited reading ability, one component of health literacy, as measured by the S-TOFHLA. Methods Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states. Participants were randomly recruited from Primary Care practices in the Vermont Diabetes Information System June 2003 – December 2004. The main outcome was limited reading ability. The primary predictor was the SILS. Results Of the 999 persons screened, 169 (17%) had limited reading ability. The sensitivity of the SILS in detecting limited reading ability was 54% [95% CI: 47%, 61%] and the specificity was 83% [95% CI: 81%, 86%] with an area under the Receiver Operating Characteristics Curve (ROC) of 0.73 [95% CI: 0.69, 0.78]. Seven hundred seventy (77%) screened negative on the SILS and 692 of these subjects had adequate reading skills (negative predictive value = 0.90 [95% CI: 0.88, 0.92]). Of the 229 who scored positive on the SILS, 92 had limited reading ability (positive predictive value = 0.4 [95% CI: 0.34, 0.47]). Conclusion The SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. Further study of the use of the SILS in clinical settings and with more diverse populations is warranted.
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            Health literacy measurement: an inventory and descriptive summary of 51 instruments.

            Jolie N. Haun, Melissa A Valerio, Lauren McCormack … (2014)
            This article aimed to provide a descriptive review of the psychometric properties and conceptual dimensions of published health literacy measurement tools. PsycINFO and PubMed search from 1999 through 2013, review of the grey literature, and an environmental scan was conducted to identify health literacy measurement tools. For each tool, we evaluated the conceptual dimensions assessed, test parameters, and psychometric properties. Of the 51 tools identified, 26 measured general health literacy, and 15 were disease or content specific, and 10 aimed at specific populations. Most tools are performance based, require in-person administration, and are exclusively available in a pencil and paper testing mode. The tools assess 0 (proxy measure) to 9 of the 11 defined dimensions of health literacy. Reported administration times vary, from less than 1 to 60 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups (i.e., race, age, ethnicity, and gender). The health literacy measurement tools currently available generally represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools lack information on key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. As researchers develop new measures, inclusion of a full range of conceptual dimensions of health literacy, more representative sampling for testing, and additional modes of administration will allow a more refined and flexible approach to research in this field.
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              The rise of multiple imputation: a review of the reporting and implementation of the method in medical research

              Panteha Hayati Rezvan, Katherine J Lee, Julie A. Simpson (2015)
              Background Missing data are common in medical research, which can lead to a loss in statistical power and potentially biased results if not handled appropriately. Multiple imputation (MI) is a statistical method, widely adopted in practice, for dealing with missing data. Many academic journals now emphasise the importance of reporting information regarding missing data and proposed guidelines for documenting the application of MI have been published. This review evaluated the reporting of missing data, the application of MI including the details provided regarding the imputation model, and the frequency of sensitivity analyses within the MI framework in medical research articles. Methods A systematic review of articles published in the Lancet and New England Journal of Medicine between January 2008 and December 2013 in which MI was implemented was carried out. Results We identified 103 papers that used MI, with the number of papers increasing from 11 in 2008 to 26 in 2013. Nearly half of the papers specified the proportion of complete cases or the proportion with missing data by each variable. In the majority of the articles (86%) the imputed variables were specified. Of the 38 papers (37%) that stated the method of imputation, 20 used chained equations, 8 used multivariate normal imputation, and 10 used alternative methods. Very few articles (9%) detailed how they handled non-normally distributed variables during imputation. Thirty-nine papers (38%) stated the variables included in the imputation model. Less than half of the papers (46%) reported the number of imputations, and only two papers compared the distribution of imputed and observed data. Sixty-six papers presented the results from MI as a secondary analysis. Only three articles carried out a sensitivity analysis following MI to assess departures from the missing at random assumption, with details of the sensitivity analyses only provided by one article. Conclusions This review outlined deficiencies in the documenting of missing data and the details provided about imputation. Furthermore, only a few articles performed sensitivity analyses following MI even though this is strongly recommended in guidelines. Authors are encouraged to follow the available guidelines and provide information on missing data and the imputation process. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0022-1) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2018
                Publication date (Electronic): 6 July 2018
                Volume: 8
                Issue: 7
                Electronic Location Identifier: e022132
                Affiliations
                [1 ] departmentNIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections (HCAI) and Antimicrobial Resistance (AMR) , Imperial College London , London, UK
                [2 ] departmentDepartment of Obstetrics and Gynaecology , Hospital Universitario de la Ribera , Valencia, Spain
                [3 ] departmentFaculty of Nursing , Universidad Católica de Valencia ‘San Vicente Mártir’ , Valencia, Spain
                [4 ] Xàtiva-Ontinyent Health Department , Xàtiva, Spain
                [5 ] Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO) , Valencia, Spain
                [6 ] departmentDepartment of Nursing , University of Alicante. San Vicente del Raspeig , Alicante, Spain
                Author notes
                [Correspondence to ] Dr Enrique Castro-Sánchez; e.castro-sanchez@ 123456imperial.ac.uk
                Author information
                http://orcid.org/0000-0002-3351-9496
                Article
                Publisher ID: bmjopen-2018-022132
                DOI: 10.1136/bmjopen-2018-022132
                PMC ID: 6042548
                PubMed ID: 29982220
                SO-VID: 4e22ad18-e9c8-4647-a411-13c0caa92909
                Copyright © © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 02 February 2018
                Date revision received : 17 April 2018
                Date accepted : 07 June 2018
                Funding
                Funded by: National Institute for Health Research (NIHR);
                Funded by: Universidad Católica de Valencia "San Vicente Mártir";
                Categories
                Subject: Public Health
                Subject: Research
                Subject: 1506
                Subject: 1724
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: immunisation,influenza,pertussis,health literacy,maternal medicine
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: immunisation, influenza, pertussis, health literacy, maternal medicine

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