Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Dig Dis Sci. 2021 Aug;66(8):2603-2609. doi: 10.1007/s10620-020-06583-x. Epub 2020 Sep 5.
Health education interventions are successful in modifying lifestyle. Functional health literacy (FHL) can determine patient adherence to clinic visits and procedures and may adversely impact the success of these interventions.
We sought to evaluate the hypothesis that a health education intervention would improve compliance with hepatocellular cancer (HCC) screening and that poor FHL would reduce such compliance.
We assessed FHL using a short version test of functional health literacy in adults (STOFHLA). Cirrhotic patients free of HCC were prospectively enrolled from clinics and provided an educational intervention consisting of focused physician-led discussion regarding cirrhosis and HCC, along with written material on these topics for the subject to review at home. Patients were subsequently followed for 6 months (prospective time period), and the same cohort's clinic/HCC screening behavior between 6 and 12 months prior to the educational intervention (retrospective time period) was compared.
In total, 104 cirrhotic patients (age 60.01 ± 8.58 years, 80% men, MELD 12.70 ± 5.76) were included. Of these, 89 (85.57%) of patients had educational level 12th grade and higher. There were 76% (n = 79) with adequate, while 24% (n = 25) had inadequate/marginal FHL on S-TOHFLA. The number of HCC-related imaging increased from 59 (56.7%) to 86 (82.6%, p < 0.0001) post-education in the prospective compared to prior time period which was similar regardless of FHL.
While the educational intervention was successful in improving compliance with HCC screenings, FHL status did not impact the power of this intervention. Hence, the combination of specific verbal information, along with targeted written material, improved compliance with clinic visits and liver imaging for HCC.
健康教育干预措施在改变生活方式方面取得了成功。功能性健康素养（FHL）可以确定患者对就诊和治疗的依从性，并且可能对这些干预措施的成功产生不利影响。
我们旨在验证假设，即健康教育干预措施可提高肝细胞癌（HCC）筛查的依从性，而较差的 FHL 则会降低这种依从性。
我们使用成人功能性健康素养简短测试（STOFHLA）评估 FHL。从诊所前瞻性招募无 HCC 的肝硬化患者，并提供一个教育干预，包括由医生主导的关于肝硬化和 HCC 的讨论，以及关于这些主题的书面材料，供患者在家中复习。随后对患者进行了 6 个月的随访（前瞻性时间段），并比较了教育干预前 6 至 12 个月同一队列的就诊/HCC 筛查行为（回顾性时间段）。
共有 104 名肝硬化患者（年龄 60.01±8.58 岁，80%为男性，MELD 12.70±5.76）被纳入研究。其中 89 名（85.57%）患者的教育水平达到 12 年级及以上。在 S-TOHFLA 上，76%（n=79）患者具有足够的 FHL，而 24%（n=25）患者具有不足/边缘 FHL。与回顾性时间段相比，前瞻性时间段接受教育后 HCC 相关影像学检查的数量从 59 次（56.7%）增加到 86 次（82.6%，p<0.0001），而无论 FHL 如何，这一比例都相似。
尽管教育干预成功地提高了 HCC 筛查的依从性，但 FHL 状况并未影响该干预措施的效果。因此，特定的口头信息与针对性的书面材料相结合，提高了就诊和 HCC 肝脏影像学检查的依从性。
