Public Health Literacy and Emergency Department Utilization in Saudi Arabia: A Cross-Sectional Study

Muna Aljahany,1 Rasha Doumi,2 Ruba Adel Alhuthail,2 Hind Yahiya Alshangiti,2 Reem Abdullah Alsugair,2 Laila Salah Aldokhail,2 Lujain Hatim Aljohani,2 Nuwayyir Abdullah Alqasimi,2 Enar Mohammed Alotaibi,2 Lujain Mohamed Alaradi,2 Norah Abdulaziz Alabdullah,2 Nadeen Saad Alkelabi,2 Nouran A Aleyeidi,2 Amel Fayed2 1Department of Internal Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Rasha Doumi, Family and Community Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +00966505813784, Email [email protected]: Health literacy (HL) is the degree in which individuals are able to access, comprehend, and use publicly available health resources and services. A previous study was done in the Kingdom of Saudi Arabia (KSA) assessing the prevalence of HL, the study shows that almost half of KSA residents had limited HL. Most studies that show the level of HL and its relationship to emergency department (ED) utilization were conducted outside KSA. This study aims to assess the association between HL and utilization of ED services and to estimate the prevalence, factors, and outcomes of low HL in KSA.Patients and methods: A cross-sectional study was conducted among 903 participants in KSA over a period of 2 months (April and May 2023) using an online survey. Participants were asked about sociodemographic characteristics (age, sex, nationality, marital status, education, work status, income), associated factors (chronic diseases, psychiatric disorders, Covid-19 infection, Covid-19 vaccination, ED visits), and Health Literacy (read, access, understand, evaluation, decision). A health literacy instrument for adults (HELIA), which consists of the previously mentioned five subscales, was used to estimate the level of HL and its association with the risk factors.Results: Almost 529 (58.58%) and 374 (41.42%) had limited HL and adequate HL, respectively. Participants with limited HL were mostly aged 35– 45 years (61.7%), men (p 30 thousand riyals (55.6%, p < 0.05), were previously infected with COVID-19 (43%), and did not visit ED in the preceding year (42.3%).Conclusion: A high prevalence of low HL among KSA residents was observed. There was no significant difference in ED utilization between participants who had adequate and limited HL.Keywords: health literacy instrument for adults, emergency department utilization, COVID-1

Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills.

IntroductionIn hospital cardiac arrest (IHCA) affects 200,000 adults in the United States each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a program of "mock codes" improves group-level performance of IHCA skills. Our primary outcome of interest was change in CPR fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesized that a sustained program of mock codes would translate to greater than 10% improvement in each of these core metrics over the first three years of the program.MethodsWe conducted mock codes in an urban teaching hospital between August, 2012 and October, 2015. Mock codes occurred on telemetry and medical/surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital's "Code Blue" team, and data were recorded by trained observers. Data were summarized using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model.ResultsFifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per six-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly.ConclusionsWhile we observed a significant improvement in CPR fraction over the course of this program of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance