Health Literacy in the Everyday Lives of Older Adults in Greece, Hungary, and the Netherlands

Health literacy (HL) encompasses someone’s knowledge and abilities to access and use health information in order to make appropriate health decisions in life. HL is particularly valuable in later life when health challenges grow. An individual’s HL is typically considered a fixed and skills-based characteristic, without taking into account how these are situated in the context of everyday life. Also, lay perspectives on health literacy are relatively scarce. Therefore, the aim of this article is to explore the context-specific perspectives of older adults and health professionals on HL in later life in Greece, Hungary, and the Netherlands. We adopted a qualitative methodology and conducted 12 focus groups: seven with 50 older adults and five with 30 health professionals to gain insight into individual perspectives on HL as situated in the health care and everyday life contexts. An informed grounded theory approach was used in analyzing the data. The results are structured in three themes: (1) interactions with health professionals, (2) perceived quality of the health care system, and (3) managing health in the context of everyday life. An overarching finding is that, for older adults, HL reflects the demands placed on them when managing their health. In the experience of older adults, these demands are placed upon them by healthcare professionals, the healthcare system, as well as their everyday lives. Our findings underscore the importance of Critical Health Literacy (CHL) as that concept foregrounds that HL is context specific. Also, CHL has been argued to be a community characteristic, which is why we call for community-based approaches to improve H

Women’s Mass-Observation Diaries: Writing, Time & ‘Subjective Cameras’

This thesis concerns women’s wartime diaries written for the radical social research organisation Mass-Observation (M-O) between 1939 and 1967, treating these as ‘social texts’ informed by social and temporal practices which also influence what ‘a diary’ is more widely perceived to ‘be’ as a genre of writing. It analyses the centrality of time and temporality to these social practices, to the relationship between writing and representation, and also to what it was to write a diary specifically for M-O and thus to position oneself as a ‘subjective camera’. Chapter One overviews the genesis and activities of M-O, its co-founders’ research perspectives and how these influenced activities in Worktown and the Economics of Everyday Life project and also in Blackheath, London. Blackheath activities are examined in detail because M-O’s Directives and Day-Diaries were organised from there, the latter providing the material for Jennings and Madge’s (1937) May Twelfth, the basis for their conceptualisation of ‘subjective cameras’ and also the starting point for the wartime diaries. Chapter Two discusses the origins of the wartime diaries, and analyses anthologies compiled using this material, the individual M-O diaries that have been published, and two attempts in the 1940s to produce M-O books from the diaries, discussing how previous uses have influenced my own analytic approach. Chapter Three examines the complications that M-O diaries make to popular understandings of the diary form, in particular by the multiple and diverse influences impinging upon writing a diary for M-O. A key example concerns overlaps between M-O diaries and letters, showing that epistolary conventions and practices are extensively drawn on by M-O and its diarists and that inscription of times and dates are central to this. Chapter Four examines temporal aspects of the diary-genre and analyses their writing ‘over time’ by focusing on the long-term diary written by Nella Last, what she did with time in its pages, and how the methodological approach I utilised for sampling and analysing it impacts on interpretation of temporal matters. Chapter Five analyses diary-entries written by different women for the same dates, exploring discrete specific temporal points to examine what is happening with time in relation to this, again reflectively commenting on the interpretational consequences of methodological strategies. The Conclusion considers M-O’s idea of diarists as ‘subjective cameras’ and theorises its connections to time and diary-writing

The association of health literacy with adherence in older 2 adults, and its role in interventions: a systematic meta-review

Background: Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this older age group with low health literacy was also explored. Methods: Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results: Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions: Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions

IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119.

AAPM Task Group 119 has produced quantitative confidence limits as baseline expectation values for IMRT commissioning. A set of test cases was developed to assess the overall accuracy of planning and delivery of IMRT treatments. Each test uses contours of targets and avoidance structures drawn within rectangular phantoms. These tests were planned, delivered, measured, and analyzed by nine facilities using a variety of IMRT planning and delivery systems. Each facility had passed the Radiological Physics Center credentialing tests for IMRT. The agreement between the planned and measured doses was determined using ion chamber dosimetry in high and low dose regions, film dosimetry on coronal planes in the phantom with all fields delivered, and planar dosimetry for each field measured perpendicular to the central axis. The planar dose distributions were assessed using gamma criteria of 3%/3 mm. The mean values and standard deviations were used to develop confidence limits for the test results using the concept confidence limit = /mean/ + 1.96sigma. Other facilities can use the test protocol and results as a basis for comparison to this group. Locally derived confidence limits that substantially exceed these baseline values may indicate the need for improved IMRT commissioning