Influence of Caretakers' Health Literacy on Delays to Traumatic Brain Injury Care in Uganda.
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2020-10
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Abstract
Background
Traumatic brain injury (TBI) is a life-altering condition, and delays to care can significantly impact outcomes. In Uganda, where nurse shortages are prevalent, patients' family members are the primary caretakers of these patients and play an important role in ensuring patients' access to timely care. However, caretakers often have little or no knowledge of appropriate patient care. Caretakers' ability to navigate the healthcare system and find and use health information to support their patients can impact delays in seeking, reaching, and receiving care.Objectives
This study seeks to determine the factors that impact TBI patient caretakers' health literacy and examine how these factors influence delays in care.Methods
This study was carried out in the Mulago National Referral Hospital neurosurgical ward, where 27 adult caretakers were interviewed using semi-structured, in-depth, qualitative interviews. "The Three Delay Framework" was utilized to understand participants' experiences in seeking, reaching, and receiving care for TBI patients. Thematic content analysis and manual coding was used to analyze interview transcripts and identify overarching themes in participant responses.Findings
The main health literacy themes identified were Extrinsic, Intrinsic and Health System Factors. Nine sub-themes were identified: Government Support, Community Support, Financial Burdens, Lack of Medical Resources, Access to Health Information, Physician Support, Emotional Challenges, Navigational Skills, and Understanding of Health Information. These components were found to influence the delays to care to varying degrees. Financial Burdens, Government Support, Emotional Challenges, Physician Support and Lack of Medical Resources were recurring factors across the three delays.Conclusion
The health literacy factors identified in this study influence caretakers' functional health literacy and delays to care in a co-dependent manner. A better understanding of how these factors impact patient outcomes is necessary for the development of interventions targeted at improving a caretaker's ability to maneuver the healthcare system and support patients in resource-poor settings.Type
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Nwosu, Chinemerem, Charis A Spears, Charles Pate, Deborah T Gold, Gary Bennett, Michael Haglund and Anthony Fuller (2020). Influence of Caretakers' Health Literacy on Delays to Traumatic Brain Injury Care in Uganda. Annals of global health, 86(1). p. 127. 10.5334/aogh.2978 Retrieved from https://hdl.handle.net/10161/30662.
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Scholars@Duke
Deborah T. Gold
My research has centered on the psychosocial consequences of chronic illness for older adults. Although I have studied breast cancer, syncope, head and neck cancer, Parkinson's disease and Paget's disease of bone, my primary interest and focus has been on osteoporosis and its psychological and social impact on those who suffer from it.
In particular, my current research focuses on compliance and persistence with osteoporosis medications. One current study focuses on the impact of race/ethnicity on medication decision making. We are trying to determine the relative weight of cost, convenience, dosing interval, efficacy, and safety in making medication decisions and taking medication on a regular basis as prescribed by a health care provider. I am also on the Steering Committees of two major observational studies with different osteoporosis medications.
Finally, I have worked with voluntary health organizations to translate our research findings into positive real-world outcomes for people with chronic illness. I serve on the Board of Trustees of the National Osteoporosis Foundation and am Chair of its Education Committee. I have also chaired the International Symposium on Osteoporosis (ISO) for the last 8 years.
Gary G. Bennett
Gary G. Bennett, Ph.D., is dean of the Trinity College of Arts & Sciences at Duke University.
As dean, Dr. Bennett is responsible for defining and articulating the strategic mission of Trinity College, ensuring a world-class liberal arts education in a research environment for all students, and attracting, retaining, and nurturing a diverse community of distinguished faculty.
Dr. Bennett is a professor of psychology & neuroscience, global health, medicine, and nursing, and is the founding director of the Duke Digital Health Science Center. He is a global leader in designing, testing, and disseminating digital behavior change interventions. Dr. Bennett developed the interactive obesity treatment approach (iOTA); his recent work demonstrates the effectiveness of digital strategies in treating obesity in the primary care setting.
Nearly 20 years ago, Dr. Bennett created one of the first digital health research programs. His laboratory has since become a global leader in designing, testing, and disseminating digital behavior change interventions, especially for medically vulnerable populations. Dr. Bennett has authored nearly 200 scientific papers, and the National Institutes of Health have continuously funded his research program with more than $20m in grant support. From 2018-2019, Dr. Bennett served as president of the Society of Behavioral Medicine, the nation's largest organization of behavioral change scientists. Dr. Bennett is an elected Academy of Behavioral Medicine Research and Behavioral Medicine Research Council member.
Before assuming his role as dean of Trinity College in February 2023, Dr. Bennett served as vice provost for undergraduate education. He provided strategic vision and leadership for Duke’s undergraduate experience. As vice provost, he oversaw the Office of Undergraduate Education, comprising 15 units that enrich Duke's undergraduate academic experience through academic advising, academic support, nationally competitive scholarships, merit scholar programs, financial aid, study abroad, and several co-curricular programs. Under Bennett’s leadership, Duke introduced several advancements to make the undergraduate experience more enriching and equitable for all students, including the DukeLIFE program to support first-generation and low-income students, and QuadEx, Duke’s inclusive living and learning model that integrates undergraduates’ social, residential and intellectual experiences.
Dr. Bennett is a member of Duke's Bass Society of Fellows and is the founding director of Duke's undergraduate major in global health. He has served on committees to examine Duke's undergraduate curriculum and develop the university's strategic plan and has co-led the Board of Trustees Undergraduate Education Committee since 2018. His students' course ratings have repeatedly placed Dr. Bennett in the top 5% of Duke's undergraduate instructors.
Dr. Bennett has also co-founded three digital health ventures. Crimson Health Solutions developed digital disease management interventions and was acquired by Health Dialog in 2007. In 2014, he co founded Scale Down, a digital obesity treatment startup based on the science of daily self-weighing. Scale Down was acquired by Anthem in 2017. He is a co-founder of Coeus Health, a leading provider of health APIs. Dr. Bennett advises leading digital health and consumer electronic organizations on the science of health behavior change.
Before joining Duke in 2009, Dr. Bennett served on the Harvard School of Public Health and the Dana-Farber Cancer Institute faculties. Dr. Bennett earned a bachelor's degree at Morehouse College, an AM and PhD in clinical health psychology at Duke University, completed a clinical internship in medical psychology at the Duke University Medical Center, and was the Alonzo Yerby postdoctoral fellow in social epidemiology at the Harvard School of Public Health.
Dr. Bennett lives in Raleigh with his wife (also a Duke alum) and his two daughters.
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