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Mediational Analysis

A selection of mediational analysis methods shedding light on the causal relationship between health literacy and health outcomes.

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Consider the following examples of other mediational analysis and how they may be applied within a health literacy context.

Cox proportional hazard models

Yaffe, K., Falvey, C., Harris, T. B., Newman, A., Satterfield, S., Koster, A., ... & Simonsick, E. (2013). Effect of socioeconomic disparities on incidence of dementia among biracial older adults: Prospective study. Bmj, 347, f7051. http://www.bmj.com/content/347/bmj.f7051

Linear regression

Albert, N. M., Trochelman, K., Meyer, K. H., & Nutter, B. (2009). Characteristics associated with racial disparities in illness beliefs of patients with heart failure. Behavioral Medicine, 35(4), 112-125. https://www.ncbi.nlm.nih.gov/pubmed/?term=Characteristics+associated+with+racial+disparities+in+illness+beliefs+of+patients+with+heart+failure

Linear regression/multivariate GEE models

Curtis, L. M., Wolf, M. S., Weiss, K. B., & Grammer, L. C. (2012). The impact of health literacy and socioeconomic status on asthma disparities. Journal of Asthma, 49(2), 178-183. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509174/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509174/

Logistic regression

Howard, D. H., Sentell, T., & Gazmararian, J. A. (2006). Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of general internal medicine, 21(8), 857-861. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831584/

Sentell, T. L., & Halpin, H. A. (2006). Importance of adult literacy in understanding health disparities. Journal of General Internal Medicine, 21(8), 862-866. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831569/

Wolf, M. S., Knight, S. J., Lyons, E. A., Durazo-Arvizu, R., Pickard, S. A., Arseven, A., ... & Bennett, C. L. (2006). Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology, 68(1), 89-93. https://www.ncbi.nlm.nih.gov/pubmed/16844451
Osborn, C. Y., Paasche-Orlow, M. K., Davis, T. C., & Wolf, M. S. (2007). Health literacy: an overlooked factor in understanding HIV health disparities. American journal of preventive medicine, 33(5), 374-378. https://www.ncbi.nlm.nih.gov/pubmed/17950402

Volandes, A. E., Paasche-Orlow, M., Gillick, M. R., Cook, E. F., Shaykevich, S., Abbo, E. D., & Lehmann, L. (2008). Health literacy not race predicts end-of-life care preferences. Journal of palliative medicine, 11(5), 754-762. https://www.ncbi.nlm.nih.gov/pubmed/18588408

SteelFisher, G. K., Schneider, E. C., Zaslavsky, A. M., & Blendon, R. J. (2009). Can Quality Reports Help Address Health Care Disparities?: Use and Awareness of Comparative Quality Information by African Americans. Journal of health care for the poor and underserved, 20(3), 884-895. https://www.ncbi.nlm.nih.gov/pubmed/19648714

Sisco, S., Gross, A. L., Shih, R. A., Sachs, B. C., Glymour, M. M., Bangen, K. J., ... & Manly, J. J. (2014). The role of early-life educational quality and literacy in explaining racial disparities in cognition in late life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, gbt133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462668/

Freedman, R. A., Kouri, E. M., West, D. W., & Keating, N. L. (2015). Racial/ethnic differences in patients' selection of surgeons and hospitals for breast cancer surgery. JAMA oncology, 1(2), 222-230. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944092/

Multivariable generalized linear models

Waite, K. R., Federman, A. D., McCarthy, D. M., Sudore, R., Curtis, L. M., Baker, D. W., ... & Paasche‐Orlow, M. K. (2013). Literacy and race as risk factors for low rates of advance directives in older adults. Journal of the American Geriatrics Society, 61(3), 403-406. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891653/

Multivariate log-binomial regression

Wang, C., Li, H., Li, L., Xu, D., Kane, R. L., & Meng, Q. (2013). Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area. Health and quality of life outcomes, 11(1), 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847672/

Path analysis

Gwynn, K. B., Winter, M. R., Cabral, H. J., Wolf, M. S., Hanchate, A. D., Henault, L., ... & Paasche-Orlow, M. K. (2016). Racial disparities in patient activation: Evaluating the mediating role of health literacy with path analyses. Patient education and counseling. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912873/

Regression models

Bennett, I. M., Chen, J., Soroui, J. S., & White, S. (2009). The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. The Annals of Family Medicine, 7(3), 204-211.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682976/

Regression models/structural influence model

Hovick, S. R., Liang, M. C., & Kahlor, L. (2014). Predicting cancer risk knowledge and information seeking: The role of social and cognitive factors. Health communication, 29(7), 656-668. https://www.ncbi.nlm.nih.gov/pubmed/?term=Predicting+cancer+risk+knowledge+and+information+seeking%3A+The+role+of+social+and+cognitive+factors

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