Barry D Weiss

Interests

Teaching

Writing for Publication

Research

Health Literacy; Patient-Physician Communication

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Weiss, B. D., Armin, J. S., Ryan, A. M., & Pettit, J. M. (2019). Medical-Legal Partnerships to Enhance Residency Training in Advance Care Planning. Family Medicine, 51(4), 353-357.
• Jacobs, B., Ryan, A. M., Henrichs, K. S., & Weiss, B. D. (2018). Medical Interpreters in Outpatient Practice. Annals of family medicine, 16(1), 70-76.
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  This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs. The only exception is providers whose only federal assistance is through Medicare Part B, an exception that applies to a very small percentage of practicing physicians. All required language assistance services must be free and provided by qualified translators and interpreters. Interpreters must meet specified qualifications and ideally be certified. Although the cost of interpreter services can be considerable, ranging from $45-$150/hour for in-person interpreters, to $1.25-$3.00/minute for telephone interpreters, and $1.95-$3.49/minute for video remote interpreting, it may be reimbursed or covered by a patient's Medicaid or other federally funded medical insurance. Failure to use qualified interpreters can have serious negative consequences for both practitioners and patients. In one study, 1 of every 40 malpractice claims were related, all or in part, to failure to provide appropriate interpreter services. Most importantly, however, the use of qualified interpreters results in better and more efficient patient care.
• Mabachi, N. M., Cifuentes, M., Barnard, J., Brega, A. G., Albright, K., Weiss, B. D., Brach, C., & West, D. (2018). Demonstration of the Health Literacy Universal Precautions Toolkit: Lessons for Quality Improvement. The Journal of ambulatory care management, 39(3), 199-208.
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  The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements.
• Mansfield, E., Gillis, D., & Weiss, B. D. (2018). Canadian adaption of the Newest Vital Sign – a health literacy assessment tool. Public Health Nutrition.
• Paaschee-Orlow, M., Schillinger, D., & Weiss, B. D. (2018). Health Literacy and Power. Health Literacy Reserach and Practice, 2, e132-133.
• Sexton, S., Lin, K., Weiss, B. D., Bunt, C. W., Ebell, M. H., Saguil, A., & Middleton, J. (2018). Preventing gun violence: the role of family physicians. American Family Physician, 98, 560-567.
• Weiss, B. D. (2018). Assessing patients’ health literacy skills not necessary in clinical practice. American Family Physician, 97, 768.
• Weiss, B. D. (2018). The Newest Vital Sign - Frequently Asked Questions. Health Literacy Research and Practice, 2, e125-127.
• Weiss, B. D. (2017). Electrolytes: Foreword. FP essentials, 459, 2.
• Weiss, B. D. (2017). Progress in health literacy – encouraging and not so encouraging. Health Literacy Research and Practice., 1, 231-232.
• Heberer, M. A., Komenaka, I. K., Nodora, J. N., Hsu, C. H., Gandhi, S. G., Welch, L. E., Bouton, M. E., Aristizabal, P., Weiss, B. D., & Martinez, M. E. (2016). Factors associated with cervical cancer screening in a safety net population. World journal of clinical oncology, 7(5), 406-413.
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  To identify factors associated with Papanicolaou-smear (Pap-smear) cervical cancer screening rates in a safety net population.
• Weiss, B. D. (2016). Care of Patients at the End of Life: Foreword. FP essentials, 447, 2.
• Weiss, B. D. (2016). Demonstration of the Health Literacy Universal Precautions Toolkit: Lessons for quality improvement. Journal of Ambulatory Care Management., 39(3), 199-208.
• Weiss, B. D. (2016). Immunology Update: Foreword. FP essentials, 450, 2.
• Weiss, B. D. (2016). The Changing Drug Culture: Foreword. FP essentials, 441, 2.
• Weiss, B. D., Brega, A. G., LeBlanc, W. G., Mabachi, N. M., Barnard, J., Albright, K., Cifuentes, M., Brach, C., & West, D. R. (2016). Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit. Journal of the American Board of Family Medicine : JABFM, 29(1), 18-23.
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  Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices.
• Winton, L. M., Nodora, J. N., Martinez, M. E., Hsu, C., Djenic, B., Bouton, M. E., Aristizabal, P., Ferguson, E. M., Weiss, B. D., & Komenaka, I. K. (2016). Factors associated with surgical management in an underinsured, safety net population. Surgery, 159(2), 580-90.
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  Few studies include significant numbers of racial and ethnic minority patients. The current study was performed to examine factors that affect breast cancer operations in an underinsured population.
• Brega, A. G., Barnard, J. J., Mabachi, N. M., Weiss, B. D., DeWalt, D. A., Brach, C., Cifuentes, M., Albrights, K., & West, D. R. (2015). AHRQ Health Literacy Universal Precautions Toolkit. Second Edition.
• Brega, A. G., Freedman, M. A., LeBlanc, W. G., Barnard, J., Mabachi, N. M., Cifuentes, M., Albright, K., Weiss, B. D., Brach, C., & West, D. R. (2015). Using the Health Literacy Universal Precautions Toolkit to Improve the Quality of Patient Materials. Journal of health communication, 20 Suppl 2, 69-76.
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  Patient materials are often written above the reading level of most adults. Tool 11 of the Health Literacy Universal Precautions Toolkit ("Design Easy-to-Read Material") provides guidance on ensuring that written patient materials are easy to understand. As part of a pragmatic demonstration of the Toolkit, we examined how four primary care practices implemented Tool 11 and whether written materials improved as a result. We conducted interviews to learn about practices' implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre- and postimplementation site visits. Interview data indicated that practices followed many action steps recommended in Tool 11, including training staff, assessing readability, and developing or revising materials, typically focusing on brief documents such as patient letters and information sheets. Many of the revised and newly developed documents had reading levels appropriate for most patients and--in the case of revised documents--better readability than the original materials. In contrast, the readability, understandability, and actionability of lengthier patient education materials were poor and did not improve over the 6-month implementation period. Findings guided revisions to Tool 11 and highlighted the importance of engaging multiple stakeholders in improving the quality of patient materials.
• Khalife, T., Pettit, J. M., & Weiss, B. D. (2015). Caring for Muslim patients who fast during ramadan. American family physician, 91(9), 640-2.
• Komenaka, I. K., Nodora, J. N., Hsu, C., Martinez, M. E., Gandhi, S. G., Bouton, M. E., Klemens, A. E., Wikholm, L. I., & Weiss, B. D. (2015). Association of health literacy with adherence to screening mammography guidelines. Obstetrics and gynecology, 125(4), 852-9.
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  To investigate the relationship of health literacy and screening mammography.
• Mabachi, N. M., Cifuentes, M., Barnard, J., Brega, A. G., Albright, K., Weiss, B. D., Brach, C., & West, D. (2015). Demonstration of the Health Literacy Universal Precautions Toolkit: Lessons for quality improvement. Journal of Ambulatory Care Management.
• Menchola, M., & Weiss, B. D. (2015). Addressing Alzheimer's: a pragmatic approach. The Journal of family practice, 64(1), 10-8.
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  Family physicians are ideally positioned to support patients with Alzheimer's and their families through all facets of the disease, from initial diagnosis to end-of-life care.
• Menchola, M., & Weiss, B. D. (2015). Addressing Alzheimer’s: A pragmatic approach.. The Journal of Family Practice,, 64, 10-18..
• Weiss, B. D. (2015). Acute Coronary Syndrome: Foreword. FP essentials, 437, 2.
• Weiss, B. D. (2015). Aneurysms: foreword. FP essentials, 431, 2.
• Weiss, B. D. (2015). Barriers to adult immunization. American Academy of Family Physicians CME Bulletin.
• Weiss, B. D. (2015). Genital Cancers in Women: Foreword. FP essentials, 438, 2.
• Weiss, B. D. (2015). Health Literacy Research: Isn't There Something Better We Could Be Doing?. Health communication, 30(12), 1173-5.
  More info

  The number of health literacy articles published each year in scientific journals has increased considerably in recent years. However, the content of those articles continues to focus on the same issues: developing instruments to assess health literacy skills, measuring the health literacy skills of patients, and measuring the reading level of patient education materials. We need to change the focus of health literacy research by studying which approaches to dealing with health literacy result in the best outcomes for patients--making them healthier, having fewer complications, and reducing their health care costs. There is a paucity of high-quality research on such issues, but that is the direction in which the field needs to go.
• Weiss, B. D. (2015). Health Literacy: What Do You Need to Do?. American family physician, 92(2), 84-90.
• Weiss, B. D. (2015). Metabolic Syndrome: Foreword. FP essentials, 435, 2.
• Coles, M. E., Schubert, J. R., Heimberg, R. G., & Weiss, B. D. (2014). Disseminating treatment for anxiety disorders: step 1: recognizing the problem as a precursor to seeking help. Journal of anxiety disorders, 28(8), 737-40.
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  Untreated mental illness is a substantial public health issue in the United States, with only approximately 1/3 of the estimated 46 million adults in the US with mental illness receiving treatment. Many of the individuals with mental illness suffer from excessive anxiety, as over 25% of Americans experience an anxiety disorder during their lifetime and most of these individuals remain untreated. Building from the premise that recognizing one's symptoms precedes requests for help, the current paper presents data from 577 adults (50% Caucasian, 50% African American) in the US regarding their ability to recognize anxiety disorders. Findings from a national survey showed that when presented with detailed vignettes portraying symptoms and their impact, 50% of respondents correctly recognized depression, whereas less than 20% correctly recognized the anxiety disorders. Recognition that the symptoms were a cause for concern was much more common, with 75% or more of the sample noting concern. Responses were surprisingly similar across the two races, and few consistent moderators were found. In conclusion, increasing recognition of anxiety disorders may be a useful first step toward increasing service utilization.
• Fransen, M. P., Leenaars, K. E., Rowlands, G., Weiss, B. D., Maat, H. P., & Essink-Bot, M. (2014). International application of health literacy measures: adaptation and validation of the newest vital sign in The Netherlands. Patient education and counseling, 97(3), 403-9.
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  The newest vital sign assesses individual reading and numeracy skills. The aim of this study was to create a Dutch version (NVS-D) and to assess its feasibility, reliability, and validity in The Netherlands.
• Hardeman, J. A., & Weiss, B. D. (2014). In reply. American family physician, 90(11), 752.
• Hardeman, J. A., & Weiss, B. D. (2014). In reply. American family physician, 90(9), 612.
• Hardeman, J., & Weiss, B. D. (2014). Intrauterine devices: an update. American family physician, 89(6), 445-50.
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  Three intrauterine devices (IUDs) are available in the United States: the copper T 380A and two levonorgestrel-releasing IUDs, one that releases 20 mcg of levonorgestrel per 24 hours, and one that releases 14 mcg per 24 hours. All are safe and effective methods of contraception that work predominantly by prefertilization mechanisms. The copper T 380A IUD may be placed in nonpregnant women at any time in the menstrual cycle. The prescribing information for the 20- and 14-mcg levonorgestrel-releasing IUDs advises that insertion occur during the first seven days of menses. Insertion immediately after vaginal or cesarean delivery may be considered with the copper T 380A and the 20-mcg levonorgestrel-releasing IUDs; however, expulsion rates are higher than with delayed postpartum insertion. The prescribing information for both levonorgestrel-releasing IUDs advises a waiting period of six weeks postpartum or following second-trimester pregnancy loss. Current guidelines indicate that IUDs are acceptable for use in nulliparous women, in adolescents, and in women who are breastfeeding. They may also be used in women who have a history of sexually transmitted infection, although screening is recommended. IUDs should not be inserted for at least three months after resolution of a sexually transmitted infection. Neither antibiotic prophylaxis nor misoprostol use before IUD insertion is beneficial. If pregnancy occurs, the IUD should be removed if feasible. Possible side effects of levonorgestrel-releasing IUDs include headaches, nausea, hair loss, breast tenderness, depression, decreased libido, ovarian cysts, oligomenorrhea, and amenorrhea. The main side effect of the copper T 380A IUD is increased menstrual bleeding, which may continue even with long-term use.
• Komenaka, I. K., Nodora, J. N., Machado, L., Hsu, C., Klemens, A. E., Martinez, M. E., Bouton, M. E., Wilhelmson, K. L., & Weiss, B. D. (2014). Health literacy assessment and patient satisfaction in surgical practice. Surgery, 155(3), 374-83.
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  Individuals with limited health literacy have barriers to patient-physician communication. Problems in communication are known to contribute to malpractice litigation. Concern exists, however, about the feasibility and patient acceptance of a health literacy assessment. This study was performed to determine the feasibility of health literacy assessment in surgical practice and its effect on patient satisfaction.
• Schubert, J. R., Coles, M. E., Heimberg, R. G., & Weiss, B. D. (2014). Disseminating treatment for anxiety disorders step 2: peer recommendations to seek help. Journal of anxiety disorders, 28(7), 712-6.
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  Despite the high prevalence of and significant psychological burden caused by anxiety disorders, as few as 25% of individuals with these disorders seek treatment, and treatment seeking by African-Americans is particularly uncommon. This purpose of the current study was to gather information regarding the public's recommendations regarding help-seeking for several anxiety disorders and to compare Caucasian and African-American participants on these variables. A community sample of 577 US adults completed a telephone survey that included vignettes portraying individuals with generalized anxiety disorder (GAD), social phobia/social anxiety disorder (SP/SAD), panic disorder (PD), and for comparison, depression. The sample was ½ Caucasian and ½ African American. Respondents were significantly less likely to recommend help-seeking for SP/SAD and GAD (78.8% and 84.3%, respectively) than for depression (90.9%). In contrast, recommendations to seek help for panic disorder were common (93.6%) and similar to rates found for depression. The most common recommendations were to seek help from a primary care physician (PCP). African Americans were more likely to recommend help-seeking for GAD than Caucasians. Findings suggested that respondents believed individuals with anxiety disorders should seek treatment. Given that respondents often recommended consulting a PCP, we recommend educating PCPs about anxiety disorders and empirically-supported interventions.
• Weiss, B. D. (2014). Anorectal conditions: foreward. FP essentials, 419, 2.
• Weiss, B. D. (2014). Cardiac risk factors: foreword. FP essentials, 421, 2.
• Weiss, B. D. (2014). Dermatology procedures: foreword. FP essentials, 426, 2.
• Weiss, B. D. (2014). Foreword. FP essentials, 424, 2.
• Weiss, B. D. (2014). Hepatitis C: foreword. FP essentials, 427, 2.
• Weiss, B. D. (2014). Sodium restriction in heart failure: how low should you go?. American family physician, 89(7), 508-10.
• Coles, M. E., Heimberg, R. G., & Weiss, B. D. (2013). The public's knowledge and beliefs about obsessive compulsive disorder. Depression and anxiety, 30(8), 778-85.
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  Obsessive compulsive disorder (OCD) is a disabling condition associated with significant personal and societal burdens. Despite the availability of efficacious treatments, in most cases, the disorder remains unrecognized and untreated. Lack of knowledge (i.e. poor mental health literacy, MHL) regarding OCD may be an impediment to seeking treatment. Therefore, the current study assessed public knowledge and beliefs about OCD and examined factors influencing MHL.
• Mackert, M., Champlin, S. E., Pasch, K. E., & Weiss, B. D. (2013). Understanding health literacy measurement through eye tracking. Journal of health communication, 18 Suppl 1, 185-96.
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  This study used eye-tracking technology to explore how individuals with different levels of health literacy visualize health-related information. The authors recruited 25 university administrative staff (more likely to have adequate health literacy skills) and 25 adults enrolled in an adult literacy program (more likely to have limited health literacy skills). The authors administered the Newest Vital Sign (NVS) health literacy assessment to each participant. The assessment involves having individuals answer questions about a nutrition label while viewing the label. The authors used computerized eye-tracking technology to measure the amount of time each participant spent fixing their view at nutrition label information that was relevant to the questions being asked and the amount of time they spent viewing nonrelevant information. Results showed that lower NVS scores were significantly associated with more time spent on information not relevant for answering the NVS items. This finding suggests that efforts to improve health literacy measurement should include the ability to differentiate not just between individuals who have difficulty interpreting and using health information, but also between those who have difficulty finding relevant information. In addition, this finding suggests that health education material should minimize the inclusion of nonrelevant information.
• Rowlands, G., Khazaezadeh, N., Oteng-Ntim, E., Seed, P., Barr, S., & Weiss, B. D. (2013). Development and validation of a measure of health literacy in the UK: the newest vital sign. BMC public health, 13, 116.
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  Health literacy (HL) is an important public health issue. Current measures have drawbacks in length and/or acceptability. The US-developed Newest Vital Sign (NVS) health literacy instrument measures both reading comprehension and numeracy skills using a nutrition label, takes 3 minutes to administer, and has proven to be acceptable to research subjects. This study aimed to amend and validate it for the UK population.
• Weiss, B. D. (2013). Endoscopy and esophageal pH study. Foreword. FP essentials, 413, 2.
• Weiss, B. D. (2013). Foreword. FP essentials, 409, 2.
• Weiss, B. D., Mollon, L., & Lee, J. K. (2013). Readability of patient education information on the American Geriatrics Society Foundation's Health-in-Aging website. Journal of the American Geriatrics Society, 61(10), 1845-6.
• Cagno, C. K., Pettit, J. M., & Weiss, B. D. (2012). Prevention of perinatal group B streptococcal disease: updated CDC guideline. American family physician, 86(1), 59-65.
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  Group B streptococcus is the leading cause of early-onset neonatal sepsis in the United States. Universal screening is recommended for pregnant women at 35 to 37 weeks' gestation. The Centers for Disease Control and Prevention recently updated its guideline for the prevention of early-onset neonatal group B streptococcal disease. The new guideline contains six important changes. First, there is a recommendation to consider using sensitive nucleic acid amplification tests, rather than just routine cultures, for detection of group B streptococcus in rectal and vaginal specimens. Second, the colony count required to consider a urine specimen positive is at least 104 colony-forming units per mL. Third, the new guideline presents separate algorithms for management of preterm labor and preterm premature rupture of membranes, rather than a single algorithm for both conditions. Fourth, there are minor changes in the recommended dose of penicillin G for intrapartum chemoprophylaxis. Fifth, the guideline provides new recommendations about antibiotic regimens for women with penicillin allergy. Cefazolin is recommended for women with minor allergies. For those at serious risk of anaphylaxis, clindamycin is recommended if the organism is susceptible [corrected] and vancomycin is recommended if there is clindamycin resistance or if susceptibility is unknown. [corrected]. Finally, the new algorithm for secondary prevention of early-onset group B streptococcal disease in newborns should be applied to all infants, not only those at high risk of infection. The algorithm clarifies the extent of evaluation and duration of observation required for infants in different risk categories.
• Post, R. E., Weese, T. J., Mainous, A. G., & Weiss, B. D. (2012). Publication productivity by family medicine faculty: 1999 to 2009. Family medicine, 44(5), 312-7.
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  Scholarly work is an important part of all medical specialties. A decline in publications by academic family medicine faculty during the 1990s was documented. The purpose of this study was to compare the publication productivity of family medicine academicians during the 2000s to that in the 1990s.
• Wallace, L. S., Vaughn, C. J., Rogers, E. S., Rust, C. F., Devoe, J. E., & Weiss, B. D. (2012). Use of theory in low-literacy intervention research from 1980 to 2009. American journal of health behavior, 36(2), 145-52.
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  To examine whether theories and/or models are used in interventions geared towards improving health-related outcomes for individuals with limited literacy skills.
• Weiss, B. D., & Lee, J. K. (2012). Aging: Is your patient taking too many pills?. The Journal of family practice, 61(11), 652-61.
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  Before you prescribe another drug, consider whether new symptoms might be caused by the medications the patient is already taking.
• Weiss, B. D., Berman, E. A., Howe, C. L., & Fleming, R. B. (2012). Medical decision-making for older adults without family. Journal of the American Geriatrics Society, 60(11), 2144-50.
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  Each year in the United States, individuals who lack decision-making capacity because of acute or chronic cognitive impairment are in situations in which important medical decisions must be made for them, but tens of thousands of these individuals have no known family members or designated surrogates available to help with those decisions. Such individuals constitute 16% of patients in intensive care units, 3% of nursing home residents, and a large but unspecified number of individuals in a variety of settings who are facing end-of-life decisions. Several approaches are currently used to aid in medical decision-making for people without families or designated surrogates, including hospital ethics committees, court-appointed surrogate agents, reliance on advance directives if they are available, and even the use of computer-based decision systems. These approaches all have limitations and often result in individuals receiving care that would not have been their preference. Additionally, because clinical care teams must wrestle with uncertainty about best approaches to care, lengths of hospital stay for individuals without family are longer, resulting in higher healthcare costs and potentially more-aggressive interventions than individuals with family experience. This article reviews medical decision-making for older adults without families or designated surrogates and proposes a solution: "health fiduciaries"--a new type of professional trained and certified to act as a surrogate decision-maker for individuals who are unable to make decisions for themselves.
• Weiss, B. D. (2010). Reflections on 18 years in the editor's chair. Family medicine, 42(3), 208-10.
• Weiss, B. D. (2010). Reviewer Acknowledgments. Family medicine, 42(1), 10-11.
• Franks, A. S., Ray, S. M., Wallace, L. S., Keenum, A. J., & Weiss, B. D. (2009). Do medication samples jeopardize patient safety?. The Annals of pharmacotherapy, 43(1), 51-6.
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  Medication samples are commonly dispensed by prescribers. Written consumer medication information (CMI) provided with sample packaging is an important source of patient information. Although one-third of Americans have health literacy deficiencies, previous studies have found that CMI is often too complex for many patients to understand. This may prevent patients from using these medications appropriately.
• Mainous, A. G., Smith, M. A., & Weiss, B. D. (2009). Essays and commentaries in family medicine. The human side of health care. Family medicine, 41(2), 134-5.
• Weiss, B. D., & Fain, M. J. (2009). Geriatric education for the physicians of tomorrow. Archives of gerontology and geriatrics, 49 Suppl 2, S17-20.
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  The world's population is aging and there is need for more geriatricians. Current training programs, however, are not producing a sufficient number of geriatricians to meet that need, largely because students and residents lack interest in a career in geriatrics. A variety of reasons have been suggested to explain that lack of interest, and several changes in geriatrics training might increase the number of medical trainees who choose a career in geriatrics. These changes include recruiting medical students who are predisposed to geriatrics, loan forgiveness programs for those who enter careers in geriatrics, increased reimbursement for geriatric care, providing geriatric education to physicians in all specialties throughout their training, and refocusing geriatrics training so it includes the care of healthy vigorous older adults, rather than an exclusive focus on those with debility and chronic or fatal illnesses.
• Weiss, B. D., Sheehan, C. P., & Gushwa, L. L. (2009). Is low literacy a risk factor for symptoms of depression in postpartum women?. The Journal of reproductive medicine, 54(9), 563-8.
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  To determine if postpartum women with limited literacy are at higher risk for depression symptoms than women with adequate literacy.
• Roskos, S. E., Wallace, L. S., & Weiss, B. D. (2008). Readability of consumer medication information for intranasal corticosteroid inhalers. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 65(1), 65-8.
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  The readability of consumer medication information (CMI) inserts accompanying intranasal corticosteroid (INCS) inhalers currently prescribed in the United States was studied.
• Ryan, J. G., Leguen, F., Weiss, B. D., Albury, S., Jennings, T., Velez, F., & Salibi, N. (2008). Will patients agree to have their literacy skills assessed in clinical practice?. Health education research, 23(4), 603-11.
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  If health providers are aware of their patients' literacy skills, they can more appropriately tailor their communication with patients. Few providers, however, assess patient's literacy skills for fear of offending patients, but no research has ever determined if patients object to such assessments. Our objectives were to determine the percentage of patients seen for routine health care that would agree to undergo literacy assessment and if satisfaction of patients differs in practices that perform literacy assessments versus practices that do not. We randomized 20 private and public medical practices to an intervention group that implemented literacy assessments with the Newest Vital Sign and a control group that did not. For intervention practices, we noted the percentage of patients agreeing to undergo the assessment. For both intervention and control practices, we assessed patient satisfaction. Of 289 patients asked to undergo literacy assessment in the intervention practices, 284 (98.3%) agreed to do so, including 125 (46.1%) with low or possibly low literacy skills. There was no difference in satisfaction between the intervention group and the control group. We conclude that patients are willing to undergo literacy assessments during routine office visits and performing such assessments does not decrease patient satisfaction.
• Wallace, L. S., Keenum, A. J., Roskos, S. E., Blake, G. H., Colwell, S. T., & Weiss, B. D. (2008). Suitability and readability of consumer medical information accompanying prescription medication samples. Patient education and counseling, 70(3), 420-5.
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  To examine readability and formatting characteristics of consumer medication information (CMI) accompanying prescription medication samples.
• Wallace, L. S., Rogers, E. S., & Weiss, B. D. (2008). Relationship between health literacy and health-related quality of life among Tennesseans. Tennessee medicine : journal of the Tennessee Medical Association, 101(5), 35-9.
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  The purpose of this study was to examine the relationship between health literacy and health-related quality of life (HRQOL) in a sample of English-speaking Tennesseans attending a university-based family medicine residency clinic. We measured the health literacy skills of patients (n = 249) using the Rapid Estimate of Adult Literacy in Medicine (REALM), dividing patients' scores into limited (< or = 8th-grade level) and adequate (> or = 9th-grade) literacy skill levels. We measured HRQOL using four items developed and validated by the Centers for Disease Control and Prevention (CDC). Scores on the REALM indicated that 28.5 percent of patients had limited and 71.5 percent had adequate health literacy skills. There was a significant correlation between patients' health literacy skills and self-reported general health (rho = 0.249, P < 0.01). Patients with limited health literacy skills had a higher median number of physically unhealthy days (P = 0.05) and activity limitation days (P = 0.05) compared with patients with adequate health literacy skills. Based on this study, patients' health literacy skills are associated with several components of HRQOL.
• Asplund, C., Barkdull, T., & Weiss, B. D. (2007). Genitourinary problems in bicyclists. Current sports medicine reports, 6(5), 333-9.
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  Genitourinary complaints are common in cyclists. Bicycle fit, improper saddle type, and individual anatomic factors are important evaluation criteria to consider when diagnosing symptoms and determining treatment options. By learning how to recognize and treat contributing factors, as well as learning a few simple bike-fitting techniques, physicians can treat and prevent many common problems associated with bicycling.
• Hahn, E. A., Cella, D., Dobrez, D. G., Weiss, B. D., Du, H., Lai, J., Victorson, D., & Garcia, S. F. (2007). The impact of literacy on health-related quality of life measurement and outcomes in cancer outpatients. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 16(3), 495-507.
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  Limited evidence exists regarding the relationship between literacy and health-related quality of life (HRQL). Research is needed to develop measurement techniques for low literacy populations and to evaluate potential literacy-related measurement bias.
• Hueston, W. J., Mainous, A. G., Weiss, B. D., Macaulay, A. C., Hickner, J., Sherwood, R. A., , N. A., & , S. o. (2006). Protecting participants in family medicine research: a consensus statement on improving research integrity and participants' safety in educational research, community-based participatory research, and practice network research. Family medicine, 38(2), 116-20.
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  Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.
• Katz, M. G., Kripalani, S., & Weiss, B. D. (2006). Use of pictorial aids in medication instructions: a review of the literature. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 63(23), 2391-7.
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  The effects of pictorial aids in medication instructions on medication recall, comprehension, and adherence are reviewed.
• Kripalani, S., & Weiss, B. D. (2006). Teaching about health literacy and clear communication. Journal of general internal medicine, 21(8), 888-90.
• Martinez, P., & Weiss, B. D. (2006). Unchanged asthma prevalence during 1990-1999 in rural Alaska Natives. International journal of circumpolar health, 65(4), 341-6.
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  The prevalence of asthma has been increasing throughout the world, but the reasons for the increase are unclear. Some have hypothesized that the increase is due to industrial and agricultural pollutants in urban and rural areas, respectively. The objective of this research was to determine if the prevalence of asthma has increased in a remote area of Alaska where the population lives a subsistence lifestyle and is not exposed to such pollution.
• Rogers, E. S., Wallace, L. S., & Weiss, B. D. (2006). Misperceptions of medical understanding in low-literacy patients: implications for cancer prevention. Cancer control : journal of the Moffitt Cancer Center, 13(3), 225-9.
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  Patients with limited literacy skills often have difficulty understanding medical information, are less likely to undergo cancer screening, and present with cancer at later stages than patients with better literacy skills. Since primary care physicians are responsible for performing or initiating the majority of cancer screening in the United States, they need to be able to not only identify patients who might not understand medical information but also communicate effectively with them about cancer prevention and screening.
• Wallace, L. S., Rogers, E. S., Roskos, S. E., Holiday, D. B., & Weiss, B. D. (2006). Brief report: screening items to identify patients with limited health literacy skills. Journal of general internal medicine, 21(8), 874-7.
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  Patients with limited literacy skills are routinely encountered in clinical practice, but they are not always identified by clinicians.
• Wallace, L. S., Rogers, E. S., Turner, L. W., Keenum, A. J., & Weiss, B. D. (2006). Suitability of written supplemental materials available on the Internet for nonprescription medications. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 63(1), 71-8.
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  The suitability, readability, and cultural appropriateness of written supplemental materials available on the Internet for nonprescription medications were examined.
• Weiss, B. D., Francis, L., Senf, J. H., Heist, K., & Hargraves, R. (2006). Literacy education as treatment for depression in patients with limited literacy and depression: a randomized controlled trial. Journal of general internal medicine, 21(8), 823-8.
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  Individuals with limited literacy and those with depression share many characteristics, including low self-esteem, feelings of worthlessness, and shame.
• Wallace, L. S., Turner, L. W., Ballard, J. E., Keenum, A. J., & Weiss, B. D. (2005). Evaluation of web-based osteoporosis educational materials. Journal of women's health (2002), 14(10), 936-45.
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  Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults.
• Weiss, B. D. (2005). Selecting medications for the treatment of urinary incontinence. American family physician, 71(2), 315-22.
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  In response to the growing population of older patients with incontinence, pharmaceutical companies are developing new drugs to treat the condition. Before prescribing medications for incontinence, however, physicians should determine the nature and cause of the patient's incontinence. The evaluation should rule out reversible conditions, conditions requiring special evaluation, and overflow bladder. The best treatment for urge incontinence is behavior therapy in the form of pelvic floor muscle exercises. Medications, used as an adjunct to behavior therapy, can provide additional benefit. Many therapies are available for patients with stress incontinence, including pelvic floor muscle exercise, surgery, intravaginal support devices, pessaries, peri-urethral injections, magnetic chairs, and intraurethral inserts. No medication has been approved for the treatment of stress incontinence, although medications are under development.
• Weiss, B. D., Smith, M. A., & Magill, M. K. (2005). Journal Policy Statement--IRB approval for educational research. Family medicine, 37(3), 219-20.
• Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H., Susman, J. L., Ewigman, B., & Bowman, M. (2004). Simplifying the language of evidence to improve patient care: Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in medical literature. The Journal of family practice, 53(2), 111-20.
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  Several taxonomies exist for rating individual studies and the strength of recommendations, making the analysis of evidence confusing for practitioners. A new grading scale-the Strength of Recommendation Taxonomy (SORT)-will be used by several family medicine and primary care journals (required or optional), allowing readers to learn 1 consistently applied taxonomy of evidence. SORT is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. Levels of evidence from 1 to 3 for individual studies also are defined. An A-level recommendation is based on consistent and good-quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited-quality patient-oriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening.
• Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H., Susman, J., Ewigman, B., & Bowman, M. (2004). Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. American family physician, 69(3), 548-56.
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  A large number of taxonomies are used to rate the quality of an individual study and the strength of a recommendation based on a body of evidence. We have developed a new grading scale that will be used by several family medicine and primary care journals (required or optional), with the goal of allowing readers to learn one taxonomy that will apply to many sources of evidence. Our scale is called the Strength of Recommendation Taxonomy. It addresses the quality, quantity, and consistency of evidence and allows authors to rate individual studies or bodies of evidence. The taxonomy is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. An A-level recommendation is based on consistent and good-quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited-quality patient-oriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening. Levels of evidence from 1 to 3 for individual studies also are defined. We hope that consistent use of this taxonomy will improve the ability of authors and readers to communicate about the translation of research into practice.
• Hahn, E. A., Cella, D., Dobrez, D., Shiomoto, G., Marcus, E., Taylor, S. G., Vohra, M., Chang, C., Wright, B. D., Linacre, J. M., Weiss, B. D., Valenzuela, V., Chiang, H., & Webster, K. (2004). The talking touchscreen: a new approach to outcomes assessment in low literacy. Psycho-oncology, 13(2), 86-95.
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  Cancer patients who are deficient in literacy skills are particularly vulnerable to experiencing different outcomes due to disparities in care or barriers to care. Outcomes measurement in low literacy patients may provide new insight into problems previously undetected due to the challenges of completing paper-and-pencil forms.
• Weiss, B. D. (2004). Are we competent to assess competence?. Family medicine, 36(3), 214-6.
• Weiss, B. D. (2004). SORT: Strength of recommendation taxonomy. Family medicine, 36(2), 141-3.
• Van Hook, F. W., Demonbreun, D., & Weiss, B. D. (2003). Ambulatory devices for chronic gait disorders in the elderly. American family physician, 67(8), 1717-24.
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  Gait disorders in the elderly are common and in most cases cannot be treated medically or surgically. Therefore, treatment often relies on ambulatory devices such as canes, crutches, and walkers. Before selecting a device, the patient should be evaluated to define whether one or both upper extremities are required to achieve balance or bear weight. Patients requiring only one upper extremity can use a cane, while patients requiring both upper extremities are best served by forearm crutches or walkers. The patient's need to bear weight through the device will help the physician choose a specific device. When measuring the device, anatomic landmarks and the angle of the elbow must be taken into consideration. Because time often is limited during a routine office visit, a physical therapist often can provide further training for patients learning to use such a device.
• Weiss, B. D. (2003). Why is aspirin a contraindication for trigger-point injections?. American family physician, 67(1), 32.
• Weiss, B. D. (2002). Publications by family medicine faculty in the biomedical literature: 1989-1999. Family medicine, 34(1), 10-6.
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  Concern has been expressed about a possible decrease in publication productivity of family medicine faculty. This study measured trends in publication productivity by family medicine faculty from 1989 to 1999 and determined the journals in which these individuals published their work.
• Williams, M. V., Davis, T., Parker, R. M., & Weiss, B. D. (2002). The role of health literacy in patient-physician communication. Family medicine, 34(5), 383-9.
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  Patients' health literacy is increasingly recognized as a critical factor affecting patient-physician communication and health outcomes. We reviewed research on health literacy, examined its impact on patient-physician communication, and offer recommendations to enhance communication with patients who have poor health literacy.
• Weiss, B. D. (2001). Health literacy: an important issue for communicating health information to patients. Zhonghua yi xue za zhi = Chinese medical journal; Free China ed, 64(11), 603-8.
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  "Health literacy" refers to an individual's ability to read, understand, and use the information necessary to obtain adequate health care. Because so much health-related information is provided to patients in written form, some degree of health literacy is essential. A review of the international medical and education literature was conducted to identify research on health literacy. Limited health literacy is a widespread problem in both non-industrialized and industrialized nations, and it is mostly related to deficient reading skills. Deficient reading skills are most prevalent among those with a limited educational background, but considerable research shows that limited reading skills exist even among those who have completed a formal education. Risk factors for limited literacy include poverty, membership in an ethnic minority group, advanced age, and other sociodemographic characteristics. Limited health literacy highly associated with poor health status, and literacy skills more accurately predict health status than education level, income, ethnic background, or any other sociodemographic variable. Individuals with limited literacy have higher rates of illness and more hospitalizations than individuals with more well-developed reading skills. Considerable effort has been directed at creating special health education materials for communicating with patients who have limited reading skills, but there is minimal evidence that these interventions have any effect on the health status of these individuals. In conclusion, poor health literacy is a common problem with important implications for health status. Limited data are available about how to best address the needs of patients with limited literacy skills.
• Weiss, B. D. (2001). Management of MVP with antibiotic prophylaxis. American family physician, 64(1), 36.
• Weiss, B. D. (2001). POEMS (patient-oriented evidence that matters) spark discussion. The Journal of family practice, 50(10), 901.
• Weiss, B. D. (2000). Family practice residency training: can we make it better?. Family medicine, 32(5), 346-9.
• Kellerman, R., & Weiss, B. D. (1999). Health literacy and the JAMA Patient Page. JAMA, 282(6), 525-6; author reply 526-7.

Presentations

• Wallace, L., DeVoe, J., & Weiss, B. D. (2015, October). Does Administration Mode Influence Adults' Newest Vital Sign Scores?. annual meeting of the North American Primary Care Research Group (NAPCRG).

Poster Presentations

• Bannis, K., Bhargava, R. K., Mandel, R., Weiss, B. D., O'Neill, L., Mohler, J., Wang, J., Cheng, K., Ananth, A., & Fain, M. J. (2015, April). Elder Care. A Novel Application-Based Medical Database. Arizona Geriatric Society.