Health Literacy bei vulnerablen Zielgruppen: Entwicklung und Konzeption des HLS-NRW-Q-Fragebogens

Feasibility of a patient-oriented navigation programme for patients with lung cancer or stroke in Germany: Protocol of the CoreNAVI study

BACKGROUND

Patient navigation programmes were introduced in the United States and recently gained interest in Germany, where the health care system is fragmented. Navigation programmes aim to decrease barriers to care for patients with age-associated diseases and complex care paths. Here we describe a feasibility study to evaluate a patient-oriented navigation model that was developed in a first project phase by integrating data about barriers to care, vulnerable patient populations and existing support services.

METHODS

We designed a mixed-methods feasibility study that consists of two two-arm randomized controlled trials aligned with observational cohorts. The intervention group of the RCTs gets support by personal navigators for 12 months. The control group receives a brochure with regional support offers for patients and caregivers. The feasibility of the patient-oriented navigation model for two prototypic age-associated diseases, lung cancer and stroke, is evaluated with regard to its acceptance, demand, practicality and efficacy. This investigation includes process evaluation measures with detailed documentation of the screening and recruitment process, questionnaires about satisfaction with navigation, observant participation and qualitative interviews. Estimates of efficacy for patient-reported outcomes are obtained at three follow-up time points including satisfaction with care and health-related quality of life. Furthermore, we analyze health insurance data from patients of the RCT insured at a large German health insurance (AOK Nordost) to investigate heath care utilization, costs and cost effectiveness.

TRIAL REGISTRATION

The study is registered at the German Clinical Trial Register (DRKS-ID: DRKS00025476).

Schulprogramme zur Förderung der psychischen Gesundheit. Die psychische Gesundheitskompetenz von Lehrpersonen als wichtiger Umsetzungsfaktor

Hintergrund

Weltweit sind bis zu einem Fünftel der Kinder und Jugendlichen von psychischen Störungen betroffen. Auffälligkeiten, die bereits im Schulalter auftreten, sind insbesondere für die Betroffenen, aber auch die Lehrpersonen belastend. Schulische Präventionsprogramme zur psychischen Gesundheit haben das Potenzial, die Belastungen beidseitig zu reduzieren. Die psychische Gesundheitskompetenz von Lehrpersonen, die nicht nur das Wissen und das Verständnis, sondern auch die Handlungen untersucht, gilt dabei als wichtiger Umsetzungsfaktor. Die Studienlage ist mager.

Ziele

Die Studie untersucht die psychische Gesundheitskompetenz von Lehrpersonen im Kontext von Belastungssituation der Schülerinnen und Schüler sowie das Vorhandensein entsprechender Schulprogramme.

Methoden

Im Schuljahr 2019/2020 wurden alle Lehrpersonen in einer Deutschschweizer Stadt zu einem Online-Survey eingeladen (n = 1514; Rücklauf: 38 %). Die Daten wurden quantitativ mittels bivariater und multivariater Methoden ausgewertet. Eine offene Frage zum Verständnis psychischer Störungen wurde qualitativ mittels einer Inhaltsanalyse ausgewertet.

Resultate und Diskussion

Die Befragten betreuten oder unterrichteten im letzten Jahr durchschnittlich 4,7 psychisch belastete Schülerinnen und Schülern. Die Anzahl Betroffener unterschied sich nach Schulstufe und Schulfunktion. Die Lehrpersonen schätzten ihre Fähigkeit, Informationen zum Thema zu finden und zu verstehen als (sehr) gut ein, es fiel ihnen jedoch schwerer, zu beurteilen, ob die gefundenen Informationen korrekt sind. Die Handlungskompetenz der Lehrkräfte war partiell gering, beispielsweise beim Wissen über Störungsbilder und stellt ein Hindernis in der Umsetzung von Schulprogrammen dar. Lehrkräfte relativierten auffälliges Verhalten, was die Triage für weitere Abklärungen erschwert. Den Schulen wird zum einen empfohlen in die Eigeninitiative der Lehrpersonen zu investieren, zum anderen sollte die Steigerung der psychischen Gesundheitskompetenz nicht nur Aufgabe der Lehrpersonen sein, sondern durch eine entsprechende Schulkultur und gesellschaftlich gefördert werden.

Digital Health Information Provided by Public Health Stakeholders on Colorectal Cancer Screening: A Systematic Evaluation

In the federal state of Germany, Saxony-Anhalt, colorectal cancer is the second most frequent cause of death among cancer patients. In order to identify cancer precursors early, colorectal cancer screenings are essential. In this context, health information contributes to informing individuals and imparting them with necessary knowledge to make a decision about (non-)utilization of preventive services. Numerous public health stakeholders (e.g., statutory health insurances) provide health information. This study aimed to evaluate the quality of web-based health information offered by public health stakeholders in Saxony-Anhalt, Germany. A systematic evaluation was used. A search was performed using pre-defined eligibility criteria and search terms. Two independent reviewers assessed the search results based on seven main categories (60 items) developed by the study team in line with the "Guideline Evidence-based Health Information". In total, 37 materials from 16 different stakeholders were included and yielded a "mediocre quality" (median = 69%). The materials had only partially fulfilled the requirements of national recommendations for evidence-based health information. Access to digital health information regarding colon cancer screening was unsatisfactory, especially for individuals with auditory or visual impairments, due to use of inappropriate communication technologies. Further efforts are required to improve digital health information about colorectal cancer screening.

Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic

Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.

Explaining variation in health information seeking behaviour - Insights from a multilingual survey

OBJECTIVE

How best to provide an increasingly diverse population with health information has become a major concern for health policy makers in Europe and beyond. Our study aims to investigate factors explaining variation in people's health information seeking behaviour. Our findings can be used to identify target groups for policy interventions that aim to provide health information efficiently.

METHODS

Cross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants' choice of ten sources of health information.

FINDINGS

Participants' choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information.

CONCLUSION

Policy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.

Development and Psychometric Properties of a Questionnaire Assessing Self-Reported Generic Health Literacy in Adolescence

Health literacy is a promising approach to promoting health and preventing disease among children and adolescents. Promoting health literacy in early stages of life could contribute to reducing health inequalities. However, it is difficult to identify concrete needs for action as there are few age-adjusted measures to assess generic health literacy in young people. Our aim was to develop a multidimensional measure of health literacy in German to assess generic health literacy among 14- to 17-year-old adolescents, namely, the "Measurement of Health Literacy Among Adolescents Questionnaire" (MOHLAA-Q). The development process included two stages. Stage 1 comprised the development and validation using a literature review, two rounds of cognitive interviews, two focus groups and two rounds of expert assessments by health literacy experts. Stage 2 included a standard pretest (n = 625) of the questionnaire draft to examine the psychometric properties, reliability and different validity aspects. The MOHLAA-Q consists of 29 items in four scales: (A) "Dealing with health-related information (HLS-EU-Q12-adolescents-DE)"; (B) "Communication and interaction skills", (C) "Attitudes toward one's own health and health information", and (D) "Health-related knowledge". The confirmatory factor analysis indicated a multidimensional structure of the MOHLAA-Q. The internal consistency coefficients (Cronbach's α) of the scales varied from 0.54 to 0.77. The development of the MOHLAA-Q constitutes a significant step towards the comprehensive measurement of adolescents' health literacy. However, further research is necessary to re-examine its structural validity and to improve the internal consistency of two scales.

Health literacy among different age groups in Germany: results of a cross-sectional survey

Background

Health literacy is of increasing importance in public health research. It is a necessary pre-condition for the involvement in decisions about health and health care and related to health outcomes. Knowledge about limited health literacy in different age groups is crucial to better target public health interventions for subgroups of the population. However, little is known about health literacy in Germany. The study therefore assesses the prevalence of limited health literacy and associated factors among different age groups.

Methods

The Health Literacy Survey Germany is a cross-sectional study with 2,000 participants aged 15 years or older in private households. Perceived health literacy was assessed via computer-assisted personal interviews using the HLS-EU-Q-47 questionnaire. Descriptive analyses, chi-square tests and odds ratios were performed stratified for different age groups.

Results

The population affected by limited perceived health literacy increases by age. Of the respondents aged 15–29 years, 47.3 % had limited perceived health literacy and 47.2 % of those aged 30–45 years, whereas 55.2 % of the respondents aged 46–64 years and 66.4 % aged 65 years and older showed limited perceived health literacy. In all age groups, limited perceived health literacy was associated with limited functional health literacy, low social status, and a high frequency of doctor visits.

Conclusions

The results suggest a need to further investigate perceived health literacy in all phases of the life-course. Particular attention should be devoted to persons with lower social status, limited functional health literacy and/or a high number of doctor visits in all age groups.