Validation of the short-form Health Literacy Scale in patients with stroke

Evaluation of a digital patient education programme for Chinese immigrants after a heart attack

AIMS

To evaluate a self-administered digital education resource for patients after a heart attack (adapted simplified Chinese version of Cardiac College™) on secondary prevention knowledge and health behaviour change outcomes.

METHODS AND RESULTS

Chinese immigrants recovering from a heart attack were recruited from cardiac rehabilitation programmes at four metropolitan tertiary hospitals. Participants provided access to Cardiac College™ (adapted simplified Chinese version), a self-learning secondary prevention virtual education resource over 4 weeks. The web-based resources include 9 booklets and 10 pre-recorded video education sessions. Assessments included health literacy, secondary prevention knowledge, self-management behaviours, self-reported physical activity, and a heart-healthy diet. Satisfaction, acceptability, and engagement were also assessed.From 81 patients screened, 67 were recruited, and 64 (95.5%) completed the study. The participants' mean age was 67.2 ± 8.1 years old, 81.2% were males, and the majority had no English proficiency (65.6%). Following the intervention, significant improvements were observed for secondary prevention knowledge overall and in all subdomains, with the most improvement occurring in medical, exercise, and psychological domains (P < 0.001). Dietary and self-management behaviours also improved significantly (P < 0.05). According to participants, the educational materials were engaging (100%), and the content was adequate (68.8%); however, 26.6% found the information overwhelming. Overall, 46.9% were highly satisfied with the resources.

CONCLUSION

A self-learning virtual patient-education package improved secondary prevention knowledge and self-care behaviour in Chinese immigrants after a heart attack. The culturally adapted version of Cardiac College™ offers an alternative education model where bilingual staff or translated resources are limited.

Development of health literacy assessment scale for Thai stroke patients

BACKGROUND

One important factor influencing the treatment and rehabilitation results for stroke patients is their level of health literacy. In order to acquire comprehensive information for appropriate treatment and rehabilitation programs that will promote the optimal possible health outcomes, health literacy assessment should be done in stroke patients from the earliest stages of stroke onset.

OBJECTIVES

This research aimed to develop a health literacy assessment scale for Thai stroke patients and to evaluate the HL levels of those patients using that assessment scale.

METHODS

A draft version of the scale has been developed based on the literature review and focus group discussions. After tryout, content validity, corrected item-total correlation and internal consistency were examined. A confirmatory factor analysis (CFA) was conducted in 400 patients with stroke to test the construct validity.

RESULTS

The Health Literacy Assessment Scale for Thai Stroke Patients was successfully developed. The complete version featured 50 health literacy-related questions, along with seven demographic-related questions. This tool demonstrated good psychometric properties, including content validity (Item-objective congruence; IOC > 0.50), internal consistency (Cronbach's alpha = 0.951 to 0.955, overall = 0.94). Confirmatory factor analysis (CFA) also revealed good construct validity.

CONCLUSIONS

The Health Literacy Assessment Scale for Thai Stroke Patients (HLS-Th) is measuring five components cover all health literacy aspects necessary for Thai stroke patient. This novel measurement scale is an accurate psychometric tool for assessing the level of health literacy among Thai stroke survivors.

Simple scoring algorithm to identify community-dwelling older adults with limited health literacy: a cross-sectional study in Taiwan

OBJECTIVE

Health literacy (HL) is the degree of individuals' capacity to access, understand, appraise and apply health information and services required to make appropriate health decisions. This study aimed to establish a predictive algorithm for identifying community-dwelling older adults with a high risk of limited HL.

DESIGN

A cross-sectional study.

SETTING

Four communities in northern, central and southern Taiwan.

PARTICIPANTS

A total of 648 older adults were included. Moreover, 85% of the core data set was used to generate the prediction model for the scoring algorithm, and 15% was used to test the fitness of the model.

PRIMARY AND SECONDARY OUTCOME MEASURES

Pearson's χ² test and multiple logistic regression were used to identify the significant factors associated with the HL level. An optimal cut-off point for the scoring algorithm was identified on the basis of the maximum sensitivity and specificity.

RESULTS

A total of 350 (54.6%) patients were classified as having limited HL. We identified 24 variables that could significantly differentiate between sufficient and limited HL. Eight factors that could significantly predict limited HL were identified as follows: a socioenvironmental determinant (ie, dominant spoken dialect), a health service use factor (ie, having family doctors), a health cost factor (ie, self-paid vaccination), a heath behaviour factor (ie, searching online health information), two health outcomes (ie, difficulty in performing activities of daily living and requiring assistance while visiting doctors), a participation factor (ie, attending health classes) and an empowerment factor (ie, self-management during illness). The scoring algorithm yielded an area under the curve of 0.71, and an optimal cut-off value of 5 represented moderate sensitivity (62.0%) and satisfactory specificity (76.2%).

CONCLUSION

This simple scoring algorithm can efficiently and effectively identify community-dwelling older adults with a high risk of limited HL.

[Health literacy in low- and middle-income countries: a systematic review]

Health literacy (HL) is linked to individual capacities of access, understanding, assessment and application of health information to make decisions in everyday life, in order to maintain or improve health. The scope of this article is to review studies on HL conducted in low- and middle-income countries, with an emphasis on the definition used for HL. It involved a systematic search in the Medline, Embase, Scopus, LILACS and SciELO databases. It included studies that showed the definition of HL, studies in countries with low- and middle-income economies and Latin American studies. Initially, a selection of studies was made by reading the titles and/or abstracts. Two independent evaluators conducted the reading of the full text. Disagreements were discussed by consensus. A total of 6,025 references were located and 36 were selected for the final sample. Most studies (58.3%) were from countries on the Asian continent, followed by studies from South American countries (27.8%), including Brazil. Most studies (58.3%) evaluated the functional dimension of the HL (FHL). The most frequent definitions were from the Institute of Medicine and from the World Health Organization. Approximately 30% of the studies that evaluated FHL used broader definitions of HL as theoretical frameworks.

Ideal instruments used to measure health literacy related to medication use: A systematic review

BACKGROUND

Prior studies showed the association between inadequate health literacy (HL) and poor medication-related skills, while none of the published studies have reviewed and compared the existing instruments used to measure medication-related HL. This systematic review comprehensively summarizes the existing instruments that assess medication-related HL.

OBJECTIVES

To identify appropriate HL instruments related to medication use as screening tools for enhancing patients' ability to use medications correctly.

METHODS

This review retrieved medication-related HL instruments that were published between 2000 and 2019 from three databases (i.e., PubMed, Scopus, EMBASE) and by hand-searching. The PRISMA procedure was followed as well as the SURGE guideline to assess the quality of studies. Psychometric properties, HL dimensions, and types of medication information gleaned from the items in three types of HL instruments (i.e., general, disease-specific, medication-specific) were compared to identify appropriate medication-related HL instruments.

RESULT

Forty-eight instruments were identified from 44 studies, whereas 70.8% instruments were either disease- or medication-specific HL instruments. Most instruments with different sample sizes showed certain an extent of reliability and validity. The distributions of HL dimensions and types of medication information among the relevant items were varied across different types of instruments. The five instruments (named as the 16SQ, AKQ-CQ, DHLKI, AKT, and ChMLM) were identified as the most appropriate instruments for three types of medication-related HL, respectively. These appropriate instruments consistently covered items related to HL dimensions of literacy and comprehension and medication-related information regarding dosing, treatment indication, and side effects/precautions.

CONCLUSION

Of 48 identified instruments mainly derived from disease- or medication-specific studies, the five most appropriate medication-related HL instruments were identified to support clinicians in facilitating patients' correct medication use. Further confirmation to explore the usefulness among these instruments are needed.

Improving the utility of the European Health Literacy Survey Questionnaire: a computerized adaptive test for patients with stroke

PURPOSE

Health literacy among patients is crucial for effective stroke management. The European Health Literacy Survey Questionnaire is a theory-based measure that comprehensively captures 12 domains of health literacy. We aimed to develop a computerized adaptive test of the European Health Literacy Survey Questionnaire to efficiently assess health literacy among patients with stroke.

MATERIALS AND METHODS

The European Health Literacy Survey Questionnaire data of 311 patients and item parameters were retrieved from a Rasch validation study. Real data simulations were performed to develop a computerized adaptive test of the European Health Literacy Survey Questionnaire and explore its efficiency and reliability.

RESULTS

The computerized adaptive test of the European Health Literacy Survey Questionnaire displayed suitable reliability in all 12 domains (0.72-0.84) with a mean test length of 17 items (36.2% of the 47-item European Health Literacy Survey Questionnaire).

CONCLUSIONS

Our findings indicate that the computerized adaptive test of the European Health Literacy Survey Questionnaire, which assesses 12 domains of health literacy among patients with stroke in a timely and precise fashion, is efficient and reliable.Implications for rehabilitationThe computerized adaptive test of the European Health Literacy Survey Questionnaire assesses the subjective fit of personal health literacy competencies to environmental demands, providing insight into patient strengths and weaknesses when dealing with health tasks and interacting with health systems.The computerized adaptive test of the European Health Literacy Survey Questionnaire assesses the 12 domains of health literacy among patients with stroke in a timely and precise manner.Our study has demonstrated the utility of the computerized adaptive test of the European Health Literacy Survey Questionnaire in reducing the assessment burden of patients in clinical practice.Developing of the computerized adaptive test of the European Health Literacy Survey Questionnaire provided findings that may benefit researchers and clinicians interested in developing efficient outcome measures.

Development of a battery of phase-adaptive health literacy tests for stroke survivors

OBJECTIVE

We aimed to develop a health literacy battery for three phases of stroke (HL-3S).

METHODS

Three Rasch-based item banks corresponding to health care, disability prevention, and health promotion in the acute, subacute, and chronic phases of stroke, respectively, were developed by a multidisciplinary stroke team. To construct the HL-3S, a panel of clinical and Rasch experts selected items from the three Rasch-based item banks according to content representativeness and item difficulty diversity. Additionally, the validity and reliability of the HL-3S were examined using Rasch analysis.

RESULTS

This study included 442 patients. Each of the three tests in the HL-3S contained 10 items with a 5-point scale of difficulty levels. The items in HL-3S demonstrated unidimensionality, local independence, and favorable Rasch reliability.

CONCLUSION

The HL-3S, with 10 items in each test, had favorable construct validity and Rasch reliability. The HL-3S can be considered as a quick-to-administer and phase-adaptive test battery of health literacy for stroke survivors.

PRACTICE IMPLICATIONS

Clinicians may select one of the tests in the HL-3S corresponding with the patient's stroke recovery timeline and thereby provide adaptive health education programs to increase the patient's ability to actively participate in health care, disability prevention, and health promotion, respectively.

Tools to measure health literacy among Chinese speakers: A systematic review

OBJECTIVE

Health literacy measurement can identify healthcare consumers' needs and help inform healthcare service delivery. The objective of this review is to identify and evaluate tools to measure health literacy among Chinese speakers.

METHODS

A systematic literature search was undertaken in nine databases, both English and Chinese, on articles published from the databases' inception to May 2018, addressing health literacy among Chinese speakers.

RESULTS

Ten health literacy instruments in the Chinese language were reported in 17 studies, of which ten were published in English and seven in Chinese. Of the 17 studies, six reported on a new instrument, while the remainder reported on derivative instruments. All, except for one, are self-administered. These studies applied various implicit or explicit conceptual or operational health literacy definitions. The psychometric strength varied across the instruments.

CONCLUSIONS

A number of instruments are available for assessing health literacy among Chinese speakers. Careful selection is recommended, given the variation in components and psychometric properties assessed.

PRACTICE IMPLICATIONS

This review can be used by healthcare providers and researchers to select effective health literacy tools to examine patients' ability to understand and apply health information so that services can be more appropriately tailored to Chinese speaking patients.

A Scoping Review of Health Literacy Measurement Tools in the Context of Cardiovascular Health

Background. Despite the strong link between health literacy and cardiovascular health outcomes, health literacy measurements remain flawed and fragmented. There exists a gap in the knowledge when formulating a valid measurement to capture the broad concept of health literacy. The existence of various tools for health literacy measurement also hampers the availability of health literacy data. Additionally, little research is available on a valid measurement tool for cardiovascular health literacy. Objective. This study aims to provide an overview of the health literacy measurement tools used in the context of cardiovascular health. Method. A scoping review was conducted. Two electronic databases, Medline and Embase, were searched to identify studies that described a tool for the measurement of health literacy in the context of cardiovascular health. Results. After reviewing the available studies, 53 studies met the inclusion criteria. A total of 26 health literacy measurement tools were identified in the studies. Among the 26 tools, 16 used an objective measurement approach, 9 adopted a subjective approach, and 1 employed a mixed approach. Additionally, 28 studies used tools to measure print literacy, 15 studies measured print literacy and numeracy, and 5 studies measured print literacy, oral literacy, and numeracy. Conclusions. STOFHLA, TOFHLA, and REALM were the mostly commonly used tools in the selected studies. The majority of tools were based heavily on reading skills and word recognition. Researchers should focus on the development of more comprehensive and reliable health literacy measurement tool(s) specific to cardiovascular health to assist health care providers to more efficiently and accurately identify people with cardiovascular problems who have inadequate health literacy.