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Ayre J, Mac O, McCaffery K, McKay BR, Liu M, Shi Y, Rezwan A, Dunn AG. New Frontiers in Health Literacy: Using ChatGPT to Simplify Health Information for People in the Community. J Gen Intern Med 2024; 39:573-577. [PMID: 37940756 DOI: 10.1007/s11606-023-08469-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Most health information does not meet the health literacy needs of our communities. Writing health information in plain language is time-consuming but the release of tools like ChatGPT may make it easier to produce reliable plain language health information. OBJECTIVE To investigate the capacity for ChatGPT to produce plain language versions of health texts. DESIGN Observational study of 26 health texts from reputable websites. METHODS ChatGPT was prompted to 'rewrite the text for people with low literacy'. Researchers captured three revised versions of each original text. MAIN MEASURES Objective health literacy assessment, including Simple Measure of Gobbledygook (SMOG), proportion of the text that contains complex language (%), number of instances of passive voice and subjective ratings of key messages retained (%). KEY RESULTS On average, original texts were written at grade 12.8 (SD = 2.2) and revised to grade 11.0 (SD = 1.2), p < 0.001. Original texts were on average 22.8% complex (SD = 7.5%) compared to 14.4% (SD = 5.6%) in revised texts, p < 0.001. Original texts had on average 4.7 instances (SD = 3.2) of passive text compared to 1.7 (SD = 1.2) in revised texts, p < 0.001. On average 80% of key messages were retained (SD = 15.0). The more complex original texts showed more improvements than less complex original texts. For example, when original texts were ≥ grade 13, revised versions improved by an average 3.3 grades (SD = 2.2), p < 0.001. Simpler original texts (< grade 11) improved by an average 0.5 grades (SD = 1.4), p < 0.001. CONCLUSIONS This study used multiple objective assessments of health literacy to demonstrate that ChatGPT can simplify health information while retaining most key messages. However, the revised texts typically did not meet health literacy targets for grade reading score, and improvements were marginal for texts that were already relatively simple.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia.
| | - Olivia Mac
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia
| | - Brad R McKay
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia
| | - Mingyi Liu
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia
| | - Yi Shi
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia
| | - Atria Rezwan
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128C Edward Ford Building, Sydney, NSW, Australia
| | - Adam G Dunn
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Palu E, McBride KA, Simmons D, Thompson R, Cavallaro C, Cooper E, Felila M, MacMillan F. Adequacy of health message tailoring for ethnic minorities: Pasifika communities in Sydney, Australia, during COVID-19. Health Promot Int 2024; 39:daad197. [PMID: 38365189 DOI: 10.1093/heapro/daad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Ethnic minorities, such as Pasifika, residing in high-income countries were at higher risk of COVID-19 infection during the pandemic. To understand the experiences of Pasifika, including message dissemination and barriers to tailored public health messaging during the pandemic, a qualitative study was undertaken, underpinned by Laswell's Model of Communication and Bandura's social cognitive theory with data collected using Pasifika methods. Pasifika adults (n = 65) were recruited across Sydney from July 2020 to March 2022. Health care professionals (HCP) (n = 17) employed by four local health districts (LHDs) and Pasifika community-based organizations delivering multicultural COVID-19-related work within the study catchment, were also recruited. Five themes were constructed from the data of: (i) prevailing fear and uncertainty over COVID-19 infection and losing employment; (ii) limited knowledge of government perpetuating distrust in Government as a benevolent source of information; (iii) faith and trust as priorities for health decision-making; (iv) 'Coconut wireless'-the role of family, friends and community in disseminating public health messages through word of mouth; and (v) limited health literacy affecting compliance with public health orders. Community members identified important messages and resources had not been sufficiently distributed. Most HCPs understood the necessity of grassroots-level engagement but reported existing approaches were inadequate to navigate challenges. These findings highlight the need for public health promotion and communication strategies that consider both the social and cultural determinants of health. We propose a 7-point checklist as a cultural appropriateness lens to assist the development and rating of existing or new health promotion messaging and resources.
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Affiliation(s)
- Elizabeth Palu
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Kate A McBride
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia
| | - Ronda Thompson
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | | | - Ellen Cooper
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Makeleta Felila
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Western Sydney Local Health District, Westmead, NSW, Australia
| | - Freya MacMillan
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
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Townley C, Properjohn C, Grace R, McClean T. Stay home, stay safe? Public health assumptions about how we live with COVID. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:327-340. [PMID: 37313978 DOI: 10.1080/14461242.2023.2199724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/19/2023] [Indexed: 06/15/2023]
Abstract
The COVID pandemic has had an uneven impact on families and communities, exacerbating existing structural disadvantage. We demonstrate that the construction of the pandemic by policymakers as primarily a medical problem has shaped the public health response in such a way as to hide the resulting lack of access to necessities for many and deterioration in people's wellbeing. We interviewed social welfare service providers in an urban area of high cultural and linguistic diversity and low socioeconomic advantage, about their experiences in the 2021 lockdown period. Our findings highlight the unanticipated impacts of the public health response on people who cannot be recognised in the normative subjects constructed by policy. We bring to the fore the hidden experiences behind the government-reported COVID health statistics and explore the (dis)integration of services that support survival. To avoid worsening structural disadvantage, policy responses to crisis require conceptualising the problem and its solutions from diverse standpoints, built on an understanding of the different elements that shape who we are and the way we live.
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Affiliation(s)
- Cris Townley
- TeEACH, Western Sydney University, Sydney, Australia
| | | | - Rebekah Grace
- TeEACH, Western Sydney University, Sydney, Australia
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4
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Dahm MR, Bull R, Sadow L, Tran D, Zurynski Y, Amin J, Hadley F, Harrison LJ, Waniganayake M, Wong S, Degotardi S. Readability and beyond - Health literacy and numeracy and COVID-19 communications in early childhood education: Are we communicating effectively? PATIENT EDUCATION AND COUNSELING 2023; 114:107823. [PMID: 37270932 PMCID: PMC10210820 DOI: 10.1016/j.pec.2023.107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Analyse the linguistic and numerical complexity of COVID-19-related health information communicated from Australian national and state governments and health agencies to national and local early childhood education (ECE) settings. METHODS Publicly available health information (n = 630) was collected from Australian national and state governments and health agencies, and ECE agencies and service providers. A purposive sample of documents (n = 33) from 2020 to 2021 was analysed inductively and deductively combining readability, health numeracy and linguistic analyses and focusing on the most frequent actionable health advice topics. RESULTS COVID-19 health advice most frequently related to hygiene, distancing and exclusion. Readability scores in 79% (n = 23) of documents were above the recommended grade 6 reading level for the public. Advice was delivered using direct linguistic strategies (n = 288), indirect strategies (n = 73), and frequent mitigating hedges (n = 142). Most numerical concepts were relatively simple, but lacked elaborative features (e.g., analogies) and/or required subjective interpretation. CONCLUSION COVID-19 health advice available to the ECE sector included linguistic and numerical information open to mis/interpretation making it difficult to understand and implement. PRACTICE IMPLICATIONS Combining readability scores with measures of linguistic and numerical complexity offers a more holistic approach to assessing accessibility of health advice and improving health literacy among its recipients.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care, College of Arts and Social Science, Australian National University, Canberra, Australia.
| | - Rebecca Bull
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Lauren Sadow
- Institute for Communication in Health Care, College of Arts and Social Science, Australian National University, Canberra, Australia; Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Dung Tran
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation and the NHMRC Partnership Centre for Health System Sustainability, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Janaki Amin
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | - Fay Hadley
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Linda J Harrison
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | | | - Sandie Wong
- Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Sheila Degotardi
- Macquarie School of Education, Macquarie University, Sydney, Australia
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5
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Heinrichs DH, Wang A, Zhou J, Seale H. Multilingual COVID-19 vaccination videos in NSW, Australia: a case study of cultural-responsiveness on social media. J Vis Commun Med 2023; 46:133-142. [PMID: 37746710 DOI: 10.1080/17453054.2023.2258940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
Multimodal communication via social media employed by governments as a COVID-19 communication strategy with multilingual populations hopes to alter behaviours and attitudes. However, there is presently no understanding about the responsiveness of these videos to the needs of culturally and linguistically diverse (CaLD) populations in Australia. This study aimed to analyse the cultural responsiveness of content in multilingual videos shared via a government social media page from NSW, Australia. A systematic search of videos shared between June 2021 and October 2021 was conducted. Using quantitative methods, 37 videos were analysed using a modified version of the Patient-oriented and culturally-adapted (POCA) healthcare translation model and readability indexes. Of these, 5/37 were classified as culturally responsive. The culturally responsive videos scored higher than those that were not culturally responsive. While credible sources, positive language and cultural symbols were observed in several of the videos, there was a lack of familiar experiences and economically viable vaccine uptake behaviours. Videos favoured generic examples of vaccine practices and failed to address concerns about vaccine eligibility, cost, and transport. All videos exceeded recommended readability indices for CaLD populations. Removing complex and abstract terminology and including familiar vaccine experiences could improve multilingual communication for CaLD communities.
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Affiliation(s)
- Danielle H Heinrichs
- Centre for Social and Cultural Research, Griffith University, Mt Gravatt, QLD, Australia
| | - Amy Wang
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Jessica Zhou
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Bonner C, Batcup C, Cvejic E, Ayre J, Pickles K, Copp T, Cornell S, Nickel B, Dhahir M, McCaffery K. Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments. JMIR Public Health Surveill 2023; 9:e40441. [PMID: 37172319 PMCID: PMC10337324 DOI: 10.2196/40441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/31/2023] [Accepted: 05/12/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. OBJECTIVE We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. METHODS The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy-sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). RESULTS In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy-sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. CONCLUSIONS This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true.
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Affiliation(s)
- Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carys Batcup
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Erin Cvejic
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Ayre
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kristen Pickles
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tessa Copp
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samuel Cornell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mustafa Dhahir
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Seale H, Harris-Roxas B, Mustafa K, McDermid P. Communication and engagement of community members from ethnic minorities during COVID-19: a scoping review. BMJ Open 2023; 13:e069552. [PMID: 37344110 DOI: 10.1136/bmjopen-2022-069552] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES This review examined the factors influencing communication and engagement with ethnic and racial minority groups in Australia during the COVID-19 pandemic. It aimed to answer two main questions: (1) what communication problems people from these communities typically faced during the pandemic? and (2) what strategies and recommendations were suggested to enhance communication and engagement for ethnic and racial minorities during the current COVID-19 pandemic and any similar events in the future? DESIGN Scoping review. DATA SOURCES PubMed, EMBASE, Cochrane Library, PsychINFO and CINAHL. Grey literature was searched within organisations' websites and a Google search of key terms. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included original research, case studies, reports (including government and charity reports), systematic and scoping articles and literature reviews in English, published from January 2020 to August 2022. DATA EXTRACTION AND SYNTHESIS Two researchers independently assessed the literature for eligibility and extracted data from the included literature. The selected papers were analysed and summarised into themes relevant to the research questions. The final review included 38 studies combining published academic papers and grey literature. RESULTS Key themes relating to communication and engagement issues included a lack of trust in authority, a lack of access to information and ineffective communication channels and a lack of timely and culturally responsive materials. To reduce the issues, the papers spoke about the key role of community organisations to provide local support and community leaders as trusted spokespersons. Lastly, key recommendations to reduce inequity and strengthen future pandemic responses focused on the need for collaborations and consultations, increasing the number of bilingual workers and supporting community-led communication efforts. CONCLUSIONS The insights gained from the activities and experiences documented in this review during the COVID-19 pandemic should be incorporated into future decision-making and interventions to enhance communication and engagement strategies.
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Affiliation(s)
- Holly Seale
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kinza Mustafa
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pippa McDermid
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Taba M, Ayre J, Freeman B, McCaffery K, Bonner C. COVID-19 messages targeting young people on social media: content analysis of Australian health authority posts. Health Promot Int 2023; 38:7143327. [PMID: 37099680 DOI: 10.1093/heapro/daad034] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Health authorities utilized social media during the COVID-19 pandemic to disseminate critical and timely health messages, specifically targeting priority groups such as young people. To understand how social media was used for this purpose, we investigated the content of COVID-19-related social media posts targeting young people (16-29 years old) shared by Australian health departments. Posts targeting young people with COVID-19 information were extracted from all eight Australian State and Territory health department Facebook, Instagram and TikTok accounts over 1 month of the Delta outbreak (September 2021) and analysed thematically. In total, 238 posts targeting young people were identified from 1059 COVID-19 posts extracted. All eight health departments used Facebook, five used Instagram and only one used TikTok. The majority of posts implicitly targeted young people; only 14.7% explicitly mentioned age or 'young people'. All posts included accompanying visuals; 77% were still images like photos or illustrations whilst 23% were moving images like videos and GIFs. Communication techniques included calls to action (63% of posts), responsive communication (32% of posts) and positive emotional appeal (31% of posts). Social marketing techniques catering to young people were used to varying extents despite receiving higher levels of engagement; 45% featured emojis whilst only 16% used humour, 14% featured celebrities and 6% were memes. Priority groups like ethnic/cultural groups and chronic health/disability communities were rarely targeted in this communication. The findings indicate a lack of health communication on social media directed towards young people, highlighting an opportunity for increased use of platforms like TikTok and trends popular with young people online.
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Affiliation(s)
- Melody Taba
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy & Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Julie Ayre
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy & Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Muscat DM, Mouwad D, McCaffery K, Zachariah D, Tunchon L, Ayre J, Nutbeam D. Embedding health literacy research and best practice within a socioeconomically and culturally diverse health service: A narrative case study and revised model of co-creation. Health Expect 2023; 26:452-462. [PMID: 36448214 PMCID: PMC9854312 DOI: 10.1111/hex.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/12/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Health literacy interventions and research outcomes are not routinely or systematically implemented within healthcare systems. Co-creation with stakeholders is a potential vehicle through which to accelerate and scale up the implementation of innovation from research. METHODS This narrative case study describes an example of the application of a co-creation approach to improve health literacy in an Australian public health system that provides hospital and community health services to one million people from socioeconomically and culturally diverse backgrounds. We provide a detailed overview of the value co-creation stages and strategies used to build a practical and sustainable working relationship between a University-based academic research group and the local health district focussed on improving health literacy. RESULTS Insights from our experience over a 5-year period informed the development of a revised model of co-creation. The model incorporates a practical focus on the structural enablers of co-creation, including the development of a Community of Practice, co-created strategic direction and shared management systems. The model also includes a spectrum of partnership modalities (spanning relationship-building, partnering and co-creating), acknowledging the evolving nature of research partnerships and reinforcing the flexibility and commitment required to achieve meaningful co-creation in research. Four key facilitators of health literacy co-creation are identified: (i) local champions, (ii) co-generated resources, (iii) evolving capability and understanding and (iv) increasing trust and partnership synergy. CONCLUSION Our case study and co-creation model provide insights into mechanisms to create effective and collaborative ways of working in health literacy which may be transferable to other health fields in Australia and beyond. PATIENT AND PUBLIC CONTRIBUTION Our co-creation approach brought together a community of practice of consumers, healthcare professionals and researchers as equal partners.
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Affiliation(s)
- Danielle M. Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Dana Mouwad
- Western Sydney Local Health District, Integrated and Community HealthHealth Literacy HubSydneyNew South WalesAustralia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Dipti Zachariah
- Western Sydney Local Health District, Integrated and Community HealthMulticultural HealthSydneyNew South WalesAustralia
| | - Lyn Tunchon
- Western Sydney Local Health District, Integrated and Community HealthChild and Family HealthSydneyNew South WalesAustralia
| | - Julie Ayre
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Don Nutbeam
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Muscat DM, Ayre J, Mac O, Batcup C, Cvejic E, Pickles K, Dolan H, Bonner C, Mouwad D, Zachariah D, Turalic U, Santalucia Y, Chen T, Vasic G, McCaffery KJ. Psychological, social and financial impacts of COVID-19 on culturally and linguistically diverse communities in Sydney, Australia. BMJ Open 2022; 12:e058323. [PMID: 35537788 PMCID: PMC9091490 DOI: 10.1136/bmjopen-2021-058323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/25/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the psychological, social and financial outcomes of COVID-19-and the sociodemographic predictors of those outcomes-among culturally and linguistically diverse communities in Sydney, Australia. DESIGN Cross-sectional survey informed by the Framework for Culturally Competent Health Research conducted between March and July 2021. SETTING Participants who primarily speak a language other than English at home were recruited from Greater Western Sydney, New South Wales. PARTICIPANTS 708 community members (mean age: 45.4 years (range 18-91)). 88% (n=622) were born outside of Australia, 31% (n=220) did not speak English well or at all, and 41% (n=290) had inadequate health literacy. OUTCOME MEASURES Thirteen items regarding COVID-19-related psychological, social and financial outcomes were adapted from validated scales, previous surveys or co-designed in partnership with Multicultural Health and interpreter service staff. Logistic regression models (using poststratification weighted frequencies) were used to identify sociodemographic predictors of outcomes. Surveys were available in English or translated (11 languages). RESULTS In this analysis, conducted prior to the 2021 COVID-19 outbreak in Sydney, 25% of the sample reported feeling nervous or stressed most/all of the time and 22% felt lonely or alone most/all of the time. A quarter of participants reported negative impacts on their spousal relationships as a result of COVID-19 and most parents reported that their children were less active (64%), had more screen time (63%) and were finding school harder (45%). Mean financial burden was 2.9/5 (95% CI 2.8 to 2.9). Regression analyses consistently showed more negative outcomes for those with comorbidities and differences across language groups. CONCLUSION Culturally and linguistically diverse communities experience significant psychological, social and financial impacts of COVID-19. A whole-of-government approach is needed to support rapid co-design of culturally safe support packages in response to COVID-19 and other national health emergencies, tailored appropriately to specific language groups and accounting for pre-existing health disparities.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Ayre
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Mac
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carys Batcup
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Pickles
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hankiz Dolan
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dana Mouwad
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Dipti Zachariah
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Una Turalic
- Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Yvonne Santalucia
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tingting Chen
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gordana Vasic
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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