"A bit of everything": Health literacy interventions in chronic conditions - a systematic review

The mediating role of health literacy for COVID-19 between preventive behaviors and quality of life

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic rapidly developed around the world. Plenty of health information about the virus was available from multiple media platforms, but such information was not always accurate. Identifying misinformation depends on an individual's health literacy.

AIMS

The purposes of this study were to explore sociodemographic factors affecting health literacy in terms of COVID-19 and preventive behaviors, and relationships among health literacy, preventive behaviors, and quality of life by path modeling.

METHODS

A cross-sectional study design was conducted in July to November 2020. Participants were healthy adults aged over 20 years in the United States. Data collection used self-developed questionnaires designed by our research team and the World Health Organization-Quality of Life Scale. Descriptive analyses, independent t-tests, a one-way analysis of variance, and a partial least squares path model were performed for the statistical analyses.

RESULTS

In total, 467 people responded. Results showed significant differences in health literacy and preventive behavior scores in terms of age, gender, alcohol consumption, smoking status, being a health professional, and having been tested for COVID-19. A significant path model was developed with satisfactory to good composite reliability, good convergent validity and discriminant validity, and an acceptable model fit.

CONCLUSIONS

Health literacy was a significant mediator between preventive behaviors and quality of life in the path model. Individuals can improve their health literacy to reinforce engaging in preventive behaviors and promoting quality of life during the pandemic.

Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context

BACKGROUND

Individuals with chronic musculoskeletal conditions experience persistent pain and disability that has deleterious impacts on physical function, psychological health, social engagement, relationships, and work participation. This impact is greater in people with psychosocial risk factors, and best practice musculoskeletal care recommends a biopsychosocial approach to management. Orthopaedic surgery is often an effective management approach for chronic musculoskeletal conditions, but research has only recently explored the links between differing patient outcomes after orthopaedic surgery and psychosocial risk factors. Implementing biopsychosocial approaches to musculoskeletal care has taken great strides in the primary care setting however, implementation of the biopsychosocial approach in orthopaedic surgery brings complexity as the context changes from primary care to hospital based secondary care. The aim of this review therefore is to explore implementation of psychosocial care in the elective orthopaedic surgery context, informed by evidence in musculoskeletal care.

ASSESSMENT AND MANAGEMENT OF PSYCHOSOCIAL FACTORS

Several composite screening tools for psychosocial factors or 'yellow flags' are recommended for use in primary care for musculoskeletal conditions alongside a comprehensive patient interview. However, in the orthopaedic surgery context, composite measures have focused on discharge destination, and there is not a universal approach to comprehensive patient interview incorporating a biopsychosocial approach. A range of biopsychosocial approaches to musculoskeletal conditions have been developed for the primary care setting, yet few have been explored in the context of orthopaedic surgery.

IMPLEMENTATION OF PSYCHOSOCIAL CARE

Implementing best practice psychosocial care into the orthopaedic context has enormous potential for all stakeholders, but several barriers exist at the level of the individual patient and practitioner, workforce, health service and society. We have discussed key considerations for implementation including workforce composition, patient-centred care and shared decision making, health literacy, continuity of care, and consideration of preferences for women and culturally diverse communities.

CONCLUSION

This review considers current literature exploring implementation of psychosocial care into the orthopaedic surgery context, informed by current research in musculoskeletal care. This presents a critical opportunity for orthopaedic surgery to provide optimised, equitable, high-value, patient-centred care.

Health literacy profiles in kidney transplanted patients: A cluster analysis

BACKGROUND

Health literacy is important in chronic conditions, such as kidney transplantation. Understanding patients' health literacy profiles can assist tailoring follow-up and educational programmes to the health literacy needs of vulnerable kidney transplant recipients. This approach enabled us to cluster patients according to their profiles of challenges and strengths in different health literacy domains.

OBJECTIVES

This study aimed to identify different health literacy profiles within kidney transplant recipients and what characterized the different profiles.

DESIGN

Cross-sectional study.

PARTICIPANTS

One hundred ninety-five kidney transplanted recipients were included.

MEASUREMENTS

We used the self-reported Health Literacy Questionnaire and analyzed using Ward's method (hierarchical cluster approach). We also collected background characteristics and clinical variables, including psychological distress (Hopkins Symptoms Checklist) and perceived health status (visual analogue scale, EuroQol-5D).

RESULTS

The analysis revealed four clusters with substantial differences in health literacy profiles. One cluster's patients had the most challenges in all health literacy domains constituting 24% of the sample. Compared to the other three clusters, this cluster was associated with shorter duration of kidney disease, higher number of patients in dialysis before transplantation, higher percentage of male patients, lower number of kidneys from living donors, higher number of patients not working and higher representation of psychological distress. All four clusters reported the most challenges in the same domain: the ability to critically appraise health information.

CONCLUSION

In kidney transplant recipients, profiling clusters with the Health Literacy Questionnaire and Ward's method aids in identifying health literacy needs in vulnerable groups, enabling transplant professionals to offer tailored health literacy support.

Health literacy levels of patients with chronic obstructive pulmonary disease: a cross-sectional study

Health literacy is defined as an individual's ability to access, understand and use information to make informed decisions. This study aimed to assess health literacy levels and explore the relationship between health literacy and chronic obstructive pulmonary disease (COPD) severity. A cross-sectional study of health literacy in patients with COPD used the Health Literacy Questionnaire (HLQ) and the Medical Research Council Breathlessness Scale to assess COPD severity. HLQ domains of 'having sufficient information to manage my health', 'actively managing health', and 'understanding health information' scored most highly. Patients with the greatest COPD severity had lower scores in the domain 'having sufficient information to manage my health', but indicated an improved ability to appraise health information. Patients with increased COPD severity have greater self-reported skills in appraising health information, but they report reduced confidence in having sufficient information to manage their health. This study highlights the importance of considering health literacy levels, as this could be a barrier to successful self-management.

Perceptions of the 2D short animated videos for literacy against chronic diseases among adults with diabetes and/or hypertension: a qualitative study in primary care clinics

BACKGROUND

Animation has promise for teaching complex health content through smartphone applications. However, smartphones have had limited use in Thailand for health literacy improvement among adults with chronic diseases. This study aims to explore the perceptions of adults with diabetes and/or hypertension resulting from 2D short animated videos for literacy against chronic disease that are available via smartphones.

METHODS

Four animated videos were initially developed based on clinical practice guidelines and nursing experience. Physicians, an expert in health education, and an animation team developed and revised scripts and storyboards of the animated videos. Lastly, videos were validated by physicians and health educators for content breadth and depth and by media experts for motion graphics and illustration. Each video presents a different situation in diabetes, hypertension, missing appointments, and obesity, ranging from 2.18 to 4.14 min in duration. The inclusion criteria were adults 35-70 years old with diabetes or hypertension who received care from primary care units. Thematic analysis was performed on the extracted data.

RESULTS

Twenty participants with a mean age of 58.4 years (SD 6.7; ranged 41-68) were focus-group interviewed. Three animation elements were assessed, including presentation, impacts, and suggestions. Participants had positive responses regarding the presentation (suitability of images and smooth motion graphics, short length of videos, simple language, understandable content, and clear sound) and impacts (recalling information, enhancing engagement, and motivating health awareness and behavior change). Suggested improvements were for a bigger font size for subtitles and considering the use of spoken text instead of on-screen text for recommendations at the end of the animations.

CONCLUSIONS

Animated videos are acceptable for delivering health information. Pilot testing animated videos for promoting literacy against chronic diseases in adults with diabetes and hypertension is needed for optimal utility.

Validation of the Japanese version of the scales of the attitudes toward people with epilepsy (SAPE-J)

OBJECTIVE

The aims of this study were to translate the SAPE questionnaire (Scales of the Attitudes toward People with Epilepsy) questionnaire developed in Germany that assesses attitudes toward people with epilepsy (PWE) into Japanese and to examine its reliability and validity.

METHODS

We crafted the Japanese version of SAPE (SAPE-J) by drawing upon the original German version. On May 22nd and 23rd, 2023, we surveyed the general public registered with an online research survey service (Cross Marketing Group Inc., Tokyo, Japan) using an online questionnaire. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in Japanese, and the ability to comprehend the Japanese questionnaires. In addition to the translated SAPE-J, we asked about knowledge of epilepsy, personal experience with epilepsy, and gathered information about age, gender, employment status, education level, marital status, and household income in accordance with the validation of the German version of the SAPE.

RESULTS

400 adults from the general public who had heard or read about epilepsy were asked to participate, granted informed consent, and completed the study questionnaire. The SAPE-J questionnaire has 6 scales: 1. Social Distance; 2. Stereotypes; 3. Concerns when encountering a person with epilepsy (PWE) and emotional reactions differentiated by 4.1 Fear, 4.2. Anger, and 4.3 Pity; with a total of 26 items. The reliability of these scales ranged between acceptable to high (Cronbach's alpha 0.74-0.92) and confirmatory factor analyses (CFA) confirmed the presumed six-factor structure of the SAPE (factorial validity). Multivariate generalized linear models (GLM) were used to investigate the construct validity and showed that, depending on subscale, different variables such as age, gender, education level, personal contact to PWE, and epilepsy specific knowledge were significant predictors of attitudes.

SIGNIFICANCE

The Japanese version of the SAPE proved reliable and valid for assessing attitudes toward PWE in the Japanese public. Increasing understanding about how to deal with and accept persons with epilepsy may help reduce negative attitudes and fears about the condition.

PLAIN LANGUAGE SUMMARY

The study translated the German SAPE questionnaire, which measures attitudes toward people with epilepsy (PWE), into Japanese and tested its reliability and validity. The Japanese version (SAPE-J) was created and surveyed online among 400 adults in Japan. The SAPE-J has 6 scales covering social distance, stereotypes, and emotional reactions like fear, anger, and pity. Reliability was high (Cronbach's alpha 0.74-0.92), and factor analyses confirmed its structure. The study found age, gender, education, and personal contact with PWE influenced attitudes. The SAPE-J is reliable and valid for assessing attitudes toward PWE in Japan, potentially reducing negative views and fears about epilepsy.

Health literacy friendly organizations - A scoping review about promoting health literacy in a surgical setting

OBJECTIVE

This review aims to describe interventions that promote health literacy in a surgical setting and identify knowledge gaps for future research.

METHODS

A scoping review with a systematic search was performed in Medline, CINAHL, Scopus, and Web of Science between January 1, 2012, and January 23, 2024. All screening was conducted using the Covidence software. In total, the search yielded 6 281 articles.

RESULTS

Eighteen articles were included in the results. Studies were heterogeneous regarding the type of health literacy measured, type of surgery, and type of intervention. Most interventions were educational to improve knowledge, decision making or health literacy through digital media, group sessions or consent forms. Most interventions had a positive impact on health literacy.

CONCLUSIONS

Patients with limited health literacy may benefit from a variety of interventions. However, research in this area is sparse. Further research is needed into interventions that may be beneficial for patients.

PRACTICE IMPLICATIONS

Measure, evaluate and implement health literacy-friendly options to ensure people can make safe and sound decisions for their care. Researchers need to consider the type of health literacy investigated and the type of instrument used in the research.

Effectiveness of a health communication intervention on health literacy in the first year following kidney transplantation - A randomized controlled study

OBJECTIVE

This study aimed to evaluate the effect of a new health communication intervention focusing on knowledge management skills on health literacy and medication adherence during the first year following kidney transplantation.

METHODS

We randomized 195 patients during 2020-2021, to either intervention- or control group. Questionnaires were completed at baseline and at 12 months post-transplantation with a 12-month response rate of 84%. Health literacy was measured by the multidimensional Health Literacy Questionnaire (HLQ) instrument. Medication adherence was measured by the self-reported questionnaire (BAASIS©).

RESULTS

Results showed that the intervention group had a significant increase in 2 HLQ domains compared to the control group capturing the "ability to appraise health information" Domain 5, (p-value = 0.002) and the "ability to navigate the healthcare system" Domain 7, (p-value <0.04). The effect sizes of SRM were 0.49 (Domain 5) and 0.33 (Domain 7). Medication adherence was comparable in the groups at any measure points.

CONCLUSIONS

This study contributes to important knowledge about how a health communication intervention focusing on knowledge translation using motivational interviewing techniques positively strengthens health literacy in kidney transplant recipients.

PRACTICAL IMPLICATIONS

Current patient education practice may benefit from focusing on knowledge translation in combination with motivational interview technique.

Health literacy and adolescents' substance use behaviors and correlates: a scoping review

From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable correlates of substance use prevention [e.g. health literacy (HL)], which, if embedded in interventions, may improve uptake and outcomes. Hence, this study conducted a scoping review to answer the question: What is known from the existing literature about the relationship between HL and substance use correlates and behaviors in adolescents? Five electronic databases and the bibliography of review articles were searched and a total of 1770 records were identified. After removing duplicates and engaging in three levels of screening to identify studies that included adolescents ≤ 25 years old and assessed the relationship between general HL (vs. behavior/disease-specific health knowledge) and substance use behaviors and correlates, 16 studies were retained. Studies assessed alcohol-related (n = 11), tobacco-related (n = 12), electronic vapor product use-related (n = 4), cannabis-related (n = 1), and amphetamines/methamphetamines-related (n = 1) outcomes. Studies spanned Africa, Asia, Europe, and North and Central America. Most studies included substance use as an outcome and found an inverse relationship between HL and use. Few studies examined substance use correlates (e.g. risk perception). There were no longitudinal or intervention studies. This review highlighted that the topic of adolescent HL and its relationship with substance use remains inadequately researched. Notable gaps for future studies include intervention and longitudinal designs, expansion of outcomes (e.g. more studies on marijuana, prescription drug misuse, vaping, substance use-related correlates), and examining HL as a mediator or moderator of substance use and its correlates.

Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey

BACKGROUND

College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors.

OBJECTIVE

As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students.

METHODS

The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants.

RESULTS

More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=-5.97, P<.001) and perceived efficacy (t411=-4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (β=3.81, P<.001), self-tracking health practices (β=2.22, P=.03), and eHealth literacy (β=24.29, P<.001).

CONCLUSIONS

Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students.

Is Primary Care Patient Experience Associated with Provider-Patient Language Concordance and Use of Interpreters for Spanish-preferring Patients: A Systematic Literature Review

BACKGROUND

Healthcare provided by a bilingual provider or with the assistance of an interpreter improves care quality; however, their associations with patient experience are unknown. We reviewed associations of patient experience with provider-patient language concordance (LC) and use of interpreters for Spanish-preferring patients.

METHOD

We reviewed articles from academic databases 2005-2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Joanna Briggs Institute Checklists to rate study quality. We reviewed 217 (of 2193) articles, yielding 17 for inclusion.

RESULTS

Of the 17 included articles, most articles focused on primary (n = 6 studies) or pediatric care (n = 5). All were cross-sectional, collecting data by self-administered surveys (n = 7) or interviews (n = 4). Most assessed the relationship between LC or interpreter use and patient experience by cross-sectional associations (n = 13). Two compared subgroups, and two provided descriptive insights into the conversational content (provider-interpreter-patient). None evaluated interventions, so evidence on effective strategies is lacking. LC for Spanish-preferring patients was a mix of null findings (n = 4) and associations with better patient experience (n = 3) (e.g., receiving diet/exercise counseling and better provider communication). Evidence on interpreter use indicated better (n = 2), worse (n = 2), and no association (n = 2) with patient experience. Associations between Spanish-language preference and patient experience were not significant (n = 5) or indicated worse experience (n = 4) (e.g., long waits, problems getting appointments, and not understanding nurses).

CONCLUSION

LC is associated with better patient experience. Using interpreters is associated with better patient experience but only with high-quality interpreters. Strategies are needed to eliminate disparities and enhance communication for all Spanish-preferring primary care patients, whether with a bilingual provider or an interpreter.

Health literacy interventions for informal caregivers: systematic review

AIM

The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.

METHODS

MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool.

RESULTS

Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL.

DISCUSSION

Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.

Psychosocial interventions affecting global perceptions of control in people with Parkinson's disease: a scoping review

PURPOSE

Perceived control is an important construct for the psychological well-being of people affected by chronic conditions, and higher perceived control is associated with better outcomes. Psychosocial interventions have been trialled in these populations to improve both global and specific perceptions of control. However, most interventions involving people with Parkinson's have focused on single-domain forms of control, while those addressing global perceived control are yet to be reviewed. This study aimed to identify and map the types of psychosocial interventions in individuals with Parkinson's which have included forms of global perceived control as an outcome.

MATERIALS AND METHODS

Scoping review based on a search across MEDLINE, PsycINFO, CINAHL, Academic Search Ultimate.

RESULTS

From an initial return of 4388 citations, 12 citations were eventually included. These consisted of 8 quantitative and 4 qualitative studies, and covered 4 overarching categories of psychosocial interventions. Mixed results were found for cognitive, educational, and physical interventions, while a randomised controlled trial on mindfulness-based lifestyle programme showed more preliminary positive evidence.

CONCLUSIONS

Further rigorous research is required on the topic to build on these preliminary findings. In the meantime, clinicians may need to consider programmes which proved effective with populations similar to people with Parkinson's.IMPLICATIONS FOR REHABILITATIONPerceived control is a psychological construct important for people with chronic illnesses, which can be targeted by psychosocial interventions.This article reviewed psychosocial interventions targeting global forms of perceived control in Parkinson's.Mixed results were reported for the cognitive, educational, and physical interventions identified, while a randomised controlled trial on a mindfulness-based lifestyle programme showed more promising evidence.In the meantime, clinicians may need to consider programmes found to be effective with people with similar conditions to Parkinson's.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Health literacy and musculoskeletal disorders in adolescents: a scoping review

OBJECTIVES

Health literacy (HL) related to musculoskeletal disorders (MSDs) in adolescents is a field with limited previous evidence. This study aimed to review and synthesise studies on MSDs and HL as well as various dimensions of HL in adolescents.

DESIGN

Scoping review in accordance with Arksey and O'Malleys framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

SEARCH STRATEGY

The search strategy was performed in the following databases in November 2021 (initial search) and December 2022 (updated search); Medline, EMBASE, PsychINFO, Cochrane, CINAHL, ERIC, Web of Science and Google Scholar. Eligible studies involving MSDs and HL or either of the HL dimensions related to finding, understanding, appraising or applying health information in adolescents were considered. Any dimension of HL studied, the outcome measure(s) used to assess HL and the type of MSD examined were charted, reviewed and synthesised. A directed content analysis was used for the subjective interpretation of text data.

RESULTS

A total of 16 841 studies were identified and 33 were eligible for inclusion. Ten articles presented HL with a definition or description in the theoretical background. The remaining 23 studies involved finding, understanding, appraising or applying health information, without using the term 'health literacy'. Most of the studies addressed how adolescents understand (n=32), and apply (n=23) health information, while few studies focused on how they find (n=11) and appraise (n=7) musculoskeletal health information.

CONCLUSION

Few studies have addressed HL and MSDs in adolescents explicitly, while most studies have considered dimensions of HL. Our findings suggest that there is important work to be done to align conceptual understandings with the measurement of HL in adolescents and that further research should be carried out to explore how HL is distributed among adolescents with MSDs and how adolescents living with MSDs report their HL.

Developing and maintaining health literacy: A continuous emotional, cognitive, and social process for parents of children with epilepsy-A qualitative study

Childhood epilepsy is often complicated by neurobehavioral comorbidities, and parents are expected to actively engage in managing the condition. Insufficient parental health literacy (HL) has been associated with reduced health outcomes for children with epilepsy. Little is known about the parents' experiences of information seeking, social support, navigating the healthcare system, and interactions with healthcare professionals and how these skills may contribute to the development of sufficient HL. This study explored parents' experiences of their caregiver responsibility and the development of their HL in relation to caring for their child with epilepsy. Ten parents of children under 12 years of age with epilepsy were purposedly sampled and interviewed individually, using semi-structured interviews. The interviews were analyzed using qualitative content analysis, in line with Graneheim & Lundman. The analyses resulted in three themes, each comprising two sub-themes. The themes were: (1) Alone with the responsibility, (2) The combat for information and support, and (3) Developing vigilance and distrust in system competence. Lack of flexibility in healthcare services, insufficient multidisciplinary collaboration, and unclear treatment provider responsibility made the parents feel alone in the caregiver's responsibility. Poor local provider competence related to childhood epilepsy was a barrier to developing sufficient HL. A trusting relationship with professionals and timely access to competent health services were facilitators for developing HL. Higher HL made the parents more critical for the healthcare services, which triggered vigilance and reduced their trust in the professionals' information. For the parents, developing and maintaining HL was a continuous emotional, cognitive, and social process. Health information and care support need to be adjusted to the severity of the child's condition, the resources are available, and the parent's HL. The results of this study may contribute to the development of future interventions for strengthening parental HL in the childhood epilepsy context.

Association between multiple chronic conditions and insufficient health literacy: cross-sectional evidence from a population-based sample of older adults living in Switzerland

BACKGROUND

Health literacy is the ability to find, understand, assess, and apply health information. Individuals suffering from multiple chronic conditions have complex healthcare needs that may challenge their health literacy skills. This study aimed to investigate the relationship between multimorbidity, the number of chronic conditions, and health literacy levels in a sample of adults aged 58+ in Switzerland.

METHODS

We used data from 1,615 respondents to a paper-and-pencil questionnaire administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy was measured using the short version of the European Health Literacy Survey questionnaire. The final score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12), and sufficient (13-16). The number of chronic conditions was self-reported based on a pre-defined list. Associations were examined using multivariable ordinary least squares and ordered probit regression models, controlling for key socio-demographic characteristics.

RESULTS

Overall, 63.5% of respondents reported having at least one chronic condition. Respondents who reported one, two, and three or more chronic conditions were more likely to have lower health literacy scores compared to respondents who did not report any chronic condition (p<0.05, p<0.01, and p<0.001, respectively). Suffering from two and three or more chronic conditions (vs. no chronic condition) was significantly associated with a higher likelihood of having inadequate or problematic health literacy levels (both p-values <0.01).

CONCLUSIONS

Our findings suggest a need to improve health literacy in older adults suffering from chronic conditions. Improved health literacy could constitute a promising lever to empower individuals to better self-manage their health to ultimately reduce the double burden of chronic diseases and insufficient health literacy in this vulnerable population.

Effectiveness of discharge education using teach-back method on readmission among heart failure patients: A systematic review and meta-analysis

OBJECTIVE

This study aims to review and evaluate the effectiveness of discharge education using the teach-back method (TBM) on readmission rates among patients with heart failure (HF).

METHODS

Searches were conducted in five electronic databases (PubMed, CINAHL, Embase, Cochrane Library, and Web of Science) published until May 2022, followed by a manual search of reference lists. The risk of bias in the studies was assessed using the Cochrane Risk of Bias and Joanna Briggs Institute quasi-experimental critical appraisal tool, and meta-analysis was conducted using Cochrane Review Manager 5.

RESULTS

Seven studies were included in the review, and the quality of the studies varied, with two studies scoring low on the overall risk of bias. Meta-analysis was conducted using six studies, demonstrating that discharge education using TBM significantly reduced the overall readmission rates (odds ratio = 0.40, 95% confidence interval 0.17-0.94).

CONCLUSIONS

TBM is an effective educational strategy for reducing the readmission rate in discharged patients with HF. More rigorously designed studies evaluating the effectiveness of education using TBM in patients with HF are needed.

PRACTICE IMPLICATIONS

Nurses in clinical settings can use TBM in their discharge education to improve HF patients' understanding of the illness and impact long-term outcomes, such as readmission rates.

Internet survey on knowledge and perceptions of epilepsy among the general public in Japan

Objective

To improve the life quality of people with epilepsy, it is necessary to provide comprehensive epilepsy care and disseminate accurate information related to epilepsy to the public. In Japan, reports of traffic accidents involving people with epilepsy started to draw attention in the media in 2011. Ever since that, the association between the image of epilepsy from the general public, "Epilepsy," and "Danger," was more robust in 2013. Since 2017, no previous surveys have examined the perceptions and knowledge of epilepsy among the public in Japan. As an essential source of information for epilepsy care, we conducted a nationwide Internet-based survey to elucidate the current state of knowledge and perceptions of epilepsy among the public without epilepsy in Japan.

Methods

We conducted an online survey from July 29 to August 2, 2021, with 213 respondents (115 male, 97 female, and one unidentified; mean age: 50.52 ± 12.34 years) registered with an online survey service in Japan. In this survey, we first questioned whether or not a respondent had epilepsy, and then those with epilepsy were excluded from participation. We collected basic demographic information, administered the Epilepsy Knowledge Scale (18 items), and asked the open-ended response question, "What kind of disease do you think epilepsy is? If you do not know, please describe epilepsy in your words." We adopted quantitative text analysis using KH Coder3 and co-occurrence network analysis to examine the connections between words.

Results

Among the respondents, 92% have heard of epilepsy, and 26.8% have observed an epileptic seizure before the survey. The knowledge scale yields an average score of 27.96 ± 21.3 (out of 100), with the question with the highest percentage of correct responses being "People with epilepsy are just as capable as other people" at 51.64%. The question with the lowest percentage of correct responses was "If the person with epilepsy only has seizures during sleep, the person can have a driver's license," at 9.85%. The average number of Japanese characters responding to open-ended text questions was 10.45 ± 8.87 characters (including Kanji, Hiragana, and Katakana). We found that the word "froth" appeared more frequently with experience of observing a seizure, and the words "occur" and "brain" appeared more frequently with higher knowledge of epilepsy. Furthermore, comparing the sources of information from what they learned about epilepsy, the words "seizure," "faint," and "consciousness" appeared more frequently in school, with family and friends, and in newspapers and television, respectively.

Conclusion

We identified the level of knowledge and perceptions of epilepsy among the general public in Japan in 2021. By analyzing the qualitative aspects of open-ended text responses, we gathered information that might be useful for informing the public of future efforts to provide accurate information related to epilepsy.

The Effectiveness of Physical Literacy Interventions: A Systematic Review with Meta-Analysis

BACKGROUND

The holistic concept of physical literacy assumes that individuals require adequate cognitive (knowledge and understanding), affective (motivation and confidence), and physical (physical competence) qualities to engage in lifelong physical activity behavior. In recent years, the research field has undergone rapid development and has also yielded an increasing number of interventions that aim to translate the theoretical-philosophical ideas into practical endeavors.

OBJECTIVE

The goal of the present pre-registered systematic review was to (a) provide a general overview of evaluation studies on physical literacy interventions and (b) to quantitatively examine the effectiveness of physical literacy interventions.

METHODS

Drawing on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched a total of 18 databases for physical literacy interventions. Inclusion criteria were English language, publication by November 2021, and interventions using physical literacy as a theoretical underpinning or evaluation outcome. Articles that met these criteria were analyzed with respect to their basic delivery characteristics, study quality, evaluation approach, and main findings. We additionally ran meta-analyses with all non-randomized and randomized controlled trials to examine and compare the effect of these interventions on five outcome categories: (i) physical competence, (ii) motivation and confidence, (iii) knowledge and understanding, (iv) physical activity behavior, and (v) total physical literacy. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the effects on the different categories.

RESULTS

The screening process with two independent raters yielded 48 eligible interventions reported in 51 eligible articles. Quantitative evaluations most frequently addressed physical competence (72.2%), followed by motivation and confidence (47.2%), physical activity behavior (41.7%), and knowledge and understanding (33.3%). The controlled intervention studies (n = 24) exerted significant effects on all five physical literacy categories. Despite meaningful heterogeneity across the subgroups, the strongest effects were found for physical competence (SMD 0.90; 95% CI 0.55-1.25), followed by physical literacy aggregate scores (SMD 0.61; 95% CI 0.20-1.01), knowledge and understanding (SMD 0.54; 95% CI 0.30-0.79), physical activity behavior (SMD 0.39; 95% CI 0.23-0.55), and motivation and confidence (SMD 0.30; 95% CI 0.17-0.44).

CONCLUSIONS

The present study empirically demonstrated the effectiveness of physical literacy interventions on several outcomes relevant for promoting physical activity and health. To better inform current practices, future studies are advised to identify those program characteristics that significantly influence the effectiveness of physical literacy interventions.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42020188926.