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Kassem AB, Al Meslamani AZ, Elmaghraby DH, Magdy Y, AbdElrahman M, Hamdan AM, Mohamed Moustafa HA. The pharmacists' interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic. J Pharm Policy Pract 2024; 17:2372040. [PMID: 39011356 PMCID: PMC11249153 DOI: 10.1080/20523211.2024.2372040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Healthcare systems in developing countries faced significant challenges during COVID-19, grappling with limited resources and staffing shortages. Assessment of the impact of pharmaceutical care expertise, particularly in critical care units during the pandemics, in developing countries remains poorly explored. The principal aim of our study was to assess the impact of the Drug and Therapeutics Committee (DTC), comprising clinical pharmacists, on the incidence, types, and severity of medication errors and associated costs in using COVID-19 medications, especially antibiotics. Methods An interventional pre-post study was carried out at a public isolation hospital in Egypt over 6 months. Results Out of 499 medication orders, 238 (47.7%) had medication errors, averaging 2.38 errors per patient. The most frequent were prescribing errors (44.9%), specifically incorrect drug choice (57.9%), excessive dosage (29.9%), treatment duplication (4.5%), inadequate dosage (4.5%), and overlooked indications (3.6%). Linezolid and Remdesivir were the most common medications associated with prescribing errors. Pharmacists intervened 315 times, primarily discontinuing medications, reducing doses, introducing new medications, and increasing doses. These actions led to statistically significant cost reductions (p < 0.05) and better clinical outcomes; improved oxygen saturation, decreased fever, stabilised respiratory rates, and normalised white blood cell counts. So, clinical pharmacist interventions made a notable clinical and economic difference (66.34% reduction of the expenses) in antibiotics usage specifically and other medications used in COVID-19 management during the pandemic. Conclusion Crucially, educational initiatives targeting clinical pharmacists can foster judicious prescribing habits.
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Affiliation(s)
- Amira B. Kassem
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Ahmad Z. Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Dina H. Elmaghraby
- Kafr El Dawar General Hospital, Department of infectious disease, Ministry of Health, Beheira, Egypt
| | - Yosr Magdy
- Kafr El Dawar General Hospital, Department of infectious disease, Ministry of Health, Beheira, Egypt
| | - Mohamed AbdElrahman
- Clinical Pharmacy Department, College of Pharmacy, Al-Mustaqbal University, Babylon, Iraq
- Clinical pharmacy Department, Badr University Hospital, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Ahmed M.E. Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
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Salwa M, Islam S, Tasnim A, Al Mamun MA, Bhuiyan MR, Choudhury SR, Amin MR, Haque MA. Health Literacy Among Non-Communicable Disease Service Seekers: A Nationwide Finding from Primary Health Care Settings of Bangladesh. Health Lit Res Pract 2024; 8:e12-e20. [PMID: 38329843 PMCID: PMC10849776 DOI: 10.3928/24748307-20240119-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/14/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. OBJECTIVE Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. METHODS In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. KEY RESULTS Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. CONCLUSIONS NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12-e20.].
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Affiliation(s)
| | | | | | | | | | | | | | - M. Atiqul Haque
- Address correspondence to M. Atiqul Haque, PhD, Room No: 343, Block B, Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh;
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Awwad O, AlMuhaissen SA, Al-Kharouf M, Al-Nashwan A, Abdeljalil M, Al-Qerem W. Validation of the Arabic Version of the Health Literacy (HLS-Q12) Questionnaire in chronically ill patients. Health Promot Int 2023; 38:7150746. [PMID: 37133881 DOI: 10.1093/heapro/daad037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Health literacy (HL) is an essential component of public health. Few tools are used to measure HL in Arabic-speaking countries, essentially the Short Test of Functional Health Literacy in Adults and the Single Item Literacy Screener. The new 12-item version of the European Health Literacy Survey Questionnaire (HLS-Q12), has not been validated in the Arabic language. This study aimed to translate the English version of HLS-Q12 into Arabic, test its structure and explain any variance in HLS-Q12 scores, allowing its use in Arabic-speaking healthcare contexts. A forward-backward translation was adopted. Reliability was assessed using Cronbach's α. Confirmatory factor analysis (CFA) and Rasch Model evaluated the model fit of the Arabic version of HLS-12. The effects of different patient-related variables on HLS-Q12 scores were tested using linear regression. A total of 389 patients visiting the site hospital outpatient clinics participated in the study. HLS-Q12 mean ± SD score was 35.8 ± 5.0, 50.9% of the participants showed an intermediate HL score. Good reliability (α = 0.832) was observed. CFA confirmed the scale unidimensionality. Rasch analysis indicated HLS-Q12 items to be within the fit acceptable thresholds except for Item 12. The only item that displayed unordered response categories was Item 4. Most of the items were considered relatively easy by respondents. Linear regression revealed age, education, healthcare-related education and income to have effects significantly different from zero on HLS-Q12 score. Interventions targeting the most health-disparate groups of individuals with characteristics contributing to lower HL, are needed.
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Affiliation(s)
- Oriana Awwad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Suha A AlMuhaissen
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Mohammad Al-Kharouf
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Ayat Al-Nashwan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Mariam Abdeljalil
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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4
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Poza-Méndez M, Bas-Sarmiento P, Erahmouni I, Fernández-Gutiérrez M. Assessment of health literacy among migrant populations in Southern Spain: A cross-sectional study. Nurs Open 2023; 10:2600-2610. [PMID: 36480226 PMCID: PMC10006600 DOI: 10.1002/nop2.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy. DESIGN A cross-sectional descriptive study. METHODS Health literacy was measured in a total of 278 immigrants using HLS-EU-Q16. An inferential descriptive and multiple regression analysis was carried out. RESULTS 65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r = .398), age (r = .178p) and perceived social status (r = .151). Participants with shorter length of stay (β = .405 1), without health sciences education (β = .205) and low education level (β = .182) had limited health literacy.
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Affiliation(s)
- Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, INIBICA, Cádiz, Spain.,The University Research Institute for Sustainable Social Development (INDESS), Cádiz, Spain
| | | | - Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, INIBICA, Cádiz, Spain.,The University Research Institute for Sustainable Social Development (INDESS), Cádiz, Spain
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5
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Bergman L, Nilsson U, Dahlberg K, Jaensson M, Wångdahl J. Validity and reliability of the arabic version of the HLS-EU-Q16 and HLS-EU-Q6 questionnaires. BMC Public Health 2023; 23:304. [PMID: 36765302 PMCID: PMC9912492 DOI: 10.1186/s12889-023-15226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Health literacy is an important social determinant of health and affects the ability to make decisions and take action to manage one's health. The purpose of this study was to psychometrically examine the Arabic versions of HLS-EU-Q16 and HLS-EU-Q6 and their response patterns among Arabic-speaking persons in Sweden. METHODS By convenience sampling from a variety of settings, a total of 335 participants were invited to participate. The participants completed a self-assessment of comprehensive health literacy by answering the Ar-HLS-EU-Q16 questionnaire, also including the six items for Ar-HLS-EU-Q6. Statistical analysis was guided by The COnsensus-based Standards for the selection of health Measurement Instruments. Floor/ceiling effects, construct, structural and criterion validity, test-retest reliability and internal consistency reliability were analysed. RESULTS In total, 320 participants were included in the psychometric evaluation. Mean age was 42.1 (SD 12.5), 63% (n = 199) were females and 53% (n = 169) had at least 10 years of education. No floor or ceiling effect were found for the Ar-HLS-EU-Q16 or Ar-HLS-EU-Q6. For both instruments, construct validity was confirmed in four out of five expected correlations (weak positive correlation to educational level, self-perceived health, and years in Sweden; moderate positive correlation with higher sum score on the Arabic electronic health literacy scale, and strong positive correlation to higher Ar-HLS-EU-Q16/Ar-HLS-EU-Q6). For Ar-HLS-EU-Q16, the principal component analysis resulted in a three-factor model with all items significantly correlating to only one factor. For Ar-HLS-EU-Q6, the principal component analysis supported a one-factor solution. Criterion validity showed poor agreement between the two questionnaires with a Cohen κ 0.58 (p < 0.001). Test-retest reliability showed a substantial agreement, Cohen's κ for Ar-HLS-EU-Q16 and Ar-HLS-EU-Q6 were both 0.89. The internal consistency of both versions was acceptable, Cronbach alpha for Arabic-HLS-EU-Q16 was 0.91 and for Arabic-HLS-EU-Q6, 0.79. Split-half reliability was 0.95 and 0.78, respectively. CONCLUSION The Arabic version of HLS-EU-Q16 shows good psychometric properties, validated in a Swedish setting. The findings can further inform and guide future validation studies in other settings worldwide. Furthermore, the results of the present study did not support criterion validity of Ar-HLS-EU-Q6.
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Affiliation(s)
- Lina Bergman
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Ulrica Nilsson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Karuna Dahlberg
- grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Josefin Wångdahl
- Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. .,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Tomtebodavägen 18a, 171 77, Solna, Sweden.
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Essam N, Khafagy MA, Alemam DS. Health literacy of pregnant women attending antenatal care clinics in Mansoura district, Egypt. J Egypt Public Health Assoc 2022; 97:24. [PMID: 36451018 PMCID: PMC9712839 DOI: 10.1186/s42506-022-00119-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Health literacy (HL) is an important maternal factor that is involved in the engagement of a mother and her children with health promotion and preventive activities. Studies have found poor HL in large proportions of the population of both developed and developing countries. This study measures the HL of pregnant women and explores its associated factors. METHODS A cross-sectional study was conducted on 382 pregnant women attending antenatal care clinics in Mansoura district, Egypt, using an interviewer-administered questionnaire. The Arabic version of the European Health Literacy Survey Questionnaire-short version (HLS-EU-Q16) was used to assess the HL of the participants. RESULTS The study showed that 79.8% of studied pregnant women had limited HL (34.5% insufficient HL and 45.3% problematic HL), and only 20.2% of them had sufficient HL. Limited HL was independently predicted by unsatisfactory income (OR = 6.9; 95% confidence interval [CI]: 3.2-15.3; P ≤ 0.05), lower than university education (OR = 5.3; 95% CI: 1.6-17.2; P ≤ 0.05), and having unplanned pregnancy (OR = 3.7; 95% CI: 1.6-8.5; P ≤ 0.05). CONCLUSION The majority of pregnant women in this study had limited HL. It was more frequent among women with lower levels of education, insufficient incomes, and unplanned pregnancies. Antenatal care programs should provide services that respond to the HL level and needs of pregnant women.
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Affiliation(s)
- Noha Essam
- grid.10251.370000000103426662Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, El-Gomhouria Street, El-Mansoura, PO 35516 Egypt
| | - Mohamad Azmy Khafagy
- grid.10251.370000000103426662Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, El-Gomhouria Street, El-Mansoura, PO 35516 Egypt
| | - Doaa Shokry Alemam
- grid.10251.370000000103426662Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, El-Gomhouria Street, El-Mansoura, PO 35516 Egypt
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7
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Validation of the COVID-19 Digital Health Literacy Instrument in the Italian Language: A Cross-Sectional Study of Italian University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106247. [PMID: 35627789 PMCID: PMC9140816 DOI: 10.3390/ijerph19106247] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
The Coronavirus Disease 19 (COVID-19) pandemic and the associated “infodemic” have shown the importance of surveillance and promotion of health literacy, especially for young adults such as university students who use digital media to a very high degree. This study aimed to assess the validity and reliability of the Italian version of the COVID-19 adapted version of the Digital Health Literacy Instrument (DHLI). This cross-sectional study is part of the COVID-19 University Students Survey involving 3985 students from two Italian universities. First, item analysis and internal consistency were assessed. Then, Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were performed comparing different models. The Italian DHLI showed good psychometric characteristics. The protecting privacy subscale was excluded, given the criticalities presented in the validation process. CFA confirmed the four-factor structure, also including a high-order factor. This result allows using the scale to measure a global level of digital health literacy and consider its levels separately for each construct component: searching the web for information, evaluating reliability, determining personal relevance, and adding self-generated content.
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8
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Correa-Rodríguez M, Rueda-Medina B, Callejas-Rubio JL, Ríos-Fernández R, de la Hera-Fernández J, Ortego-Centeno N. The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases. Clin Nurs Res 2022; 31:981-990. [PMID: 35484917 DOI: 10.1177/10547738221090558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to evaluate health literacy in a population of patients with systemic autoimmune diseases (SAD), and to analyze their potential relationships with health-related quality of life (HRQoL), attitudes and beliefs of Covid-19 and vaccination, and perceptions of changes in medical care during the pandemic. A cross-sectional study was conducted among 395 patients (81.1% were living in Spain). An anonymous online survey was distributed to an online SAD association. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the SF-36 tool was used to assess HRQoL. More than half of patients (57.7%) have inadequate health literacy and the mean health literacy level was 9.63(5.66). Patients with inadequate health literacy levels presented the lowest HRQoL scores in all SF-36 domains (p < .001). Health literacy scores were positively correlated with all SF-36 domains (p < .001). The reservations to get vaccinated against Covid-19 were linked to health literacy level (p = 0.024). There are high levels of inadequate health literacy among patients with SAD and it is associated with worse HRQoL and risk attitudes about Covid-19 vaccination and medical care during the pandemic.
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Affiliation(s)
- María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - José-Luis Callejas-Rubio
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Raquel Ríos-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Javier de la Hera-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Norberto Ortego-Centeno
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Department of Medicine, University of Granada, Granada, Spain
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Flynt Wallington S, Greaney M, Rampa S, Cummings C. Using 3 Assessment Tools to Measure Patient Health Literacy in Rhode Island at Federally Qualified Community Health Centers. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2048751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Ramos NNV, Fronteira I, Martins MRO. Building a Health Literacy Indicator from Angola Demographic and Health Survey in 2015/2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052882. [PMID: 35270574 PMCID: PMC8910521 DOI: 10.3390/ijerph19052882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023]
Abstract
Health literacy is a determinant factor for population health. It is important both for the prevention of health problems and the better management of those problems and unexpected situations that happen. Low health literacy has been consistently associated with poor health outcomes. This study aimed to develop a health literacy indicator for Angola and to analyze pertinent demographic characteristics related to it. Data were obtained from the first Angola Demographic and Health Survey conducted in 2015/16; we included 10 questions related to the American National Academy of Medicine definition of health literacy. Using factor analysis, we extracted one i indicator corresponding to four dimensions of health literacy. The indicator was dichotomized, and we used Logistic Regression to estimate factors associated with health literacy level: we obtained data from 19,785 adolescents and adults, aged 15–49 years. The internal consistency of the i indicator was reliable (Cronbach’s α = 0.83). Adjusting for other variables, males with complete secondary education or above and living in urban areas were more likely to have a high level of health literacy. There were substantial differences between the 18 regions. This is the first study evaluating health literacy in Angola using the American National Academy of Medicine definition and a Demographic and Health survey. Our study shows unfavorable results for women, individuals living in rural areas and those less educated.
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Jaensson M, Stenberg E, Liang Y, Nilsson U, Dahlberg K. Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study. BMJ Open 2021; 11:e056592. [PMID: 34848528 PMCID: PMC8634233 DOI: 10.1136/bmjopen-2021-056592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery. DESIGN A prospective cross-sectional psychometric study. SETTING Patients from three bariatric centres in Sweden were consecutively included in this study. PARTICIPANTS A total of 704 patients undergoing bariatric surgery filled in the questionnaires preoperatively. Inclusion criteria were scheduled for primary bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) and greater than 17 years, proficiency in Swedish. PRIMARY AND SECONDARY MEASURES Psychometric outcomes of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale. RESULTS There was a higher proportion of females (74.4%, n=523) to males (25.6%, n=180). The mean age was 42 years (SD 11.5). Limited functional health literacy and limited communicative and critical health literacy (including both inadequate and problematic health literacy) was reported in 55% (n=390) and 40% (n=285), respectively. Cronbach alpha for the Swedish Functional Health Literacy scale was α=0.86 and for the Swedish Communicative and Critical Health Literacy scale, α=0.87. Construct validity showed weak to negative correlations between the Swedish Functional Health Literacy scale and income, education and SF-36/RAND36 summary scores. Confirmatory factor analysis showed a one-factor solution for the Swedish Functional Health Literacy scale and a two-factor solution for the Swedish Communicative and Critical Health Literacy scale. CONCLUSIONS The Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale are valid and reliable to use for patients undergoing bariatric surgery in a Swedish context. Measuring dimensions of health literacy can be used as a guide for the development of health literacy friendly patient information in patients undergoing bariatric surgery.
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Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro university, Örebro, Sweden
| | - Yuli Liang
- Department of Statistics, School of Business, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Bouclaous CH, Salem S, Ghanem A, Saade N, El Haddad J, Bou Malham M, Al Osta S, Matar K, Nassar E, Yared G, Khiami M, Joe Eid M. Health Literacy Levels and Predictors Among Lebanese Adults Visiting Outpatient Clinics in Beirut. Health Lit Res Pract 2021; 5:e295-e309. [PMID: 34756119 PMCID: PMC8579750 DOI: 10.3928/24748307-20211012-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/09/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To date, there has been a dearth of research on health literacy in the Eastern Mediterranean Region and in particular Lebanon. OBJECTIVES This cross-sectional study assessed the levels and correlates of health literacy in Lebanese adults. METHODS A total of 587 participants (54.5% women) were recruited from the outpatient clinics of five health facilities in Beirut. The questionnaire consisted of the Arabic version of the Functional Health literacy Scale, the Arabic short version of the European Health Literacy Survey, and questions on sociodemographic and health-related factors. Descriptive and inferential statistics were performed to assess the association of these factors with functional health literacy (FHL) and comprehensive health literacy (CHL) levels. KEY RESULTS About 65.8% had inadequate or problematic FHL and 43.8% had inadequate or problematic CHL. Although FHL was negatively correlated with long-term illness, it was positively correlated with ability to pay and health status. CHL was positively correlated with education, income, ability to pay for treatment, health status, and FHL level, whereas it was negatively correlated with long-term illness. Binary logistic regression showed that low education, low socioeconomic status, and being a widow were predictive of inadequate FHL. Moreover, having inadequate FHL and low income increased the likelihood of having inadequate CHL. CONCLUSION This study has identified those with risk factors for inadequate health literacy and unfavorable health outcomes. A national action plan can guide the promotion of health literacy and its embeddedness in society to instill competencies and the environment that would eliminate health inequities and sustain health in Lebanon. [HLRP: Health Literacy Research and Practice. 2021;5(4):e295-e309.] Plain Language Summary: This study examined health literacy levels and correlates in 587 Lebanese adults using two recognized screening tools. The first tool measured functional health literacy (FHL), which represents the ability of a person to acquire information on health through reading or writing. The second tool assessed comprehensive health literacy (CHL), which encompasses the ability of a person to use their social skills to acquire health information from different media and make appropriate health decisions based on this information. Close to two-thirds of the participants had inadequate or problematic FHL. More specifically, low education, low socioeconomic status, and widowhood were predictive of inadequate FHL. Nearly one-half of the participants had inadequate or problematic CHL with an increased likelihood of inadequate levels in people with low FHL and low income.
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Affiliation(s)
- Carmel H. Bouclaous
- Address correspondence to Carmel H. Bouclaous, PhD, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University School of Medicine, P.O. Box 36, Byblos, Lebanon;
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Bouclaous C, Haddad I, Alrazim A, Kolanjian H, El Safadi A. Health literacy levels and correlates among refugees in Mount Lebanon. Public Health 2021; 199:25-31. [PMID: 34534886 DOI: 10.1016/j.puhe.2021.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The study aimed to assess the levels and correlates of health literacy among refugees. STUDY DESIGN This is a cross-sectional study design. METHODS Health literacy was assessed through face-to-face interviews in eight primary healthcare centers (PHCs) in Mount Lebanon. The questionnaire consisted of the Arabic Functional Health literacy scale, the short version of the European Health Literacy Survey (HLS-EU-Q16), socio-economic questions (sex, age, nationality, marital status, educational level, and ability to pay for medical fees at PHCs), and health-related questions (self-perceived health, long-term illness, recent visit to health care, and freedom to make health decisions). Statistical analyses were performed to evaluate the association between functional health literacy (FHL), comprehensive health literacy (CHL), and potential explanatory variables. RESULTS Of 263 participants (61.6% females), mean age 38.49 ± 12.80 years, 52.1% had inadequate FHL and 35.7% had inadequate CHL. The likelihood of having inadequate CHL was higher in refugees who were ever married (odds ratio [OR] = 2.794; 95% confidence interval [CI]: 1.187-6.576) or had average ability to pay for medical expenses at PHC (OR = 4.562; 95% CI: 1.554-13.393). The odds of having inadequate FHL was lower in refugees with some level of education (OR = 0.211; 95% CI: 0.077-0.580). Furthermore, their perceived lack of freedom to make personal health decisions was associated with inadequate levels of CHL (OR = 5.195; 95% CI: 2.693-10.022) and FHL (OR = 4.676; 95% CI: 2.610-8.376). CONCLUSIONS Health messages and delivery should be tailored to refugee health literacy levels. Initiatives should seek to improve refugee interaction with the health system, promote uptake of available health services and facilitate health-related decision-making in daily life.
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Affiliation(s)
- C Bouclaous
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
| | - I Haddad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - A Alrazim
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - H Kolanjian
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - A El Safadi
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Ashour ASA, Ali AS. Authors' Response: Can a Three-Arm RCT With Two Active Drugs Have One Placebo? Yes, the Literature Contains Many. J Pediatr Adolesc Gynecol 2021; 34:577-579. [PMID: 33762221 DOI: 10.1016/j.jpag.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ahmed S A Ashour
- Department of obstetrics and gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Ahmed S Ali
- Faculty of Medicine, Al Azhar University, Egypt
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The Sociodemographic Determinants of Health Literacy in the Ethnic Hungarian Mothers of Young Children in Eastern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115517. [PMID: 34063905 PMCID: PMC8196676 DOI: 10.3390/ijerph18115517] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022]
Abstract
Parental health literacy is a decisive factor for child health and quality of life. Children of parents with limited health literacy are at increased risk of illness and longer recovery periods. The research at the Quality of Life Research Centre is aimed at studying the health literacy of ethnic Hungarian mothers in Eastern Europe (Hungary, Slovakia, Romania) as well as at assessing its socioeconomic and demographic antecedents. The sample size is 894 mothers. Our standardized online questionnaire includes the HLS-EU-16 and the BHLS questions, with the latter intended to screen for inadequate health literacy. Predictors of health literacy in mothers are socioeconomic status, age and partnership status. A key finding is the improvement of health literacy with age. Assessing the association of partnership status and health literacy is a novelty in this region. Our analysis reinforces the role of socioeconomic capital, widely recognized to be associated with health literacy in general and with parental health literacy in particular. Results indicate the necessity of improving caregiver health literacy with a range of health promotional activities in Eastern Europe, especially among mothers with low socioeconomic status. The hardships of young mothers and single mothers should also be considered in this respect.
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Wångdahl J, Dahlberg K, Jaensson M, Nilsson U. Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study. J Med Internet Res 2021; 23:e24466. [PMID: 33749614 PMCID: PMC8074986 DOI: 10.2196/24466] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/15/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
Background Health information is often communicated through the internet. It is vital for the end user to have a range of digital skills as well as understand the information to promote their health. There is a valid and reliable 8-item instrument, the Electronic Health Literacy Scale (eHEALS), that evaluates these skills. The number of Arabic-speaking people migrating to Sweden and to other parts of the world is increasing due to unstable military and political situations in their countries of origin. Poor health and limited health literacy have been described in this population in Sweden. Still, to our knowledge, an Arabic version of eHEALS has not been tested for validity or reliability. Thus, Arabic-speaking populations in Sweden cannot be included in studies measuring eHealth literacy, which does not support equal treatment in health care. Objective The aim of this study was to translate and adapt the original English eHEALS version into Arabic and to evaluate its psychometric properties. Methods The eHEALS was rigorously translated, adapted, and evaluated for content validity. We conducted prospective psychometric evaluation with natively Arabic-speaking participants living in Sweden. Construct validity, factor structure, internal consistency, and test-retest reliability were evaluated using Spearman correlation, principal component analysis, Cronbach α, and weighted quadratic Cohen κ, respectively. Results The study population consisted of Arabic-speaking participants (n=298; age: mean 41.8 years, SD 10.5). Construct validity was supported with weak and moderate correlations. Principal component factor analysis revealed a one-factor structure. Internal consistency was high (Cronbach α=0.92); test-retest reliability was acceptable (weighted quadratic Cohen κ=0.76). Evaluation indicated that eHealth literacy threshold values should be dichotomized (limited and sufficient) rather than trichotomized (inadequate, problematic, and sufficient). Conclusions The Arabic version of eHEALS, a unidimensional scale that is valid and reliable for measuring eHealth literacy among natively Arabic-speaking people in Sweden, was found to be acceptable and feasible in a general population.
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Affiliation(s)
- Josefin Wångdahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Mostafa A, Abdelzaher A, Rashed S, AlKhawaga SI, Afifi SK, AbdelAlim S, Mostafa SA, Zidan TA. Is health literacy associated with antibiotic use, knowledge and awareness of antimicrobial resistance among non-medical university students in Egypt? A cross-sectional study. BMJ Open 2021; 11:e046453. [PMID: 33649060 PMCID: PMC8098941 DOI: 10.1136/bmjopen-2020-046453] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Antibiotic resistance is a global public health concern, especially in developing countries, where antibiotic misuse is widespread. However, studies investigating relevant factors, particularly in youth, are limited. This study examined the levels of health literacy (HL) and their association with antibiotic use, knowledge of antibiotics and awareness of antibiotic resistance among university students in Egypt. DESIGN A cross-sectional study was conducted using self-administered questionnaires during 2018. The Health Literacy Survey (HLS-EU-Q16) and the WHO Antibiotic resistance: Multi-Country Public Awareness Survey were used. Bivariate and multivariable analyses were used to compare responses on use and knowledge of antibiotics, and awareness of antibiotic resistance between the three levels of students' HL. SETTING University, Cairo, Egypt. PARTICIPANTS 508 non-medical university students. OUTCOMES Students' HL scores were categorised into sufficient, problematic and inadequate. Students' knowledge of antibiotics was categorised into good and poor. Students' awareness of antibiotic resistance was categorised into high, average and poor. RESULTS 35.1% of students had sufficient HL. 79.7% of students had poor knowledge of antibiotics. 39.9% of students reported having used antibiotics in the past month without a prescription. 92.2% had limited awareness of antibiotic resistance and 30.6% of students heard about the term 'antimicrobial resistance'. Background characteristics did not significantly differ by HL levels or knowledge scores, except for students' year of study. Sufficient HL was independently associated with students' high awareness of antibiotic resistance (adjusted OR=2.8; 95% CI: 1.3 to 5.9). CONCLUSIONS HL was insufficient in this sample of non-medical Egyptian university students. Across all levels of HL, knowledge of antibiotics and awareness of antibiotic resistance were limited, reflecting deficiency in relevant education programmes. Findings suggest that sufficient HL supports high awareness of antibiotic resistance. Incorporating HL and rational antibiotic use awareness raising programmes in university curricula is an urgent necessity to curb antibiotic resistance.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | | | - Salma Rashed
- Ain Shams University Faculty of Medicine, Cairo, Egypt
| | | | | | | | | | - Taha A Zidan
- Ain Shams University Faculty of Medicine, Cairo, Egypt
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Muflih SM, Bashir HN, Khader YS, Karasneh RA. The impact of health literacy on self-medication: a cross-sectional outpatient study. J Public Health (Oxf) 2020; 44:84-91. [PMID: 33164078 DOI: 10.1093/pubmed/fdaa188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/23/2020] [Accepted: 09/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This research project aims to measure and evaluate the impact of health literacy on self-medication and to achieve a better understating of patients' behaviors. METHODS A cross-sectional approach was conducted and participants were recruited outpatient clinics through convenience sampling. Health literacy was measured by Single Item Literacy Screener. RESULTS A total of 194 participants agreed to participate (63.9% were females). The results showed that more than half (57.2%) had adequate health literacy. Almost 30% of the participants were over the age of 50. The prevalence of self-medication was 74.2%. Nearly, two-thirds of the total participants reported self-administration of antibiotics. There was a significant relationship between the overall health literacy level and practice of self-medication. CONCLUSIONS Improving the health literacy level of the public can reduce inappropriate self-medication, especially the self-medication with antibiotics, which represented a high prevalence situation in our sample. Appropriate reading skills are important for accessing health information, using health care services, and achieving desirable health outcomes.
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Affiliation(s)
- Suhaib M Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hadeel N Bashir
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Reema A Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Bas-Sarmiento P, Poza-Méndez M, Fernández-Gutiérrez M, González-Caballero JL, Falcón Romero M. Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) for Arabic/French-Speaking Migrants in Southern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218181. [PMID: 33167475 PMCID: PMC7663905 DOI: 10.3390/ijerph17218181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022]
Abstract
Improving health literacy (HL) is critical for addressing health inequalities. Low literacy rates are believed to be more prevalent in ethnic minorities, which may have an impact on people's health. For measures to be implemented in this regard, HL must be evaluated to obtain specific indicators. Our aim, therefore, was to develop a version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which is recommended to be used with vulnerable populations, suited to Arabic/French-speaking migrants who reside in south-eastern Spain, and to explore its psychometric properties for assessing health literacy in this population. A cross-sectional survey was carried out in a convenient sample of 205 migrants. The structural validity was calculated by a confirmatory factorial analysis (CFA), which suggested appropriate adjustment indicators, and which indicated that the three-dimensional model is adequately adjusted to the data obtained in the study. The coefficient omega showed high internal consistency in the three HL dimensions (health care, disease prevention, and health promotion). Concurrent validity presented a significant correlation with the Newest Vital Sign test (r = 0.390; p < 0.001). The multigroup CFA showed that the heterogeneity of the sample used was not a problem for establishing the structural validity of the scale. The Arabic/French version showed good construct validity.
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Affiliation(s)
- Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University Institute of Research in Social Sustainable Development (INDESS), University of Cadiz, 11009 Cadiz, Spain;
| | - Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, Faculty of Nursing, University of Cadiz, 11207 Cadiz, Spain;
| | - Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University Institute of Research in Social Sustainable Development (INDESS), University of Cadiz, 11009 Cadiz, Spain;
- Correspondence: ; Tel.: +34-956-028-122
| | - Juan Luis González-Caballero
- Department of Statistics and Operational Research, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain;
| | - María Falcón Romero
- Department of Socio-Sanitary Sciences, University of Murcia, 30100 Murcia, Spain;
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Lorini C, Lastrucci V, Paolini D, Bonaccorsi G. Measuring health literacy combining performance-based and self-assessed measures: the roles of age, educational level and financial resources in predicting health literacy skills. A cross-sectional study conducted in Florence (Italy). BMJ Open 2020; 10:e035987. [PMID: 33020080 PMCID: PMC7537461 DOI: 10.1136/bmjopen-2019-035987] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The objective was to compare the results of performance-based and self-assessed measures of health literacy (HL) and to evaluate the contribution of their joint use in assessing some HL antecedents. DESIGN This was a cross-sectional study. SETTING The study was conducted on the general population in Florence (Italy). PARTICIPANTS This study is part of a larger one, where participants were randomly selected from the registries of 11 general practitioners working in the municipality of Florence. Inclusion criteria were the following: 18-69 years of age and Italian speaking. Exclusion criteria included cognitive impairment, severe psychiatric disease or end-stage disease. In this paper, 212 adults were included. OUTCOME MEASURES HL was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Newest Vital Sign (NVS). The HL levels obtained by means of the two measurement tools were combined into a new variable that described three different levels of HL skills: low HL skills, partial HL skills and high HL skills. Multivariate ordinal logistic regression analysis was performed to assess the predictive roles of age class, educational level and financial resources with respect to HL skills. RESULTS Twenty-two per cent of the sample had high HL skills, 28.3% had low HL skills and 49.5% had partial HL skills. Educational level, age class and financial resources were significantly associated with HL skills, with OR values being higher than those obtained using the NVS or the HLS-EU-Q16 individually. CONCLUSION The combination of the results obtained using the NVS and the HLS-EU-Q16 improves the understanding of HL. The new variable generated by this combination could be considered as a different way to assess HL and its multidimensional contents.
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Affiliation(s)
- Chiara Lorini
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
| | - Vieri Lastrucci
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
| | - Diana Paolini
- Department of Health Sciences, University of Florence, Firenze, FI, Italy
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Schiavone S, Attena F. Measuring Health Literacy in Southern Italy: A cross-sectional study. PLoS One 2020; 15:e0236963. [PMID: 32760150 PMCID: PMC7410250 DOI: 10.1371/journal.pone.0236963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Health Literacy (HL) is an important determinant of individual health. Limited HL is an increasing problem affecting the general population. This study aims to assess the level of HL in patients attending outpatient medical facilities in general medicine located in Naples and Caserta and investigate the association of HL with health behaviours and health status. MATERIALS AND METHODS The study involved patients attending outpatient medical facilities in general medicine. The questionnaire had four sections-the sociodemographic information, the 16-items version of the European Health Literacy Survey questionnaire, the general self-efficacy scale (GSE) and the health status scale (EQ-VAS). Univariate and multivariate analyses were performed to investigate the sociodemographic determinants of HL. The Pearson correlation coefficients were determined to compare HL with health behaviours (GSE) and health status (EQ-VAS). RESULTS The study showed that 61.6% of 503 patients had a low level of HL. After the multivariate analysis, HL was found to be higher among patients with higher education level and general self-efficacy score ≥30. There were no differences in HL between the age groups and people with or without chronic diseases. HL was stronger correlated with GSE than with EQ-VAS (0.53 vs 0.27). CONCLUSION This is the first study on HL for Southern Italy. It showed a low level of HL. As the sample was not representative of the reference population, we cannot derive a corresponding conclusion for the general population of Southern Italy. Therefore, more data in Italy are needed to plan actions for improving HL.
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Affiliation(s)
- Sara Schiavone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Attena
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- * E-mail:
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Anwar WA, Mostafa NS, Hakim SA, Sos DG, Abozaid DA, Osborne RH. Health literacy strengths and limitations among rural fishing communities in Egypt using the Health Literacy Questionnaire (HLQ). PLoS One 2020; 15:e0235550. [PMID: 32673345 PMCID: PMC7365439 DOI: 10.1371/journal.pone.0235550] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Health literacy is an important determinant of health. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of people living in a fishing community in northern Egypt. Methods and analysis Data were collected from 436 people (fisherman and their families), using the Health Literacy Questionnaire (HLQ), which includes 9 scales. Effect sizes (ES) for standardized mean differences estimated the magnitude of difference between demographic groups. Results The mean age of participants was 42 years, 50% were male, 42% were working in the fishing sector, 17.9% had access to the Internet and 36.8% were illiterate. Male participants showed higher capabilities in scales 3. Actively managing my health and 4. Social support for health (ES = 0.21 and 0.27, respectively). In comparison to other occupations, fishing occupation had a negative impact on scale 7. Navigating the healthcare system (ES -0.23). Also, higher educational level was associated with higher HLQ indicators. Across all scales, scale 2. Having sufficient information to manage my health showed the lowest mean (SD) score; 2.23 (0.76) indicating that most people reported they didn’t have enough information. Conclusions This study has revealed that fishermen and their families have a wide range of health literacy difficulties which are likely to have profound negative effects on health behavior and health outcomes.
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Affiliation(s)
- Wagida A. Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nayera S. Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- * E-mail:
| | - Sally Adel Hakim
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dalia G. Sos
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dena A. Abozaid
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Richard H. Osborne
- Centre for Global Health and Equity, Faculty of Health, Design and Arts, Swinburne University of Technology, Melbourne, Australia
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Karasneh RA, Al-Azzam SI, Alzoubi KH, Rababah LK, Muflih SM. Health literacy and related health behaviour: a community-based cross-sectional study from a developing country. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
The concept of health literacy (HL) is globally evolving, and understanding its nature and impact is essential for disease prevention and treatment. Therefore, we aimed in this study to assess level of HL and predictors of inadequate HL in Jordanian population as an example case of a developing country.
Method
This cross-sectional study was conducted in a public tertiary hospital and community pharmacies in Jordan. All respondents answered a questionnaire, which included demographic data, Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Short Test of Functional HL in Adults (S-TOFHLA), and All Aspects of HL Scale (AAHLS). Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for HL.
Key findings
Among 310 participants, REALM-R showed that around 27.1% had limited HL. Similar findings with S-TOFHLA and AAHLS were shown with a mean score 25.6 out of 35 (SD = 3.54, Range = 16–33) for AAHLS. Functional and critical HL were comparably low. Education level, age, living area and chronic conditions were significant predictors of HL (P < 0.05).
Conclusions
Health literacy was inadequate among Jordanians. Further research is required to assess the effect of inadequate HL on healthcare access and health outcomes. Health education programmes are required to improve HL particularly for patients with chronic diseases.
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Affiliation(s)
- Reema A Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Lana K Rababah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Suhaib M Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Sarhan MBA, Shannon HS, Fujiya R, Jimba M, Giacaman R. Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine. BMJ Open 2020; 10:e034943. [PMID: 32565456 PMCID: PMC7311025 DOI: 10.1136/bmjopen-2019-034943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Health literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties. DESIGN We conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews. SETTING AND PARTICIPANTS We conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017. METHODS We translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach's alpha, MacDonald's omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale's average inter-item correlation. RESULTS EFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach's alpha, MacDonald's omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59. CONCLUSION HAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.
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Affiliation(s)
- Mohammed B A Sarhan
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Harry S Shannon
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rika Fujiya
- Faculty of Nursing and Medical Care, Keio University, Fugisawa, Kanagawa, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
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İlhan N, Gencer S, Özdemir Ö, Maviyildiz S. The Relationship Between Health Literacy and Illness Self-Care Management in Turkish Patients With Cancer. Oncol Nurs Forum 2020; 47:E73-E85. [PMID: 32301929 DOI: 10.1188/20.onf.e73-e85] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the relationship between health literacy and illness self-care management in individuals with cancer. SAMPLE & SETTING 207 individuals with cancer undergoing treatment in the chemotherapy unit of a university hospital in Istanbul, Turkey. METHODS & VARIABLES Data were collected using a sociodemographic and illness characteristics questionnaire, the European Health Literacy Survey Questionnaire-Turkish Version (HLS-EU-Q-TR), and the Self-Care Management Process in Chronic Illness. Data were analyzed using descriptive statistics, one-way analysis of variance, student t test, Pearson correlation test, and multiple regression analysis. RESULTS 86% of individuals displayed an inadequate or problematic to limited level of health literacy. Extended family status and HLS-EU-Q-TR score were significant predictors of self-care management. IMPLICATIONS FOR NURSING Nurses can organize health programs designed to improve the level of health literacy in the population, but they should take into consideration the health literacy levels of their patients.
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Wångdahl J, Jaensson M, Dahlberg K, Nilsson U. The Swedish Version of the Electronic Health Literacy Scale: Prospective Psychometric Evaluation Study Including Thresholds Levels. JMIR Mhealth Uhealth 2020; 8:e16316. [PMID: 32130168 PMCID: PMC7063530 DOI: 10.2196/16316] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 01/29/2023] Open
Abstract
Background To enhance the efficacy of information and communication, health care has increasingly turned to digitalization. Electronic health (eHealth) is an important factor that influences the use and receipt of benefits from Web-based health resources. Consequently, the concept of eHealth literacy has emerged, and in 2006 Norman and Skinner developed an 8-item self-report instrument to measure these skills: the eHealth Literacy Scale (eHEALS). However, the eHEALS has not been tested for reliability and validity in the general Swedish population and no threshold values have been established. Objective The aim of this study was to translate and adapt eHEALS into a Swedish version; evaluate convergent validity and psychometric properties; and determine threshold levels for inadequate, problematic, and sufficient eHealth literacy. Methods Prospective psychometric evaluation study included 323 participants equally distributed between sexes with a mean age of 49 years recruited from 12 different arenas. Results There were some difficulties translating the English concept health resources. This resulted in this concept being translated as health information (ie, Hälsoinformation in Swedish). The eHEALS total score was 29.3 (SD 6.2), Cronbach alpha .94, Spearman-Brown coefficient .96, and response rate 94.6%. All a priori hypotheses were confirmed, supporting convergent validity. The test-retest reliability indicated an almost perfect agreement, .86 (P<.001). An exploratory factor analysis found one component explaining 64% of the total variance. No floor or ceiling effect was noted. Thresholds levels were set at 8 to 20 = inadequate, 21 to 26 = problematic, and 27 to 40 = sufficient, and there were no significant differences in distribution of the three levels between the Swedish version of eHEALS and the HLS-EU-Q16. Conclusions The Swedish version of eHEALS was assessed as being unidimensional with high internal consistency of the instrument, making the reliability adequate. Adapted threshold levels for inadequate, problematic, and sufficient levels of eHealth literacy seem to be relevant. However, there are some linguistic issues relating to the concept of health resources.
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Affiliation(s)
- Josefin Wångdahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Duplaga M. Determinants and Consequences of Limited Health Literacy in Polish Society. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020642. [PMID: 31963834 PMCID: PMC7014389 DOI: 10.3390/ijerph17020642] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/05/2020] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
Background: Health literacy (HL) is perceived as one of the most important concepts for modern health promotion activities to be successful. The research undertaken in the context of HL usually focuses on its antecedents and consequences, either for specific groups of patients or society or for the whole population. Objectives: The main aim of this study was to assess the antecedents and consequences of limited health literacy (HL) in a nationally representative sample of the Polish population. Methods: The analysis was carried out on the data obtained from a sample of 1000 Polish citizens through a telephone-based survey undertaken using a short, 16-item questionnaire developed within the European Health Literacy Project (HLS-EU). The total HLS score was calculated according to the guidelines published by the HLS-EU project. Chi2 test and logistic regression models were used for the analysis of the relationships between the variables. Results: The mean HL score (standard deviation) in the study sample was 12.99 (3.11). HL was related to age, marital and vocational status. Limited HL was associated with a lower self-assessment of health (OR, 95% CI: 2.52, 1.54–4.13), the prevalence of obesity and disability (1.71, 1.13–2.57, and 1.92, 1.25–2.94, respectively), less frequent physical activity (0.70, 0.49–0.99), a lower consumption of fruits and vegetables (0.47, 0.34–0.65), and with more frequent hospitalisations (2.02, 1.38–2.95). Conclusions: The assessment of HL using the16-item HLS-EU questionnaire may be a useful tool to enable health behaviours and utilisation of health care resources by society to be predicted.
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Affiliation(s)
- Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegorzecka Str. 20, 31-531 Krakow, Poland
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Wangdahl JM, Dahlberg K, Jaensson M, Nilsson U. Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol. BMJ Open 2019; 9:e029668. [PMID: 31530602 PMCID: PMC6756328 DOI: 10.1136/bmjopen-2019-029668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Equity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual's knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers' Health literacy and eHealth literacy levels in Sweden. METHODS AND ANALYSIS This is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ2 and Fisher's exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed. ETHICS AND DISSEMINATION The project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.
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Affiliation(s)
- Josefin M Wangdahl
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Karuna Dahlberg
- Faculty of Health and Medical Sciences, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Health and Medical Sciences, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care, Karolinska Universitetssjukhuset, Stockholm, Sweden
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Wikkeling-Scott LF, Ajja RJY, Rikard RV. Health literacy research in the Eastern Mediterranean Region: an integrative review. Int J Public Health 2019; 64:523-533. [DOI: 10.1007/s00038-018-01200-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/03/2018] [Accepted: 12/20/2018] [Indexed: 01/28/2023] Open
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Rouquette A, Nadot T, Labitrie P, Van den Broucke S, Mancini J, Rigal L, Ringa V. Validity and measurement invariance across sex, age, and education level of the French short versions of the European Health Literacy Survey Questionnaire. PLoS One 2018; 13:e0208091. [PMID: 30521552 PMCID: PMC6283623 DOI: 10.1371/journal.pone.0208091] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023] Open
Abstract
Background Short versions of the European Health Literacy Survey (HLS-EU) questionnaire are increasingly used to measure and compare health literacy (HL) in populations worldwide. As no validated versions of these questionnaires have thus far appeared in French, this study aimed to study the psychometric properties of the French translation of the 16- and 6-item short versions (HLS-EU-Q16 and HLS-EU-Q6), including their measurement invariance across sex, age, and education level. Methods A consensual French version of the HLS-EU-Q16 and HLS-EU-Q6 was developed by following the current recommendations for transcultural questionnaire adaptation. It was then completed by 317 patients recruited in waiting rooms of general practitioners in the Paris area (France). Structural validity was studied with the Rasch model for the HLS-EU-Q16 and confirmatory factorial analysis (CFA) for the HLS-EU-Q6. Concurrent and convergent validity, respectively, were assessed by scores on the Functional Communicative Critical Health Literacy (FCCHL) questionnaire and the physicians’ evaluations of their patient’s HL. Results The 16 items of the HLS-EU-Q16 were Rasch homogenous but meaningful differential item functioning (DIF) was found across sex, age, and/or education level for eight items. The CFA model fit for the HLS-EU-Q6 was poor. The overall scores for both HLS-EU short versions correlated poorly with the FCCHL scores. Similarly, HL levels defined using either short-version score did not agree with physicians’ HL assessments. Conclusion The French version of the HLS-EU-Q16 has acceptable psychometric properties, despite meaningful DIF for age, sex and education level and a poor discriminative power among subjects with average to high HL level. We recommend its use to measure HL in populations with sufficient reading skills to discriminate between subjects with low to average HL. Also, sensitivity analyses should be performed to evaluate the potential measurement bias due to DIF. Our results did not demonstrate the validity of the HLS-EU-Q6.
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Affiliation(s)
- Alexandra Rouquette
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, Le Kremlin-Bicêtre, France
| | - Théotime Nadot
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Pierre Labitrie
- Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Le Kremlin-Bicêtre, France
| | | | - Julien Mancini
- Aix-Marseille Univ, INSERM, IRD, UMR1252, SESSTIM, “Cancers, Biomedicine & Society” group, Marseille, France
- APHM, Timone Hospital, Public Health Department (BIOSTIC), Marseille, France
| | - Laurent Rigal
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Le Kremlin-Bicêtre, France
- Institut National d’Etudes Démographiques (INED), Paris, France
- * E-mail:
| | - Virginie Ringa
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Institut National d’Etudes Démographiques (INED), Paris, France
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