Health literacy supports active aging

Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study

Background

In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people's lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population.

Objective

This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces.

Methods

A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed.

Results

A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores.

Conclusions

Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases.

A Confidence Interval for the Difference Between Standardized Regression Coefficients

Researchers are often interested in comparing predictors, a practice commonly done via informal comparisons of standardized regression slopes. However, formal interval-based approaches offer advantages over informal comparison. Specifically, this article examines a delta-method-based confidence interval for the difference between two standardized regression coefficients, building upon previous work on confidence intervals for single coefficients. Using Monte Carlo simulation studies, the proposed approach is evaluated at finite sample sizes with respect to coverage rate, interval width, Type I error rate, and statistical power under a variety of conditions, and is shown to outperform an alternative approach that uses the standard covariance matrix found in regression textbooks. Additional simulations evaluate current software implementations, small sample performance, and multiple comparison procedures for simultaneously testing multiple differences of interest. Guidance on sample size planning for narrow confidence intervals, an R function to conduct the proposed method, and two empirical demonstrations are provided. The goal is to offer researchers a different tool in their toolbox for when comparisons among standardized coefficients are desired, as a supplement to, rather than a replacement for, other potentially useful analyses.

Concept analysis of "Insufficient health literacy" in older adults and refinement of a diagnosis proposal

PURPOSE

This study aims to conduct a thorough analysis of the concept of insufficient health literacy (IHL) in older adults and to refine a nursing diagnosis proposal while considering the specific characteristics of this demographic.

METHODS

A comprehensive concept analysis was undertaken using Walker & Avant's method as a framework.

FINDINGS

A systematic search across seventeen databases yielded 29 relevant studies for inclusion. Through analysis, we identified 15 antecedents, 3 attributes, and 7 consequents associated with IHL in older adults.

CONCLUSIONS

The concept analysis brought clarity to the understanding of IHL within older adults, facilitating the refinement of a diagnosis proposal. This process was instrumental in establishing a diagnostic structure that accounts for the unique needs and challenges faced by older adults.

IMPLICATIONS FOR NURSING PRACTICE

The structured diagnosis derived from the concept analysis provides a solid theoretical foundation for nurses specializing in Gerontology. By tailoring care interventions to address the specific requirements of older adults, this framework enhances the quality of nursing practice and contributes to improved patient outcomes in geriatric care settings.

Traditional Chinese medicine health literacy among rural older adults: a cross-sectional study

Background

The purpose of this study was to understand the current status of traditional Chinese medicine (TCM) health literacy among rural older adults people and its influencing factors.

Methods

This study used a random number table method to select one prefecture from Henan Province, China and used a convenience sampling method to select 200 rural older adults who met the inclusion criteria in a township in northern Henan from March to April 2023. A cross-sectional survey was conducted using a general information questionnaire and a traditional Chinese medicine health literacy questionnaire, and the influencing factors of rural older adults were analyzed using univariate analysis of variance (ANOVA) and multiple linear regression.

Results

The total TCM health literacy score of 200 rural older adults people was 84.14 ± 6.709. One-way ANOVA revealed that six factors, including education level, marital status, type of occupation, presence of family members engaged in medical-related work, main economic sources, and monthly income, influenced the TCM health literacy score of rural older adults people (p < 0.05). Multiple linear regression analysis revealed that education level, occupation type, and the presence of family members engaged in medical-related work were the factors influencing the TCM health literacy of rural older adults.

Conclusion

The TCM health literacy level of rural older adults people is at the lower to middle level, and health educators should strengthen the publicity and education of TCM healthcare knowledge for rural older adults people to improve their TCM health literacy level and thus enhance their quality of life.

Factors associated with poor health literacy in older adults: A systematic review

OBJECTIVES

To identify factors associated with poor health literacy in older adults.

METHODS

A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy".

PROSPERO - CRD

42022350140.

RESULTS

Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others).

CONCLUSIONS

The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Association between health literacy and dysphagia in the community-dwelling older population: a cross-sectional study

BACKGROUND

Dysphagia, or swallowing disorders, has become a growing concern due to the aging population, and health literacy plays a crucial role in active aging. However, the relationship between them remains unclear.

AIMS

To investigate the association between health literacy and dysphagia among community-dwelling older adults in China.

METHODS

A survey was conducted on 4462 older adults aged 65 and above in a community in Yiwu City, China, from May 2021 to January 2022. Swallowing problems were assessed using a 30 ml water swallowing test (WST) and the Eating Assessment Tool-10 questionnaire (EAT-10). The participants' health literacy was evaluated using the Chinese Health Literacy Scale (CHLS). Logistic regression and t tests were employed to measure the association between them.

RESULTS

The prevalence of dysphagia was 5.70% and 7.85% as determined by EAT-10 and 30 ml-WST, respectively. The health literacy level of community-dwelling older adults was 24.4 ± 4.93 (9-45). Participants with dysphagia exhibited lower levels of health literacy (p < 0.05). The logistic regression model demonstrated an inverse association between health literacy and dysphagia (OR = 0.94, 95%CI = 0.91-0.96 for EAT-10, and OR = 0.93, 95%CI = 0.92-0.95 for WST). Moreover, this association remained significant even after adjusting for covariates.

DISCUSSION

Older adults with dysphagia have lower levels of health literacy, particularly in terms of their ability to seek medical advice, acquire and evaluate medical information, and access social support resources.

CONCLUSIONS

Health literacy is associated with dysphagia among community-dwelling older adults. Effective interventions should be implemented to provide support in terms of both medical services and social support for this population.

The active aging level of the rural older adults with disability in China: a cross-sectional study

Background

Active aging has been listed as an important indicator to measure the quality of life of the older adults and the construction of the senior care system. There is an imbalance between the supply and demand of senior care services for the disabled older adults in rural areas, and the quality of life needs to be improved.

Objectives

We aimed to analyze the current situation of active aging and the influencing factors of the rural disabled older adults, in order to provide a reference basis for improving the quality of life of the rural disabled older adults.

Methods

We conducted a multicenter and cross-sectional study, using the Barthel Index Scale and Chinese version of the Active Aging Scale, to facilitate the selection of 304 rural older adults with disability in 26 villages under Henan Province for a questionnaire survey.

Results

The mean score for the level of active aging of rural older adults with disability was 1.87 (SD 0.36), with the highest score for the dimension of being self-reliant (Mean2.29, SD 0.61) and lower scores for the dimension of active contribution to society (Mean 1.37, SD 0.55) and building up financial security (Mean 1.37, SD 0.57). The results of the multiple regression analysis showed higher levels of active aging among the disabled older adults with retirement pay, mild disability, and longer time per activity/rehabilitation exercise (p < 0.05).

Conclusion

Active aging of the rural disabled older adults is at a low level, with insufficient economic security and social participation. The national government should help improve the quality of primary health care in rural areas, build a friendly environment for senior communities, and improve policies to protect the welfare of the older adults, so as to collaboratively empower the disabled older adults in rural areas at three levels: health, participation, and protection.

Health Support for At-Risk Older Adults during COVID-19

Older adults are highly susceptible to COVID-19 infection and at the highest risk for severe disease and death. Yet, older adults lacked access to accurate and easy-to-use COVID-19 information and support early in the pandemic. This prospective, experimental cohort study sought to examine whether older adults could be engaged during the pandemic through a community partner and if a low-touch intervention, designed with health literacy best practices, could positively impact COVID-19 knowledge, mitigation behaviors, telehealth/doctor visits, exercise, and loneliness. A senior resource kit was distributed to older adults sheltering at home through food assistance program agents from October 2020 to February 2021; the kit was developed using health literacy best practices. Simple random assignment was used to divide program participants into treatment and control groups. Both groups received senior kits, but the treatment group also received telephonic health coaching. The primary outcome was COVID-19 knowledge and mitigation behaviors as derived from self-reported surveys at baseline and after four months. Secondary outcomes included a telehealth or doctor visit, exercise frequency, and a loneliness score (3-Item Loneliness Scale). Health literacy was assessed using the BRIEF screening tool. Ninety-eight older adults consented to participate in the study and 87 completed the study (88.7% completion rate). Participants had moderate clinical risk, one-third preferred the Spanish language, and 52% were categorized as having inadequate or marginal health literacy. Significant changes were found for increasing COVID-19 mitigation behaviors and the frequency of exercise across the cohort, but not for COVID-19 knowledge, telehealth visits, or decreasing loneliness. Conclusions: Partnering with a trusted entity in the community is a feasible and important strategy to reach older adults during a lockdown and provide them with easy-to-read health information and resources. If the time horizon had been longer, improvements in other outcome variables may have been achieved.

The Multidimensionality of Low Health Literacy in Older Adults: A Scoping Review of International Studies

This scoping review aims to map the dimensions encompassing the low health literacy (HL) of older adults, describing their respective causes and consequences. A three-step search strategy was conducted using 16 databases from nine portals and reference lists. Of the 4,259 identified studies, 2,845 were screened and 29 (1%) were included. Studies were published between 1999 and 2021, most of them in English (86.2%), from the American continent (48.3%) and with observational design (86.2%). Four dimensions encompassing the low HL of older adults were mapped: (1) patient dimension, (2) healthcare system dimension, (3) social/economic dimension, and (4) health condition dimension. This review highlights specific dimensions encompassing the low literacy in older adults with evidence about its causes and consequences. These results can guide future research and evidence-based practice involving HL of older adults.

When Peppa Pig and Confucius meet, joining forces on the battlefield of health literacy-a qualitative analysis of COVID-19 educational materials for children and adolescents from China, the USA, and Europe

In times of pandemic, health literacy (HL) is very important, as it helps to find, understand, and use essential health information and services. According to WHO, HL is pivotal in fighting infodemic effectively, and education is a vital tool for developing it. In the presented work, we analyze 247 educational materials dedicated to children, adolescents, and their carers explaining the pandemic, prepared by the Chinese, American, German, Italian and Polish governments and international non-governmental organizations. Focusing on the textual and visual side of the documents, we investigated how the pandemic is explained and what discursive measures were used to inform young citizens about the risks and consequences of pandemic restrictions. Additionally, we verified whether the materials helped developing critical thinking, which is crucial to prevent spreading fake news and conspiracy theories. Although the analyzed materials were prepared in different cultural contexts, we identified that all of them contained simple instructions on the desired behaviours during the pandemic. Key messages relating to the importance of hygienic behaviors were often supplemented with guidelines on how to successfully complete each action. While the cultural particularities in presenting the state of the pandemic are visible, the challenges of dealing with the emotional and social crises were dominant all around the world. In our study, we argue that the possibilities of building HL were not fully exploited by the national and international institutions. Citizens were taught how to behave in unusual circumstances but not why they should behave differently. The educational materials lacked reliable knowledge that would allow them to deal with infodemic and develop critical thinking. We conclude that health education expertise worldwide should be focused on enhancing individuals' ability to make informed health decisions and provide three recommendations regarding the process of development of health educational resources for children and the youth.

Oral Health Behaviors and Oral Health-Related Quality of Life Among Dental Patients in China: A Cross-Sectional Study

Background and Purpose

Oral health plays an important role in overall health. But little is known about the problems with oral health behaviors and oral health-related quality of life (OHRQoL) among dental patients in China. This study aimed to investigate oral health behaviors and OHRQoL, as well as to examine the effects of oral health behaviors and associated factors on OHRQoL among dental patients.

Methods

This cross-sectional study was conducted from June 2022 to July 2022 in the Department of Stomatology of the First Mobile General Hospital of Armed Police, Hebei, China. The five-item short form of the Oral Health Impact Profile (OHIP-5) was used to evaluate OHRQoL. Oral health behaviors were assessed by a 16-items oral health behavior questionnaire, and socio-demographic data were collected by a socio-demographic questionnaire. The t-test, one-way ANOVA, and multiple linear regression analysis were used to investigate the associations between the study variables.

Results

186 participants were included in the study. The average age of the participants was 24.62 years (SD = 10.67). The mean OHIP-5 score was 4.31 (SD =3.35). Oral health-related quality of life differed significantly by smoking history, history of alcohol consumption, work status, economic pressure, self-rated oral health status, daily brushing frequency, dental caries condition, and whether they take the initiative to learn about oral health. Multivariate analysis found that the self-rated oral health status and work status were significantly associated with the OHIP scores. The retired people and those with poor self-rated oral health displayed poor OHRQoL.

Conclusion

In general, dental patients' oral health needs to be improved, the majority of patients reported practicing poor oral health behaviors, among which the retired population and hose with poor self-rated oral health showed poor OHRQoL. OHRQoL in dental patients is a complex issue associated with social and behavioral factors.

The promotion of active aging through older adult education in the context of population aging

We have entered an era of population aging, and many public health problems associated with aging are becoming more serious. Older adults have earlier onset of chronic diseases and suffer more disability. Therefore, it is extremely important to promote active aging and enhance health literacy. These involves full consideration of the need for education and the provision of solutions to problems associated with aging. The development of OAE is an important measure for implementing the strategy of active aging, and curriculum construction is a fundamental component of achieving OAE. Various subjective and objective factors have limited the development of OAE. To overcome these difficulties and ensure both active and healthy aging, the requirements for active aging should be implemented, the limitations of current OAE should be addressed, system integration should be increased, and the curriculum system should be improved. These approaches will help to achieve the goal of active aging. This paper discusses OAE from the perspective of active aging, based on the promotion of health literacy and provides suggestions to protect physical and mental health among older adults, while promoting their social participation. The provision of various social guarantees for normal life in older adults is a new educational concept.

Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study

Background

To identify gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases.

Methods

A total of 471 hospitalized older patients with chronic diseases in four hospitals were investigated from May 2019 to June 2020. The self-developed demographic information questionnaire, the "Health Literacy Scale for Patients with Chronic Diseases" and the "Self-Efficacy for Managing Chronic Diseases 6-item Scale" were applied in this study. Multiple linear regression was used to assess the factors influencing health literacy among older patients with chronic diseases by gender.

Results

The factors influencing health literacy differed by gender. Male health literacy was related to education background, number of children, monthly income, duration of chronic disease and chronic disease self-efficacy. For females, health literacy was associated with age, education background, monthly income, duration of chronic disease and chronic disease treatment.

Conclusion

Healthcare providers should focus on the above-mentioned factors that could help identify those with low health literacy differ base on gender. Gender-specific strategies should be developed to improve the health literacy of older patients with chronic diseases and strengthen their chronic disease management.

A Study on Supply-Demand Satisfaction of Community-Based Senior Care Combined with the Psychological Perception of the Elderly

Based on Maslow’s hierarchy of needs theory and customer satisfaction theory, we constructed a satisfaction model for supply–demand satisfaction for community-based senior care (SSCSC) combined with the psychological perspective of the elderly, and four dimensions of basic living needs (BLNs), living environment (LE), personal traits (PTs), and livability for the aged (LA) were selected to construct the model. The data were obtained from 296 questionnaires from seniors over 50 years old (or completed by relatives on their behalf, according to their actual situation). Twenty-two observed variables were selected for the five latent variables, and their interactions were explored using structural equation modeling. The results showed that LA was the most significant factor influencing SSCSC, and it was followed by BLNs and LE. PTs did not show a direct effect on LA, but they could have an indirect effect on SSCSC through influencing BLNs and LE. Based on the current state of community aging satisfaction, we propose to establish a community elderly care service system based on the basic needs of the elderly population, providing differentiated and refined elderly care services and improving the level of aging-friendly communities. This study provides references for the government to formulate relevant policies and other supply entities to make strategic decisions and has important implications for further enhancing community elderly services to become an important part of the social security system for the elderly.