Development of an item bank of health literacy questions appropriate for limited literacy public sector patients in South Africa

Predicting College Students’ Preventative Behavior During a Pandemic: The Role of the Health Belief Model, Source Credibility, and Health Literacy

In this study, we examined the effects of perceived source credibility of the Centers for Disease Control (CDC) and college student health literacy in predicting the likelihood of enacting preventative behaviors related to mitigating COVID-19. Using the Health Belief Model (HBM) as an explanatory tool, we analyzed how perceived source credibility and health literacy levels predict college students’ likelihood to enact preventative behaviors during a public health crisis. Sample population entirely consisted of undergraduate students enrolled in a basic communication course at a large, southern university. The participants completed survey questionnaires about their perceived health literacy, health beliefs, trust in the CDC, perceptions of COVID-19, and demographic measures during the fall 2020 semester. A multiple regression analysis revealed that (a) HBM predictors, health literacy and CDC source credibility accounted for 44% of the variance in likelihood of enacting preventative health behaviors, and (b) health literacy, CDC source credibility, and perceived severity were all positive predictors of enacting preventative health behaviors, while (c) perceived barriers negatively predicted enactment of preventative health behaviors. Perceived susceptibility and perceived benefits were not significant predictors of college student risk mitigation. Our data suggests the importance of health literacy and source credibility in predicting college students’ likelihood to enact preventative behaviors during public health crises.

Translation, cultural adaptation and psychometric properties of the Ghanaian language (Akan; Asante Twi) version of the Health Literacy Questionnaire

Background

Patients’ competencies and resources to manage their own health, which is termed health literacy, is a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity.

Methods

We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under 5 years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA).

Results

Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17,177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s alpha were > 0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales were statistically significant.

Conclusion

The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.

Sex, support and society: a journey to reclaiming sexuality for individuals living with paraplegia in Cape Town, South Africa

STUDY DESIGN

Qualitative descriptive study with inductive thematic content analysis.

OBJECTIVES

To explore how individuals living with paraplegia in South Africa experience sex and intimacy and how they perceive the related health services and support they received whilst adapting to life post injury.

SETTING

Community based in Cape Town, South Africa.

METHODS

Purposive and snowball sampling were combined to enrol ten individuals with paraplegia who were all users of the public health system and had been injured for more than 1 year. Semi-structured interviews were conducted, and data analysed using inductive thematic content analysis.

RESULTS

Four categories were derived and captured by the overarching theme of 'a journey to reclaiming sexuality', as depicted by each participant. Psychological consequences of the injury led to challenges with sex and intimacy including a strong emphasis on partner satisfaction. A perceived lack of support mechanisms particularly in relation to poor timing of health services and insufficient peer support led to a lack of understanding and difficulties adjusting to changes in sexual function. Meaningful relationships including elements of sex and/or intimacy were rediscovered following a re-adjustment period although participants often felt disabled by society as socio-cultural norms, such as gender concepts, influenced each individual journey.

CONCLUSIONS

Complex interactions between intrinsic psychological factors, such as low sexual self-esteem and external factors such as socio-cultural norms, affect sex and intimacy in individuals with paraplegia in this novel context. South Africa's health system should be strengthened to support optimal sexual outcomes of persons with a spinal cord injury.