Regional differences, repeated use, and costs of emergency medical services in Germany

BACKGROUND

Little is known about regional differences regarding the utilization and costs of emergency medical services (EMS) in Germany. Evidence on characteristics of repeated use of EMS is also scarce.

OBJECTIVES

To compare German federal states regarding the utilization and costs of EMS and to analyze characteristics of repeated EMS use.

MATERIALS AND METHODS

We used BARMER health insurance data on more than 1.4 million German EMS cases in 2022. We estimated EMS use rates (per 1000 inhabitants) and median reimbursements and costs by EMS type (ground transport with/without emergency physician (EP); helicopter emergency medical services), hospitalization status, and federal state. We applied Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI), capturing relationships between repeated use of EMS and individual characteristics, including care degree and income level.

RESULTS

Ground transport EMS use rates varied between federal states by more than 2.6-fold without EP (Bavaria: 84.6; Berlin: 223.2) and 2.1-fold with EP (Bremen: 19.1; Saxony: 41.3). Median reimbursement of ground transport with EP was 132% higher in Schleswig-Holstein (€ 1530) compared with Berlin (€ 660). Approximately one-third of all persons used EMS more than once and accounted for two-thirds of all EMS cases. Repeated EMS use was strongly related to care degree (IRR of care degree 5: 3084; 95% CI 3.012-3.158) and low income (IRR: 1.174; 95% CI 1.161-1.189).

CONCLUSIONS

The substantial regional heterogeneity in terms of utilization and costs of EMS calls for a nationwide, consistent regulation of EMS in Germany. Additionally, (outpatient) primary nursing care of persons with severe health impairments and health literacy should be strengthened.

Measuring health literacy to inform actions to address health inequities: a cluster analysis approach based on the Australian national health literacy survey

BACKGROUND

Measuring health literacy can inform interventions to address health inequities. This study used cluster analysis to examine health literacy data to determine if it can provide more insightful information than standard descriptive analysis to better inform intervention development.

METHODS

Using data from the Australian National Health Survey (2018), this study compared descriptive analysis and cluster analysis results of two states-New South Wales (NSW) and Victoria-generated from the Health Literacy Questionnaire (HLQ). Based on the nine scale scores of the HLQ, a hierarchical cluster analysis using Ward's method for linkage was undertaken.

RESULTS

The number of NSW and Victoria respondents was 1018 and 923, respectively. The nine HLQ scale full sample mean scores from both states were similar. However, the cluster analyses identified 11 clusters for NSW and 12 clusters for Victoria. While six clusters from each state presented similar health literacy patterns, five and six clusters from NSW and Victoria, respectively, displayed unique health literacy patterns.

CONCLUSIONS

The results demonstrate that descriptive analysis only provides an overview and may lead to one-size-fits-all interventions. The varying health literacy patterns among subgroups resulting from the cluster analysis pave the way to inform tailored actions to improve health equity.

Validating the short-version European Health Literacy Survey Questionnaire for community-dwelling older adults in Japan

The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is available in multiple languages, and shortened versions have also been developed. This study aimed to examine the reliability and validity of the short version of the questionnaire (HLS-Q12) developed for community-dwelling older adults in Japan. The HLS-Q12 was developed using 12 of the 47 items of the Japanese version of the HLS-EU-Q47. In this study, the survey was conducted by distributing self-administered questionnaires to community-dwelling individuals aged 65 years and older who consented to participate; their responses were collected by mail. The correlation between the HLS-Q12 and the HLS-EU-Q47 was tested to assess criterion validity. To test construct validity, nine novel hypotheses were proposed. We also conducted a confirmatory factor analysis of the HLS-Q12. Based on a resurvey after 5-7 days, test-retest reliability was examined using interclass correlation coefficients (ICCs) and Bland-Altman analysis. In total, 118 individuals provided valid responses to the questionnaire. The Spearman rank correlation coefficient between the HLS-Q12 and the HLS-EU-Q47 was r = 0.98 (p < 0.001), and eight of the nine hypotheses were supported. The ICC was 0.96 (p < 0.001), and the 95% limit of agreement was -0.26 ± 5.9, suggesting no systematic error. Thus, the Japanese version of the HLS-Q12 was found to be reliable with high criterion validity and reproducibility. Hence, the HLS-Q12 is a useful scale for measuring health literacy among older adults in Japan.

Predictors of quality of life in primary caregivers of patients with heart failure: A model of health literacy and caregiving burden

BACKGROUND

Heart Failure (HF) is a chronic disease that impairs patients' ability to care for themselves. The accumulation of caregiving activities by caregivers to patients creates stress.

OBJECTIVES

This study intends to investigate the mediating role of caregiving burden in the relationship between health literacy and quality of life of caregivers.

METHODS

This study is a cross-sectional research conducted through a questionnaire survey. A convenience sampling method was employed to select 410 primary caregivers for the study.

RESULTS

The overall mean score for quality of life for caregivers of patients with HF was (49.30±9.64). The results showed that the caregiving burden mediated the relationship between health literacy and quality of life, with the mediating effect accounting for 39.04 % (P < 0.05) of the total effect.

CONCLUSION

Caregiving burden is a mediating variable in the relationship between health literacy and quality of life. Therefore, we offer some recommendations for healthcare professionals: ①We suggest that healthcare professionals provide relevant education and training to caregivers, as this can enhance their knowledge and skills in effectively managing the health condition of patients;②Healthcare professionals can also proactively assess the caregiver's burden level and design personalized support plans based on the assessment results.

Evaluating knowledge, attitude, and physical activity levels related to cardiovascular disease in Egyptian adults with and without cardiovascular disease: a community-based cross-sectional study

BACKGROUND

Cardiovascular disease (CVD) represents a significant health challenge in Egypt, yet there exists limited understanding regarding the knowledge, attitudes, and physical activity levels associated with CVD. These factors play a pivotal role in developing effective prevention and management strategies. Hence, this cross-sectional study aimed to evaluate Egyptian adults' knowledge, attitudes, and physical activity (KAP) levels.

METHODS

Data were collected using a previously validated questionnaire encompassing demographic characteristics, CVD knowledge (including risk factors and symptoms), attitudes toward CVD, and self-reported physical activity levels. The survey was distributed among social media channels, and trained researchers administered the questionnaire via face-to-face interviews with adult patients with and without CVD admitted to Cairo University Hospital clinics.

RESULTS

The study involved 591 participants, of whom 21.7% had CVD. Overall, participants exhibited poor knowledge regarding CVD, with a mean score of 21 ± 7 out of 40, equivalent to 52.5%. Attitudes toward CVD were moderate, with a mean score of 66.38 ± 8.7 out of 85, approximately 78%. Physical activity levels per week were also moderate, averaging 1188 MET-min with a range of 1121-18,761. Subgroup analysis revealed that individuals with CVD had lower average knowledge, attitude, and physical activity levels than those without CVD. Working in the healthcare field was a predictor of higher knowledge score (standard error (SE) 5.89, 95% confidence interval (CI) 4.61 to 7.17, P < 0.001), while those with CVD and smokers were predictors of lower attitude score (SE -4.08, 95% CI -6.43 to -1.73, P < 0.001) and (SE -2.54, 95% CI -4.69 to -0.40, P = 0.02), respectively.

CONCLUSION

The study findings highlight a significant disparity in knowledge, attitudes, and physical activity levels related to CVD in Egypt. Targeted interventions aimed at improving awareness, fostering positive attitudes, and promoting physical activity among individuals at risk for CVD are crucial for effective prevention and management.

School-Based Pre- and Post-Intervention Tests Assessing Knowledge about Healthy Lifestyles: A National School Health Awareness Campaign on Children Aged between 3 and 12 Years Old

In response to the diverse health challenges faced by today's youth and their extensive time spent in schools, we conducted a school health awareness campaign aimed at prioritizing well-being and academic performance. This analytical longitudinal study, spanning 27 schools in Lebanon, aimed to assess the impact of the awareness campaign on the health knowledge and practices of 5-, 8-, and 11-year-old students throughout pre- and post-intervention testing focused on general health and healthy habits, employing 11, 14, and 15 questions tailored to 5, 8, and 11 year olds, respectively. The questions covered various aspects, including sleep, personal and dental hygiene, nutrition, physical activity, addiction, security measures, and bullying. Out of the 7100 students who participated, 16.11% (1144 students) were evaluated before and after the campaign. The results indicated a significant increase in health awareness post-intervention across all age groups. For instance, in 5-year-olds, limited awareness decreased from 91.6% to 36.38%, while adequate awareness rose from 8.03% to 62.3%. Improvement varied across health knowledge topics, with security-related questions showing the highest enhancement. Factors such as governorate, normal-weight status, and close supervision influenced improvement. However, no significant correlations were found with school type, size, gender, age, nationality, parental factors, or comorbidities. The study concludes that the school health awareness campaign successfully heightened children's health awareness, advocating for the integration of regular health promotions into the standard educational curriculum.

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.

Health literacy and the role of social support in different age groups: results of a German cross-sectional survey

BACKGROUND

Scholars demand more focus on context-related factors of health literacy as the management of health information is seen as a social practice. One prominent factor is social support that is expected to be particularly relevant for persons vulnerable for low health literacy. It was shown that health literacy can differ across the life span and especially older people have been demonstrated to be vulnerable for low health literacy. Therefore, health literacy and the relation of social support on health literacy in different age groups should be investigated.

METHODS

In a German nationwide survey 2,151 adults were interviewed face-to-face. General comprehensive health literacy was measured with the HLS19-Q47 which differentiates single steps of health information management - access, understand, appraise, and apply. Social support was measured with the Oslo 3 Social Support Scale. Bivariate and multivariate analyses were performed for all respondents and for five age groups.

RESULTS

Health literacy is relatively low in all age groups but particularly low among old-old people (76 + years). Also, the youngest adults (18-29 years) have slightly lower health literacy than middle-aged adults. On average, health literacy is higher among people with higher social support but this association varies between age groups. It tends to be quite strong among younger adults (18-45 years) and young-old persons (65-75 years) but is weak among older middle-aged (46-64 years) and old-old persons. The association also differs between steps of information management. It is stronger for accessing and applying information but there are differences in age groups as well.

CONCLUSIONS

Social support is a relevant aspect to improve individuals' health literacy and therefore should be addressed in interventions. However, it is necessary to differentiate between age groups. While both young adults and particularly old-old persons are challenged by health information management, young adults can strongly profit from social support whereas it can barely compensate the low health literacy of old-old persons. In addition, different challenges in information management steps in different age groups need to be considered when designing health literacy interventions. Thus, target group specific services and programs are needed.

Relationship between Treatment Burden, Health Literacy, and Medication Adherence in Older Adults Coping with Multiple Chronic Conditions

A prospective study was conducted to investigate the impact of treatment burden and health literacy on medication adherence among older adults with multiple chronic conditions (MCC) and to explore the potential moderating effects of demographic and clinical factors. Face-to-face structured interviews were conducted among older adults aged 60 and above using the Burden of Treatment Questionnaire (TBQ-15), Short Form Health Literacy Questionnaire (HLS-SF12), and Malaysia Medication Adherence Assessment Tool (MyMAAT). This study included 346 older adults aged 60 years and above with two or more chronic conditions (n = 346). Hypertension (30.2%), hyperlipidemia (24.0%), and diabetes (18.0%) were the most reported chronic conditions among participants. The mean score of treatment burden was 53.4 (SD = 28.2), indicating an acceptable burden of treatment. The mean score of health literacy was 16.4 (SD = 12.6), indicating a limited health literacy level among participants; meanwhile, the mean score of medication adherence was 32.6 (SD = 12.3), indicating medication non-adherence among participants. Medication adherence was significantly correlated with treatment burden (r = -0.22, p < 0.0001), health literacy (r = 0.36, p < 0.0001), number of chronic conditions (r = -0.23, p < 0.0001), and age (r = -0.11, p < 0.05). The study findings emphasize that multimorbid older adults with high treatment burdens and low health literacy are more likely to have poor medication adherence. This underscores the importance for clinicians to address these factors in order to improve medication adherence among older adults with multiple chronic conditions (MCC).

Prevalence of health literacy and its correlates from a national survey of older adults

BACKGROUND

Health literacy (HL) is an important determinant of health. Sub-optimal HL can have profound consequences for individuals and health systems. However, little is known about the HL of older Singaporeans.

OBJECTIVE

This study determined the prevalence, socio-demographic and health-related correlates of limited and marginal HL among older Singaporeans (≥65 years).

METHODS

Data from a national survey were analysed (n = 2327). HL was measured using the 4-item BRIEF with a 5-point response scale (range 4-20), and classified as limited, marginal, and adequate. Multinomial logistic regression models were applied to identify correlates of limited and marginal HL versus adequate HL.

RESULTS

The weighted prevalence of limited HL was 42.0%, marginal HL was 20.4% and adequate HL was 37.7%. In adjusted regression analysis, older adults in advanced age groups with lower education and those living in 1-3 room flats had higher risk of limited HL. Furthermore, having ≥3 chronic diseases (Relative Risk Ratio [RRR] = 1.70, 95% Confidence Interval [95% CI] = 1.15, 2.52), poor self-rated health (RRR = 2.07, 95% CI = 1.56, 2.77), vision impairment (RRR = 2.08, 95% CI = 1.55, 2.80), hearing impairment (RRR = 1.57, 95% CI = 1.15, 2.14) and mild cognitive impairment (RRR = 4.87, 95% CI = 2.12, 11.19) were also associated with limited HL. The likelihood of marginal HL was higher among those with lower education, ≥2 chronic diseases, poor self-rated health (RRR = 1.48, 95% CI = 1.09, 2.00), vision impairment (RRR = 1.45, 95% CI = 1.06, 1.99) and hearing impairment (RRR = 1.50, 95% CI = 1.08, 2.08).

CONCLUSIONS

Over two-thirds of older adults faced difficulties in reading, understanding, exchanging, and using health information and resources. There is a pressing need to create awareness about the issues that could result from the mismatch between healthcare system demands and the HL of older adults.

Do Health Information Sources Influence Health Literacy among Older Adults: A Cross-Sectional Study in the Urban Areas of Western China

BACKGROUND

Previous studies have found that the dissemination pattern and delivery mechanism of information can provide crucial resources and empowerment for individuals to the promotion of health literacy. The present study investigates how health information sources are associated with health literacy among older adults in west China, and tries to explain the mechanisms underlying the link between health information sources and health literacy in the Chinese context.

METHODS

The cross-sectional study employed a representative sample of 812 urban citizens aged 60 and older in 2017 in Western China.

RESULTS

We found that health information sources including healthcare practitioners (B = 4.577, p < 0.001), neighbors (B = 2.545, p < 0.05), newspapers (B = 4.280, p < 0.001), and television (B = 4.638, p < 0.001) were positively associated with health literacy. Additionally, age (B = -1.781, p < 0.001) was negatively associated with health literacy, and the socio-economic status factors including minority (B = -10.005, p < 0.001), financial strain status of perceived very difficult (B = -10.537, p < 0.001), primary school (B = 11.461, p < 0.001), junior high school (B = 18.016, p < 0.001), polytechnic school or senior high school (B = 21.905, p < 0.001), college and above (B = 23.433, p < 0.001) were significantly linked to health literacy, and suffering from chronic diseases (B = 3.430, p < 0.01) was also positively related to health literacy.

CONCLUSIONS

Health information sources including healthcare practitioners, neighbors, newspapers, and television have a strong influence on health literacy, which implies that the four main types of sources are the important patterns of health information dissemination in the reinforcement of health literacy. In addition, the present findings also indicate age, minority and disease differences in health literacy and confirm the influence of enabling factors including educational attainment and financial strain on health literacy. Based on these findings and their implications, specific evidence is presented for the reinforcement of health literacy in interpersonal and mass communication, and in the educational and financial settings in the Chinese context. The present results also suggest that the age-specific, minority-specific and disease-specific measures should be taken to promote health literacy among older adults.

Knowledge, Attitude, and Practice Toward Cardiovascular Diseases in the Lebanese Population

Background & Objective:

Cardiovascular diseases (CVD) are the leading cause of death globally. Assessing CVD knowledge, attitude, and practice (KAP) is necessary to spread awareness about CVD in Lebanon, their corresponding risk factors, and behaviors in which individuals can avoid or minimize the possibility of developing a CVD.

Subjects & Methods:

This was a case-control analytical study that targeted 921 CVD and non-CVD subjects. A questionnaire form was used to collect data related to patients’ demographics, socioeconomic status, habits, medical and family history, KAP towards CVD, and source of information. Data was analyzed using SPSS v.25.

Results:

Data from 921 participants were distributed over the CVD group (52.6% males aged 58.3 ± 13.7 years [n = 460]) and the non-CVD group (47.7% males aged 36.3 ± 15.4 years [n = 461]). CVD patients were significantly older than non-CVD subjects (p < 0.001). All three KAP scores of both groups were of poor to fair levels. Both CVD knowledge and attitude mean scores in CVD patients (26.6 ± 5.2 over 40 [66.50%] and 63.3 ± 10.2 over 85 [74.47%], respectively) were significantly higher than the ones of non-CVD subjects (23.5 ± 7.9 over 40 [58.75%] and 61.4 ± 12.4 over 85 [72.74%], respectively, p < 0.001). However, the CVD mean practice score was significantly lower in CVD patients (6.0 ± 1.7 over 9 [66.67%]) than the one of non-CVD subjects (6.3 ± 2.2 over 9 [70.00%] p < 0.001). Mostly, educational level (p < 0.001), governorate (p < 0.01), and smoking (p < 0.001) were predictors of KAP CVD in both groups.

Conclusion:

With an overall limited knowledge, attitude, and practice toward CVDs, the Lebanese population (with CVD or non-CVD) needs targeted national campaigns about CVD according to the identified predictors of CVD KAP to prevent and to alleviate the complications due to CVDs.

Health Behaviors and Health Literacy: Questing the Role of Weak Social Ties Among Older Persons in Rural and Urban Ghana

Background

Older persons are one of the most vulnerable groups as regards low health literacy. However, little is known about the extent of limitations and multi-faceted nature of their health literacy, such as its characteristics and social and geographical dimensions. Additionally, most existing studies have predominantly treated health literacy as a risk factor of health and wellbeing of older persons as opposed to an outcome that must be pursued.

Objectives

This study investigated the moderating role of weak social ties (bridging social capital) in the relationship between health behaviors, such as smoking, alcohol intake, voluntary body check-up and physical exercise, and health literacy among older persons in rural and urban Ghana.

Methods

Data was drawn from a cross-sectional survey comprising 522 respondents across five administrative regions in Ghana. Ordinary Least Squares regression technique was used to analyse the data.

Results

Older persons in urban areas had higher health literacy [Mean/Standard deviation (SD) = 9.1/4.1 vs. 10.1/4.2] as well as higher bridging social capital (Mean/SD = 2.0/1.2 vs. 1.6/0.9) than their rural counterparts. Bridging social capital was negatively associated with the health literacy of urban residents (B = -0.997, p < 0.01). We found evidence that smoking (B = -0.787, p < 0.05) and undertaking physical activities (B = 0.812, p < 0.01) were associated with health literacy of older persons in rural areas. Having voluntary body check-ups (B = 0.155, p < 0.01) was associated with health literacy in urban areas. Bridging social capital negatively moderated the association of smoking with health literacy in rural areas (B = -5.032, p < 0.01), but it instead positively modified the relationship between alcohol intake and health literacy in urban areas (B = 0.185, p < 0.05).

Conclusion

For policymakers and practitioners aiming to promote older persons' health literacy as a public health asset at individual and community levels, an important starting point to achieving such goals is to understand the fundamental indicators (e.g., health behaviors) and the role that social and geographical factors play in shaping their health literacy.

The Mediation Effect of Health Literacy on Social Support with Exchange and Depression in Community-Dwelling Middle-Aged and Older People in Taiwan

The proportion of the world’s population that are over 60 years old is increasing rapidly. The physical and mental health of older people is affected by depression. Health literacy is a major determinant of health and healthcare for the aging; middle-aged and older people with high health literacy are more likely to maintain a healthy lifestyle, and control or manage their chronic diseases. Therefore, this study explored the relationship between health literacy, social support with exchange, and depression, in middle-aged and older adults in the community, using data from the 2015 Taiwan Longitudinal Study on Aging (TLSA) database. Of the 7636 participants, 1481 (19.4%) were middle-aged or older persons with depression symptoms. We found age, gender, and education level to be significantly related to health literacy status, social support with exchange, and depression. Health literacy was positively correlated with depression and social exchange in social support with exchange, whereas the emotional support component of social support with exchange was negatively correlated with depression. Regression-based process analysis was used to verify the mediation effect of health literacy. Our results indicated that when health literacy was entered into the regression model (a × b path), the effect of social exchange on depression was insignificant (c′ = −0.01, p = 0.84), indicating a complete mediation effect. These findings suggest that improving health literacy may offset the impact of social support with exchange on depression, and lead to the mitigation of depression in middle-aged and older people in Taiwanese communities.

Self-reported health literacy and medication adherence in older adults: a systematic review

OBJECTIVES

To give an overview over the associations between self-reported health literacy and medication adherence in older adults.

DESIGN

A systematic literature review of quantitative studies published in English and German.

DATA SOURCES

MEDLINE via PubMed, CINAHL, Cochrane Library, Epistemonikos and LIVIVO were searched.

ELIGIBILITY CRITERIA

Included studies had to examine the associations between self-reported health literacy and medication adherence in the elderly (samples including ≥66% of ≥60 years old) and had to use a quantitative methodology and had to be written in English or German.

DATA EXTRACTION AND SYNTHESIS

All studies were screened for inclusion criteria by two independent reviewers. A narrative synthesis was applied to analyse all included studies thematically. Quality assessment was conducted using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

We found 2313 studies, of which nine publications from eight studies were included in this review. Five studies reported a majority of participants with limited health literacy, one study reported a majority of participants with adequate health literacy, and three publications from two studies only reported mean levels of health literacy. Eight publications from seven studies used self-reports to measure medication adherence, while one study used the medication possession ratio. Overall, six publications from five studies reported significantly positive associations between health literacy and medication adherence while two studies reported positive but non-significant associations between both constructs and one study reported mixed results.

CONCLUSION

In this review, associations between self-reported health literacy and medication adherence are rather consistent, indicating positive associations between both constructs in older adults. However, concepts and measures of health literacy and medication adherence applied in the included studies still show a noteworthy amount of heterogeneity (eg, different use of cutoffs). These results reveal the need for more differentiated research in this area.

PROSPERO REGISTRATION NUMBER

CRD42019141028.

Association of functional, interactive, and critical health literacy with good self-rated health among Taiwanese community-dwelling older adults

The functional, interactive, and critical domains of health literacy are associated with health. However, studies examining the relationship between health literacy subdomains and health in the Chinese-speaking context are still limited. Thus, we aimed to examine the association of functional, interactive, and critical health literacy with self-rated health among older Taiwanese adults. A total of 1,072 participants aged 60 or older were included in the analysis. Health literacy was measured by the 11-item short-form Mandarin Health Literacy Scale and validated tools. Self-rated health was categorized into good (good/very good), fair, and poor (poor/very poor) status. Multinomial logistic regression revealed that only interactive health literacy was associated with reporting good health status (OR = 2.30; 95% CI = 1.65 to 3.21). Conversely, all health literacy subdomains were not associated with reporting poor health. This study suggested that interactive health literacy was the key determinant of good self-rated health status for community-dwelling older adults.

Simple scoring algorithm to identify community-dwelling older adults with limited health literacy: a cross-sectional study in Taiwan

OBJECTIVE

Health literacy (HL) is the degree of individuals' capacity to access, understand, appraise and apply health information and services required to make appropriate health decisions. This study aimed to establish a predictive algorithm for identifying community-dwelling older adults with a high risk of limited HL.

DESIGN

A cross-sectional study.

SETTING

Four communities in northern, central and southern Taiwan.

PARTICIPANTS

A total of 648 older adults were included. Moreover, 85% of the core data set was used to generate the prediction model for the scoring algorithm, and 15% was used to test the fitness of the model.

PRIMARY AND SECONDARY OUTCOME MEASURES

Pearson's χ² test and multiple logistic regression were used to identify the significant factors associated with the HL level. An optimal cut-off point for the scoring algorithm was identified on the basis of the maximum sensitivity and specificity.

RESULTS

A total of 350 (54.6%) patients were classified as having limited HL. We identified 24 variables that could significantly differentiate between sufficient and limited HL. Eight factors that could significantly predict limited HL were identified as follows: a socioenvironmental determinant (ie, dominant spoken dialect), a health service use factor (ie, having family doctors), a health cost factor (ie, self-paid vaccination), a heath behaviour factor (ie, searching online health information), two health outcomes (ie, difficulty in performing activities of daily living and requiring assistance while visiting doctors), a participation factor (ie, attending health classes) and an empowerment factor (ie, self-management during illness). The scoring algorithm yielded an area under the curve of 0.71, and an optimal cut-off value of 5 represented moderate sensitivity (62.0%) and satisfactory specificity (76.2%).

CONCLUSION

This simple scoring algorithm can efficiently and effectively identify community-dwelling older adults with a high risk of limited HL.

Health Literacy in Germany-Findings of a Representative Follow-up Survey

BACKGROUND

Studies have shown that the health literacy of the German population is low. The aim of this article is to analyze current developments in health literacy on the basis of recent data.

METHODS

The Health Literacy Survey Germany 2 (HLS-GER 2) is a representative quantitative survey of the German-speaking resident population of Germany aged 18 and above. It was carried out in December 2019 and January 2020 by paper-assisted personal oral interview (PAPI). Data on health literacy and sociodemographic characteristics were acquired with an internationally coordinated questionnaire. The instrument for measuring general health literacy consisted of 47 questions that reflect an individual's ability to access, understand, appraise, and apply health-related information. The associations between general health literacy and sociodemographic factors were analyzed using bivariate and multivariate statistical tests.

RESULTS

58.8% of the participants had low health literacy, characterized by rating at least onethird of the questions as "difficult" or "very difficult." Many respondents stated that they had difficulties accessing (48.3%), understanding (47.7%), and applying (53.5%) information, and even more of them (74.7%) reported difficulties appraising information. The correlation coefficients reveal that health literacy is weakly associated with the following variables: age, sex, social status, literacy, level of education, financial deprivation, migration background, and the presence of one or more chronic diseases.

CONCLUSION

The findings of the HLS-GER 2 highlight the need for action in promoting health literacy in the healthcare system. As the explanation of variance is low, there are presumably other important determinants of health literacy that were not taken into account. Further studies should be performed to investigate societal conditions of supplying health information, for example, or social and personal characteristics.

Psychometric Properties of the Health Literacy Scale Used in the Taiwan Longitudinal Study on Middle-Aged and Older People

Health literacy, an important factor in public and personal health, is regarded as the core of patient-centered care. Older people with high health literacy are more likely to maintain a healthier lifestyle, with good control and management of chronic diseases, than those lacking or with poor health literacy. Purpose: The present study investigated the validity and reliability of the Taiwan Longitudinal Study on Aging (TLSA) Health Literacy Scale. We also evaluated the health literacy of middle-aged and older Taiwanese adults, and its probable association with health outcomes and life satisfaction. Method: We analyzed the internal consistency reliability of the nine items of the 2015 TLSA Health Literacy Scale, and their relationship with the demographic variables. Brody Instrumental Activities of Daily Living (IADL) and the Life Satisfaction Index were used for criterion validity. Moreover, exploratory factor analysis was used to examine the construct validity and to test the known-group validity. Results: The TLSA health literacy scale has good internal consistency reliability. Criterion-related validity was supported by the fact that the health literacy score was significantly correlated with the IADL and Life Satisfaction Index. Factor analysis indicated a three-factor structure. Known-group validity was supported by the results, showing that middle-aged and older people with good self-reported health status had better health literacy. Conclusions: The TLSA health literacy scale is a reliable and valid instrument for measuring health literacy in middle-aged and older people.

The Prevalence of Limited Health Literacy and Its Associated Factors among Elderly Patients Attending an Urban Academic Primary Care Clinic in Malaysia

Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence of limited HL levels and its associated factors among elderly patients in an urban academic primary care clinic in Selangor, Malaysia. A cross-sectional study was conducted among 413 elderly patients (≥60 years old) who attended this academic primary care clinic between January 2020 and January 2021. Sociodemographic data, clinical characteristics, and health literacy scores were collected. Descriptive statistics (median with interquartile ranges (IQR), frequency, and percentages) and multiple logistic regression were utilized. The prevalence of limited HL in our population was 19.1% (95% CI: 15.3, 23). The middle-old (70–79 years) and very-old (≥80 years) age groups were more likely to have limited HL (aOR 4.05; 95% CI: 2.19, 7.52 and aOR 4.36; 95% CI: 1.02, 18.63, respectively). Those with at least secondary school education (aOR 0.06; 95% CI: 0.02, 0.24) and those who found medical information via the internet/television (aOR 0.21; 95% CI: 0.05, 0.93) had lower odds of having limited HL. In conclusion, having limited HL levels was not common among elderly patients in this primary care clinic. Further studies involving rural and larger primary care clinics in Malaysia are required to support these findings.

Association between health literacy, general psychological factors, and adherence to medical treatment among Danes aged 50-80 years

BACKGROUND

Understanding behavioral factors associated with low health literacy (HL) is relevant for health care providers to better support their patients' health and adherence to preventive treatment. In this study, we aim to study associations between low HL and socio-demographic characteristics, medication-related perceptions and experience, as well as general psychological factors among patients aged 50-80 years.

METHODS

We used a cross-sectional survey design based on a representative group of 6,871 Danish citizens aged 50-80 years returning a web-based questionnaire with socio-demographic data added from a national registry. Chi-square tests were conducted to analyze associations between low HL and daily use of medication and self-rated health. Chi-square tests and binary logistic regression were conducted for analyzing data from respondents using prescribed medicines daily (N = 4,091).

RESULTS

Respondents with low HL were more often on daily medications (19 % [777/4,091] vs. 16 % [436/2,775]; P < 0.001) and were more likely to have poorer self-rated health (P < 0.001). Among patients on daily medications, low HL was significantly higher among men and those with lower educational attainment and lower family income. Low HL was independently and positively associated with perceptions that taking prescribed medicines daily is difficult and time-consuming, with forgetting to take prescribed medicines, and with lower satisfaction with life and poor self-assessed health.

CONCLUSIONS

Our study provides information that patients aged 50-80 years with low HL are challenged on their adherence to treatment plans which is not only related to traditional sociodemographic factors but also on perceptions related to taking medication per se.

Health literacy supports active aging

From the individual viewpoint, active aging refers to the ability of older persons, depending on their goals, functional capacity and opportunities, to engage in desired activities. This study investigated the role of health literacy in active aging among persons differing in their number of chronic conditions. Data were collected from 948 individuals, 57% women, aged 75, 80 and 85 in 2017-2018 in the city of Jyväskylä in Central Finland. Health literacy was assessed with the 16-question version of the European Health Literacy Survey (HLS-EU-Q16), active aging with the University of Jyväskylä Active Aging Scale (UJACAS) and self-reported physician-diagnosed chronic conditions. Both health literacy (r = 0.40) and number of chronic conditions (r = -0.21) correlated with the active aging score. Linear regression models revealed that health literacy was a stronger predictor than chronic conditions of active aging (β 0.18, p < 0.001 vs. β -0.06, p = 0.030) and that its predictive value remained statistically significant after adjustment for cognitive capacity, number of depressive symptoms, physical performance and length of education. Higher health literacy can enable older persons, including those with multiple chronic conditions, to maintain higher levels of active aging. As more people are projected to live with chronic conditions to older ages, health literacy may help them to cope with illnesses and functional limitations and lead a fulfilling life. These cross-sectional findings lay a foundation for future prospective and experimental studies on health literacy and active aging.

Advancing health literacy measurement in old age

Health literacy is described as a domain of competence across the life-span, gaining particular prominence in light of age-associated health restrictions. However, no specific measurement approach has been proposed for old age. The aim of this study is to augment the existing HLS-EU-Q16 scale (16 items) by items sensitive to age-specific aspects of health literacy to ensure validity and reliability for use in old age. In a first step, the HLS-EU-Q16 was administered in a sample of 463 individuals aged 72 - 92 years. Psychometric properties were evaluated using confirmatory factor analysis and item-response-theory item fit statistics. Scale reliability was found to be poor in this population segment. In a second step, age-specific items were developed based on qualitative in-depth interviews with older persons. In a third step, we tested if the additional set of age-specific items was able to enhance a valid and reliable measurement of health literacy in a second sample of older adults (N = 107, 49 - 91 years). With the inclusion of an eight-item add-on, it was possible to measure health literacy in old and very old age with both high validity and satisfying precision (reliability = 0.80). The study contributes to a population-specific measurement of health literacy.

Health literacy, preventive COVID 19 behaviour and adherence to chronic disease treatment during lockdown among patients registered at primary health facility in urban Jodhpur, Rajasthan

BACKGROUND AND AIMS

Potential role of health literacy in determining adherence to COVID-19 preventive behavior, pharmacological, and lifestyle management among diagnosed patients of chronic diseases during nationwide lockdown is inadequately investigated.

METHODS

A cross-sectional study was conducted from May-August 2020 among diagnosed patients of chronic diseases residing in a COVID-19 hotspot of urban Jodhpur, Rajasthan, and availing health services from primary care facility. Telephonic interviews of participants were conducted to determine their health literacy using HLS-EU-Q47 questionnaire, adherence to COVID-19 preventive behaviour as per World Health Organization recommendations, and compliance to prescribed pharmacological and physical activity recommendations for chronic disease.

RESULTS

All the 605 diagnosed patients of chronic diseases availing services from primary care facility were contacted for the study, yielding response rate of 68% with 412 agreeing to participate. Insufficient health literacy was observed for 65.8% participants. Only about half of participants had scored above median for COVID-19 awareness (55.1%) and preventive behavior (45.1%). Health literacy was observed to be significant predictor of COVID-19 awareness [aOR: 3.53 (95% CI: 1.81-6.88)]; COVID-19 preventive behavior [aOR: 2.06, 95%CI; 1.14-3.69] and compliance to pharmacological management [aOR: 3.05; 95% CI: 1.47-6.35] but not for physical activity.

CONCLUSION

COVID-19 awareness, preventive behavior, and compliance to pharmacological management is associated with health literacy among patients of chronic disease availing services from primary health facility. Focusing on health literacy could thus be an essential strategic intervention yielding long term benefits.

Mandarin multidimensional health literacy questionnaire for patient supporting groups: A quality improvement article

A patient support group (PSG) can serve the purposes of group therapy and education. However, how to evaluate outcome which can feedback to improve the PSG remains unclear. Health literacy, which is associated with patient outcome, has not been used in the evaluation of PSG.Since 2017, we had conducted a working group dedicated to the creation and improvement of PSG. We applied a questionnaire (Mandarin Multidimensional Health Literacy Questionnaire, MMHLQ) for PSGs of all kinds of diseases (5 types, 8 diseases). The outcome was evaluated by the MMHLQ (5 dimensions, 20 variables). We determined factors (age, 1st-time/non-1st-time participation, and patient/family participation) that were associated with all 20 health literacy.We finally obtained 458 questionnaires, with a response rate as high as 91.1% in 8 PSGs. Participants were 55.30 ± 16.39 y/o. The highest score was with the dimension of understanding (12.25 ± 1.85) and the lowest score was with the dimension of appraisal (10.66 ± 2.33). Participating patients (compared to family) were associated with a higher score with "obey the instruction of medical personnel to care disease" but lower score with "find health information from the network". Moreover, older participants (age ≥65 years) had lower scores for all questions in MMHLQ, within which the dimension of appraisal received the lowest scores (P < .001).We found that the highest score is with the dimension of understanding, and the lowest score with the dimension of appraisal. The elderly participants showed lower abilities in health literacy, especially with the dimension of the appraisal. Results from MMHLQ can be used to adjust the PSG curriculum to improve the health literacy of participants.

Health Literacy Varies According to Different Background Disease Natures and Characteristics of Participants for Patient Support Groups

Introduction: Patient support groups (PSGs) should be designed according to the backgrounds of participants and the nature of their diseases. Using health literacy as an outcome indicator for PSGs is rare. Methods: All questionnaires (Mandarin Multidimensional Health Literacy Questionnaire, MMHLQ) were collected from eight PSGs to evaluate the health literacy of participants. Background data of participants were also collected, including patient or family, age, and first-time participation or not. Results: A total of 458 questionnaires were collected from eight PSGs. The diseases were: autoimmune disease (systemic lupus nephritis (SLE), malignancy (head and neck cancer (HNC), chronic disease (diabetes mellitus or DM), chronic kidney disease (CKD), hemodialysis and chronic obstructive pulmonary disease (COPD), genetic disease (autosomal dominant polycystic kidney disease (ADPKD), and degenerative disease (osteoporosis). For vasculitis (42.21 ± 16.49 years old for SLE) and genetic disease (48.95 ± 17.58 years old for ADPKD), participants were younger. More significant differences between first-time participation and MMHLQ scores were found in disease of osteoporosis, CKD, COPD, and hemodialysis. More significant differences between role of participation (patients themselves or family) and MMHLQ scores were found in SLE, ADPKD, hemodialysis, and CKD. More significant differences between age (elderly or not) and MMHLQ score were found in HNC, DM, CKD, COPD, and osteoporosis. Conclusion: Background data of participants varied across different diseases. Different disease natures and patient background statuses should therefore demand different designs in PSG. MMHLQ before PSGs can be used to help to improve the PSG curriculum on the health literacy of patients.

Measuring Health Literacy in Southern Italy: A cross-sectional study

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.

Comprehensive Health Literacy Among Undergraduates: A Ghanaian University-Based Cross-Sectional Study

Background:

Health literacy is the ability to access, understand, and use health information for enhancing health. Health literacy research has led to the understanding of its associations with health outcomes and health-promoting behavior. Health literacy is essential to health promotion, but a gap exists in the knowledge of health literacy in Ghana, especially among university students.

Objective:

This study aimed to ascertain the levels of health literacy and its sociodemographic determinants among undergraduate university students of Kwame Nkrumah University of Science and Technology.

Methods:

A cross-sectional survey was conducted using multistage cluster sampling to select 500 students from six colleges of the University; of those, 485 were included for data analysis after exclusions. Health literacy was assessed using the 16-item short version of the European Consortium for Health Literacy Questionnaire.

Key Results:

About 55% of students were found to have limited health literacy (20.4% had “inadequate” health and 34.2% had “problematic” health literacy). Students performed low on health literacy dimensions dealing with the access and appraisal of health information, especially relating to mental health. Multivariate logistic regression showed that factors associated with limited health literacy differed for each gender but generally included college type, self-esteem, health status, and year of study.

Conclusions:

Interventions need to be implemented to improve students' health literacy. [HLRP: Health Literacy Research and Practice. 2019;3(4):e227–e237.]

Plain Language Summary:

The study reveals that health literacy may be a challenge even for the educated in Ghana especially among vulnerable people. University students should not be assumed to be health-literate and interventions that will help enhance their literacy in health should be implemented.

Health literacy in an Israeli elderly population

BACKGROUND

Health literacy is important for patients' comprehension of the health and medical messages conveyed to them and their meaning for them so that they can better manage their health. The aim of the study was to examine the level of health literacy within the elderly population. The hypothesis was that health literacy would be inadequate, and related to demographic variables.

METHOD

Sixty men and women over the age of 65 who volunteered to participate in the study completed a 13-item health literacy questionnaire.

RESULTS

Overall, the level of health literacy among the participants was mostly inadequate. They reported difficulty in reading medical material in Hebrew and understanding the doctor, thus requiring assistance (20%); difficulty in reading medical documents, completing medical forms and understanding medical terms; difficulty in reading the leaflet attached to medications (33%), test results (40%) and medical information written in English (66%) and difficulty searching the internet for information (53.3%). The level of health literacy was associated with education while the best profile for adequate health literacy was for those who spoke Hebrew and completed secondary education.

CONCLUSIONS

Medical teams have an obligation to be alert and attentive to the level of health literacy of elderly patients and to modify communication and information to an accommodating degree, so that elderly patients can better manage their health.

Assessment of health literacy among older Finns

Aims

This study examined the feasibility of the HLS-EU-Q16 (in Finnish) for use among older Finns and whether the health literacy score correlates with indicators of health and functioning.

Methods

To determine the feasibility of the instrument, we first conducted a focus group discussion with nine participants. For the quantitative analyses, we used data from the AGNES cohort study, collected between October 2017 and April 2018 at the University of Jyväskylä in Finland. 292 75-year-old Finnish men and women were interviewed face-to-face in their homes. Health literacy was measured with the HLS-EU-Q16 and health literacy score, ranging from 0 to 50, computed. The reproducibility of the instrument was test-retested. Chi-square tests were used to compare health literacy scores between participants by different socioeconomic variables, and Spearman correlation coefficients were calculated to study the associations of health literacy with cognition, depressive symptoms, chronic conditions, life-space mobility and physical performance.

Results

The mean health literacy score for all participants was 35.05 (SD 6.32). Participants who rated their financial situation and self-rated health as very good had the highest health literacy scores (38.85, SD 5.09 and 39.22, SD 6.77, respectively). Better health literacy was associated with better cognitive status, fewer depressive symptoms and chronic conditions, higher life-space mobility and better physical performance.

Conclusions

The HLS-EU-Q16 is a feasible measure for research purposes among older Finns. The associations between health literacy and indicators of health and functioning need to be more closely investigated in larger samples with a wider age-range.

Information-seeking and use of information resources among melanoma patients of German skin cancer centers

BACKGROUND

This study aimed to explore the information-seeking behavior (ISB) of melanoma patients (MPs) and MP subgroups, in order to provide data for needs-based adaptation of information provision.

METHODS

In a cross-sectional survey in 27 German skin cancer centers, we explored characteristics of the ISB of MPs with the aid of a standardized questionnaire. Sub-group differences were determined with the chi-squared test and predictors of media preferences with logistic regression.

RESULTS

67 % of the 529 participating MPs had clinical stage III or IV melanoma. Most of the participants (81 %) reported medical consultations as their regularly or frequently used information resource (IR). 58 % wished to have more advice about IRs from their physician. Only 8 % of MPs used the services of self-help groups and 12 % of MPs took advantage of the services of cancer counseling centers. The internet (63 %) and booklets (58 %) were reported to be the preferred media. Age, educational level, general need for information and lack of awareness of their own condition proved to be predictors for media preferences.

CONCLUSIONS

Most MPs expected their physician to advise them about IRs they could use in addition to medical consultations. Peer support services were quite underused by MPs. The various preferences of media by MPs should be considered when deve-loping and providing IRs.

Health Literacy and Health Service Use in Germany

BACKGROUND

Health literacy (HL) is defined as the ability to process health-related information to make decisions to maintain health and improve quality of life. A growing number of studies demonstrate that people with lower HL are less likely to use preventive services but more likely to use curative, emergency, or hospital care.

OBJECTIVE

This study investigated the relationship between HL and the use of different types of health services in a sample of the general German population, as we expected that the effect of HL on the frequency of use differs by type of health service.

METHODS

A nationally representative sample of 2,000 people in Germany was interviewed in person in 2014. Analyses of the data included frequencies of contacts with doctors, other health professionals, hospitals, and emergency services. Analysis also included a HL measure (European Health Literacy Survey Questionnaire), as well as sociodemographic and health status indicators. To test whether and how HL is related to the frequency of use of the different types of curative health services, regression analyses were performed.

KEY RESULTS

Respondents with lower HL scores reported more frequent use of all four included types of curative health services. Although multiple regression analysis showed a direct significant effect of HL only on doctor (β = -.066) and other health professionals visits (β = -.103), no significant direct effect of HL on hospital and emergency services use was found when sociodemographic and health-related factors were controlled for.

CONCLUSIONS

Health professionals should be aware that their patients are likely to have difficulties in understanding and processing health-related information. Interventions to strengthen HL should aim at improving health care literacy and, moreover, not only address individuals but also consider demands related to the health care system and health professionals' communication skills.

PLAIN LANGUAGE SUMMARY

This study investigates the relationship between health literacy and health service use in Germany. The results show that health services are used more often by individuals with low health literacy. Thus, health professionals need to take low health literacy into account in their communication with patients. [HLRP: Health Literacy Research and Practice. 2018;2(2):e115-e122.].