Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey

Relationship between socioeconomic status and stroke: An observational and network Mendelian randomization study

BACKGROUND

The relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship.

METHODS

The study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7 %) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship.

RESULTS

After adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95 % confidence interval [CI]: 0.702-0.866), and for ischemic stroke, the HR was 0.701 (95 % CI: 0.618-0.795). Those who completed full-time education at the latest age group(>18 years) had the lowest risk of stroke (HR: 0.906, 95 % CI: 0.830-0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811-0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [ORIVW] =0.796, 95 % CI: 0.675-0.940, education: ORIVW = 0.631, 95 % CI: 0.557-0.716) and ischemic stroke (income: ORIVW = 0.813, 95 % CI: 0.684-0.966, education: ORIVW = 0.641, 95 % CI: 0.559-0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12 % of the effect of income on stroke, 51.24 % on ischemic stroke, and 27 % and 24 % for education.

CONCLUSION

Higher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.

Determinants of health literacy and its impact on glycemic control among women with gestational diabetes mellitus in a tertiary care hospital, Puducherry - A cross-sectional analytical study

BACKGROUND

Health literacy is vital during pregnancy, as maternal health knowledge and behavior have a significant impact on the health of both mother and child. Hence, this study aimed to assess the health literacy status of pregnant women diagnosed with gestational diabetes mellitus (GDM), as well as its associated factors and impact on glycemic control.

MATERIALS AND METHODS

The facility-based Cross-sectional analytical study was conducted among 200 pregnant women with GDM in a tertiary care hospital. The eligible participants were consecutively selected for the study. The study was conducted from September 2022 to March 2023. A validated semi-structured questionnaire, the Health Literacy Questionnaire (HLQ) for GDM, was used to measure health literacy status. Stata V.17 software was used for data analysis.

RESULTS

Out of 200 pregnant women with GDM, the mean (SD) age of the participants is 29.5 (±5.5) years. It was observed that 164 (82%) of the participants had adequate health literacy, whereas 36 (18%) had inadequate health literacy about Gestational Diabetes. Adequate health literacy (HL) was observed among 88.5% of women with controlled blood sugar and 55.1% of women with uncontrolled blood sugar. Results of multivariate logistic regression analysis revealed that pregnant mothers' educational status (PR: 1.8; 95% CI: 1.2-2.5) and glycemic control (PR: 1.4; 95% CI (1.2-1.7) were associated with adequate HL.

CONCLUSIONS

In conclusion, this study supports the association between adequate HL and glycemic control in pregnant women with GDM. Addressing this gap is essential for healthcare officials and planners to implement programs that promote women's HL during pregnancy, with a focus on low-educated groups.

Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background

The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship.

Methods

An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed.

Results

An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA.

Conclusion

Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.

The Moderating Role of Health Literacy and Health Promoting Behavior in the Relationship Among Health Anxiety, Emotional Regulation, and Cyberchondria

Background

People are increasingly turning to the internet to find answers to their health concerns in an era where there is a wealth of online health information, which frequently causes increased health anxiety and the phenomenon known as cyberchondria. The objectives of this study were to examine the moderating role of health literacy and health promotion behavior and the mediating role of emotional regulation between health anxiety and cyberchondria among the Pakistani population.

Methods

The study used a self-administered questionnaire to collect and examine health anxiety, emotional regulation, health literacy, health promotion behavior, and cyberchondria in 755 residents. A moderated mediation model of Hayes PROCESS was used to examine this hypothesis.

Results

The findings unveiled the average score of the participants on the study variables, as well as their categorization into low, moderate, and high categories. On scale of Health Anxiety participant scores (32% vs 53% vs 15%), Emotional Regulation (25% vs 46% vs 29%), Cyberchondria (18% vs 41% vs 41%), Health Literacy (56% vs 29% vs 15%), and Health promotion Behavior (49% vs 28% vs 23%). Moreover, result revealed that emotional regulation mediates the significant positive association between health anxiety and cyberchondria (β=0.25**p<0.001). Furthermore, health literacy moderates the negative association health anxiety and emotional regulation (β=-0.42*p<0.031), and health promotion behavior also negatively moderate the relationship between emotional regulation and cyberchondria (β=-0.27*p<0.22).

Conclusion

Based on the findings, it is recommended that health policymakers consider comprehensive national initiatives that focus on educational planning. These initiatives should boost health literacy levels and promote health-related behavior. Additionally, there is urgent need for strict measures to be put in place for monitoring online platforms and websites that spread inaccurate or false health-related information.

High General Health Literacy Does Not Ensure Hearing Loss Health Literacy in Mothers of Children Who Are Deaf and Hard of Hearing

PURPOSE

The purpose of this study was to characterize general health literacy and hearing loss health literacy for mothers of children who are deaf and hard of hearing (DHH).

METHOD

Participants included 25 mothers of 2-year-old and 3-year-old children who had a diagnosis of permanent, bilateral hearing loss for at least 1 year. Measures of general health literacy and hearing loss health literacy were collected.

RESULTS

Results indicated that mothers had high general health literacy but had lower hearing loss health literacy skills than expected. Although mothers had high education and experience of at least 1 year of having a child with hearing loss, performance on hearing loss health literacy measures was low.

CONCLUSION

Caregiver understanding of hearing loss terminology and concepts is essential for decision making regarding their child's hearing loss health care.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

BACKGROUND

Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations.

OBJECTIVE

This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations.

METHODS

A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions.

RESULTS

The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023.

CONCLUSIONS

This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50798.

The health literacy level and its related factors in Iranian women with breast cancer undergoing chemotherapy

Background

Breast Cancer (BC) is the most common cause of female mortality throughout the world. Promoting public awareness about this disease is the most crucial method of its prevention or control. The present study was carried out to determine the health literacy level and its related factors in women with BC.

Methods

This cross-sectional study was conducted on BC patients undergoing chemotherapy in two teaching hospitals affiliated to Zahedan University of Medical Sciences in 2020. A total of 210 patients referred to these chemotherapy centers were selected by purposive sampling. The data collection tools included a demographic information form and a health literacy questionnaire for Iranian women with BC. The collected data were analyzed using descriptive and inferential statistics (logistic regression) in SPSS-22. p-values less than 0.05 were considered statistically significant.

Results

The mean total score of the health literacy of women with BC undergoing chemotherapy was 40.35 ± 19.01, which suggests an insufficient health literacy. The health literacy had a significant relationship with variables including university education (OR = 4.41, p = 0.005) and supplementary insurance coverage (OR = 5.83, p < 0.001).

Conclusion

The findings showed that university education and supplementary insurance coverage are associated with a higher health literacy among women with BC. Improving these factors and paying further attention to their role in the promotion of health literacy can help enhance the health literacy of women with BC.

Prevalence and factors associated with sexual and reproductive health literacy among youth living with HIV in Uganda: a cross-sectional study

BACKGROUND

Adequate sexual and reproductive health literacy (SRHL) among young people has been linked to informed sexual behaviours. Studies on SRHL have largely been conducted among the general adolescent population. Little is known about youth aged 15-24 years living with human immunodeficiency virus (YLHIV). There is a possible lack of SRHL in this population, considering the high rate of teenage pregnancies and unprotected sex reported by YLHIV. This study aimed to assess the prevalence and associated personal and environmental factors for SRHL among YLHIV at a high-volume urban HIV Clinic in Uganda.

METHODS

Through a cross-sectional survey, YLHIV receiving routine HIV care services at Baylor-Uganda HIV Clinic were interviewed using an adapted European Health Literacy Survey (HLS-EU). Using simple random sampling, eligible youth who received HIV care services between August and November 2019 were enrolled in the study. SRHL scores were computed using the HLS-EU index method; and individuals whose scores ranged from 34 to 50 were considered health literate. We used descriptive statistics to determine the prevalence. Potential associated personal and environmental factors (p<0.05) were identified by performing two-step inferential statistics, bivariate analysis and binary logistic regression. Odds ratios were calculated to estimate the likelihood of youth being health literate on sexual and reproductive health (SRH) issues in comparison with the reference categories, and 95% confidence intervals were determined to establish whether the relationships were statistically significant.

RESULTS

Of the 267 YLHIV interviewed at Baylor-Uganda HIV Clinic, 167 (62.5%) were female with a mean age of 18.9 years (SD± 2.8), and the majority (242; 90.6%) were vertically infected with HIV. Only 52 (19.5%) were health literate on SRH issues. At the multivariate level, YLHIV who never had difficulty accessing SRH information were 0.391 times less likely to be health literate on SRH issues than their counterparts with challenges in accessing SRH information (Adjusted Odds Ratio [AOR] = 0.391, 95% CI =0.178 to 0.860; p= 0.019). YLHIV who did not find it easy to access SRH care service points were 2.929 times more likely to be literate in SRH than those who found it easy to access such services (Adjusted Odds Ratio [AOR] = 2.929, 95% CI =1.241 to 6.917; p=0.014). Additionally, YLHIV who did not listen to radio health talks were 2.406 times more likely to be health literate on SRH issues than those who did (AOR = 2.406, 95% CI =1.133 to 5.112; p=0.022).

CONCLUSIONS

SRHL is an unmet need among YLHIV; only 19.5% were health literate on SRH issues. This could complicate the achievement of the UNAIDS sustainable development goal (SDG) of an HIV/AIDS-free generation by 2030 because low health literacy (HL) skills can affect the efficacy of almost all HIV disease prevention and health promotion efforts. Inaccessible SRH care service points and not listening to radio health talks were positively associated with SRHL, while having access to SRH information was negatively associated with SRHL.

Prevalence and impacts of self-medication in a disadvantaged setting: the importance of multi-dimensional health interventions

Background

Self-medication is recognized as an effective form of treatment and is increasingly encouraged to treat minor illnesses. However, misuse of self-medication leaves devastating impacts on human health and causes antimicrobial resistance. Using medication without a prescription among farmers could cause more severe effects on their health than non-farm workers since they suffer from several occupational hazards such as excessive exposure to pesticides.

Methods

A cross-sectional study was conducted in 197 residents living in Moc Chau from August to September. A structured questionnaire and face-to-face were used to collecting data. The multivariate logistic model was applied to indicate associated factors with the self-medication.

Results

The prevalence of self-medication among farmers was 67%. Pain relievers (66.7%) and antibiotics (32.5%) were the types of medicines that were the most commonly purchased and used without a medical prescription. Ethnics and health status also significantly affected the self-medication practice as well as the purchase and use of antibiotics. The distance to travel to a medical center and the dangerous or difficult travel, participants with arthritis or inpatient treatment had significantly associated with buying and using the medicine and antibiotics without the medical prescription of farmers.

Conclusion

Our research highlights a considerably high prevalence of self-medication among farmers residing in the mountainous area of Vietnam. Individual factors such as ethnics, health status, distance to health centers, and dangerous or difficult travel were found to be related to the SM practice as well as the purchase and use of antibiotics. From that, the current study suggests interventions. For instance, official guidelines are needed to raise awareness and minimize the disadvantages of self-medication; and digital health technologies should be applied to reduce the gap in healthcare service between mountainous and other areas of Vietnam.

Self-reported health among immigrants in Luxembourg: insights from a nationally representative sample

Aim

Although immigrants account for nearly half of Luxembourg's population, few studies have investigated differences in self-reported health by nationality in Luxembourg. Our study aimed to explore the association between nationality and self-reported health in Luxembourg.

Subject and methods

Cross-sectional data from the 2015-2016 Panel Socio-Economique Liewen zu Lëtzebuerg (PSELL3) were used. Nationalities included Luxembourger, Portuguese, French, Italian, Belgian and German. Multivariable logistic regression analyses examined the association between nationality and three self-reported health measures: general health status, limitation in activity due to a health problem, and living with a chronic illness or condition.

Results

Of 8084 participants, 65% were Luxembourgers, 20% were Portuguese, and the remaining 15% were French, Italian, Belgian, or German. Italian nationals were more likely to report fair, poor, or very poor health [aOR = 1.54; 95% CI = 1.07, 2.22] and Portuguese nationals demonstrated both higher odds of fair, poor, or very poor health [aOR = 1.57; 95% CI = 1.28, 1.92] and limitation in activity [aOR = 1.32; 95% CI = 1.07, 1.64] compared to Luxembourgers. However, Portuguese nationals were also less likely to report living with a chronic illness [aOR = 0.79; 95% CI = 0.63, 0.98]. In education-stratified models, primary-educated Portuguese nationals were more likely to report fair, poor, or very poor health [aOR = 1.78, 95% CI = 1.36, 1.92] and limitation in activity [aOR = 1.36, 95% CI = 1.04, 1.79], but not less likely to report living with a chronic illness.

Conclusions

Nationality and education level should be considered in future studies concerning self-reported health in Luxembourg. Further research is needed to examine disparities in self-reported health among Portuguese and Italian nationals.

Impact of COVID-19 Outbreak on Influenza and Pneumococcal Vaccination Uptake: A Multi-Center Retrospective Study

During the coronavirus disease 2019 (COVID-19) pandemic, global vaccination efforts declined due to the burden on health systems and community resistance to epidemic control measures. Influenza and pneumococcal vaccines have been recommended for vulnerable populations to prevent severe pneumonia. We investigated community response towards influenza and pneumococcal vaccines (pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine) after the COVID-19 outbreak in Taiwan. We retrospectively included adults who visited Chang Gung Memorial Hospital (CGMH) institutions for influenza or pneumococcal vaccination from January 2018 to December 2021. The first case of COVID-19 in Taiwan was detected in January 2020; therefore, in this study, hospitalized cases from January 2018 to December 2019 were defined as "before COVID-19 outbreak," and hospitalized cases from January 2020 to December 2021 were defined as "after COVID-19 outbreak". A total of 105,386 adults were enrolled in the study. An increase in influenza vaccination (n = 33,139 vs. n = 62,634) and pneumococcal vaccination (n = 3035 vs. n = 4260) were observed after the COVID-19 outbreak. In addition, there was an increased willingness to receive both influenza and pneumococcal vaccinations among women, adults without underlying disease and younger adults. The COVID-19 pandemic may have increased awareness of the importance of vaccination in Taiwan.

Relationship Between Health Literacy, Quality of Life, and Treatment Adherence in Patients with Acute Coronary Syndrome

BACKGROUND

Acute coronary syndrome is a significant global health concern that can affect patients' health outcomes and quality of life. In addition, adherence to treatment and health literacy can affect health outcomes.

OBJECTIVE

This study aimed to investigate the relationship between treatment adherence, health literacy, and quality of life among patients with acute coronary syndrome.

METHODS

This cross-sectional study was conducted on 407 patients in Iran from April 2019 to November 2019. Patients were selected by convenience sampling method. Data were collected using demographic questionnaire, World Health Organization Quality of Life Brief Version, Adherence to Treatment Questionnaire, and Health Literacy for Iranian Adults questionnaire. SPSS 25 was used for statistical analysis.

RESULTS

Based on descriptive statistics in this study, most of the participants had good treatment adherence level (56.5%); 28.7% of the participants had insufficient health literacy level. The mean score of quality of life was 51.41 ± 12.03, which was greater than the midpoint of the questionnaire. Furthermore, Pearson's correlation coefficient showed a negative association between health literacy, treatment adherence (r = -0.167, p < .01), and quality of life (r = -0.153, p < .01), and a positive association between treatment adherence and quality of life (r = 0.169, p < .01).

CONCLUSION

The results of the current study showed a negative relationship between health literacy, quality of life, and treatment adherence among patients with acute coronary syndrome. [HLRP: Health Literacy Research and Practice. 2023;7(2):e71-e79.].

Improving adolescent health literacy through school-based health literacy intervention: a mixed-method study protocol

BACKGROUND

Health-promoting actions might benefit from adolescent health literacy (AHL), however, there is scant research on it in Nepal. This study identifies adolescent students' health literacy (HL) needs and trials an intervention to improve their HL and intention to take health-promoting actions.

METHODS

This study employs a pre-and post-test mixed-method intervention involving three phases. First, we will conduct a formative and summative evaluation to identify participants' HL needs and design an intervention using quantitative and qualitative methods. Second, the intervention will be administered to the intervention group. Finally, formative and summative post-tests will be conducted to assess the effectiveness of the intervention. We will select four community schools from Birendranagar municipality based on random sampling. In quantitative research, data will be collected from adolescents selected through a census with standardized scales such as the HLS-Child-Q15, self-efficacy, social support, and health-promoting actions. A framework analysis was conducted to analyze qualitative data collected from focus group discussions with purposively chosen adolescents and key informant interviews with Health and Physical Education teachers and school nurses. The difference in difference approach will be used to analyze the intervention's outcome, i.e., the participants' improved HL, and health-promoting actions.

DISCUSSION

This is one of the first studies to explore HL in this group in Nepal. This study will provide the first insights into the overall level of AHL, potential AHL determinants, and the relationship between AHL and the intention to participate in health-promoting activities. The data can then be used to inform health promotion and health literacy initiatives.

Middle-aged and older adults' acceptance of mobile nutrition and fitness tools: A qualitative typology

Background

The utilization of mobile health (mHealth) devices such as nutrition and fitness tools seems to be promising in facilitating healthy lifestyle behaviors in middle-aged and older adults. As user acceptance plays a decisive role in the successful implementation of mHealth tools, it is vital to examine the target groups' acceptance, particularly their usage behavior and attitudes toward these tools. This qualitative study aimed to explore how far middle-aged as well as older adults accept mobile nutrition and fitness tools and to identify facilitators and barriers shaping their acceptance.

Methods

Twenty-one qualitative semi-structured interviews were conducted with German adults aged 50 years and older. Data material was analyzed using Qualitative Content Analysis (Kuckartz).

Results

A comprehensive acceptance typology with three acceptance types could be reconstructed: The Rejection Type, The Selective Acceptance Type, and The Comprehensive Acceptance Type. The target group's acceptance of mobile nutrition and fitness tools appeared to differ considerably across the three acceptance types and between the two different types of mHealth tools - with mobile nutrition tools having been less accepted. Among others, high levels of usability were identified as a key facilitator, while a desire for autonomy and privacy concerns showed to be prominent barriers.

Conclusion

The resulting typology indicates a pronounced heterogeneity among middle-aged and older adults regarding their acceptance of mobile nutrition and fitness tools. The findings highlight a need for more individualized mHealth tools along with respective promotion strategies that are specifically tailored to the needs and expectations of middle-aged and older adults.

The impact of public health education on people's demand for commercial health insurance: Empirical evidence from China

Public health education is gaining significance globally, and it is important for managing health risks. This study empirically analyzed the effect of public health education on people's demand for commercial health insurance. And we used the fixed effects and the mediating effect models, and instrumental variables regression in our research based on panel data of 31 provinces (including municipalities and autonomous regions) in China from year 2009 to 2019. The findings show that public health education significantly increases people's demand for commercial health insurance, and this effect remains significant when considering endogeneity and robustness. We further analyzed and found that the increased demand for commercial health insurance is caused by health literacy, health risk perceptions and health risk attitudes. Through heterogeneity analysis, we found that there were significant differences in the effects of public health education in regions with different demographic and socioeconomic characteristics. We found that the effect of health education on promoting people's demand for commercial health insurance is more obvious in regions with high levels of urbanization, proportion of men, education, economic development, medical resources, and social medical insurance coverage. Governments are supposed to take further measures to enhance the effectiveness of public health education, develop high-quality commercial health insurance, and continuously improve health risk coverage.

Determinants of choice of usual source of care among older people with cardiovascular diseases in China: evidence from the Study on Global Ageing and Adult Health

BACKGROUND

Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC.

METHODS

This study was a secondary analysis using data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients' choice of USC.

RESULTS

Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living.

CONCLUSIONS

Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.

Sociodemographic factors and self-restraint from social behaviors during the COVID-19 pandemic in Japan: A cross-sectional study

The control of human flow has led to better control of COVID-19 infections. Japan's state of emergency, unlike other countries, is not legally binding but is rather a request for individual self-restraint; thus, factors must be identified that do not respond to self-restraint, and countermeasures considered for those factors to enhance its efficacy. We examined the relationship between sociodemographic factors and self-restraint toward social behaviors during a pandemic in Japan. This cross-sectional study used data for February 18-19, 2021, obtained from an internet survey; 19,560 participants aged 20-65 were included in the analysis. We identified five relevant behaviors: (1) taking a day trip; (2) eating out with five people or more; (3) gathering with friends and colleagues; (4) shopping for other than daily necessities; (5) shopping for daily necessities. Multilevel logistic regression analyses were used to examine the relationship between sociodemographic factors and self-restraint for each of the behaviors. Results showed that for behaviors other than shopping for daily necessities, women, those aged 60-65, married people, highly educated people, high-income earners, desk workers and those who mainly work with interpersonal communication, and those with underlying disease reported more self-restraint. Older people had less self-restraint than younger people toward shopping for daily necessities; an underlying disease had no effect on the identified behavior. Specialized interventions for these groups that include recommendations for greater self-restraint may improve the efficacy of the implementing measures that request self-restraint.

Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson's model of health service utilization

Background

Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka.

Methods

A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression.

Results

Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level.

Conclusions

Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03249-3.

Gender differences in the association between oral health literacy and oral health-related quality of life in older adults

BACKGROUND

Poor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan.

METHODS

A cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL.

RESULTS

A total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men.

CONCLUSIONS

The relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women's oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic

BACKGROUND

One of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020.

METHODS

This descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods.

RESULTS

The mean scores of the participants' "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P < 0.001, r = 0.471). Furthermore, all health literacy dimensions of comprehension (P < 0.001), accessibility (P < 0.001), reading skills (P < 0.001), evaluation (P = 0.002), and decision making and behavior (P = 0.003) were detected as the predictors of health-promoting behaviors. Further, statistically significant relationships were noticed between the mean score of health literacy with age (r =  - 0.327, P = 0.007), level of education (F = 3.119, P = 0.002), and place of residence (t = 2.416, P = 0.004) and between health-promoting behaviors with level of education (F = 3.341, P = 0.001) and marital status (F = 2.868, P = 0.02).

CONCLUSION

According to the findings, health policymakers should adopt national measures for educational planning to promote health literacy and support health-promoting behaviors to encourage women to adopt a healthy lifestyle.

A qualitative study to explore health literacy skills in older people from a disadvantaged community in Brazil

We aim to describe older peoples' experiences of accessing, understanding, communicating and appraising health information in the context of primary care in a disadvantaged community in North-East Brazil. A qualitative interview study was conducted with 42 older people at two primary healthcare units in the city of Arapiraca, Brazil. Semi-structured interviews were guided by a qualitative health literacy instrument, translated and adapted for use in Brazil. Of the 42 participants, 30 were women and the majority (n = 32) were 60-69 years of age. Qualitative analysis identified that participants had difficulties accessing, understanding and communicating health information, often in the context of chronic disease. Few participants demonstrated an understanding about their specific health concerns, and most had difficulty explaining and interpreting health conditions more generally. Most participants indicated that they did not actively seek health information and this was compounded by physicians who were reported to provide limited information about diagnosis and treatment of health conditions. More than half of the participants reported that they did not understand medical terms included in health information, but most reported that they took no action to clarify understanding. In conclusion, we observed that conventional health literacy skills are very poor in this population of older Brazilians living in a disadvantaged community, with many resigned to not receiving health information or relying on sources other than health professionals. The findings from this study speak to the need for health literacy interventions targeting older adults in Brazil. A two-tiered approach which seeks to reduce the demands and complexities placed upon patients within the healthcare system but also targets interventions toward building the skills and capacities of individuals is likely to be most effective.

Exploring and Characterizing Patient Multibehavior Engagement Trails and Patient Behavior Preference Patterns in Pathway-Based mHealth Hypertension Self-Management: Analysis of Use Data

Background

Hypertension is a long-term medical condition. Mobile health (mHealth) services can help out-of-hospital patients to self-manage. However, not all management is effective, possibly because the behavior mechanism and behavior preferences of patients with various characteristics in hypertension management were unclear.

Objective

The purpose of this study was to (1) explore patient multibehavior engagement trails in the pathway-based hypertension self-management, (2) discover patient behavior preference patterns, and (3) identify the characteristics of patients with different behavior preferences.

Methods

This study included 863 hypertensive patients who generated 295,855 use records in the mHealth app from December 28, 2016, to July 2, 2020. Markov chain was used to infer the patient multibehavior engagement trails, which contained the type, quantity, time spent, sequence, and transition probability value (TP value) of patient behavior. K-means algorithm was used to group patients by the normalized behavior preference features: the number of behavioral states that a patient performed in each trail. The pages in the app represented the behavior states. Chi-square tests, Z-test, analyses of variance, and Bonferroni multiple comparisons were conducted to characterize the patient behavior preference patterns.

Results

Markov chain analysis revealed 3 types of behavior transition (1-way transition, cycle transition, and self-transition) and 4 trails of patient multibehavior engagement. In perform task trail (PT-T), patients preferred to start self-management from the states of task blood pressure (BP), task drug, and task weight (TP value 0.29, 0.18, and 0.20, respectively), and spent more time on the task food state (35.87 s). Some patients entered the states of task BP and task drug (TP value 0.20, 0.25) from the reminder item state. In the result-oriented trail (RO-T), patients spent more energy on the ranking state (19.66 s) compared to the health report state (13.25 s). In the knowledge learning trail (KL-T), there was a high probability of cycle transition (TP value 0.47, 0.31) between the states of knowledge list and knowledge content. In the support acquisition trail (SA-T), there was a high probability of self-transition in the questionnaire (TP value 0.29) state. Cluster analysis discovered 3 patient behavior preference patterns: PT-T cluster, PT-T and KL-T cluster, and PT-T and SA-T cluster. There were statistically significant associations between the behavior preference pattern and gender, education level, and BP.

Conclusions

This study identified the dynamic, longitudinal, and multidimensional characteristics of patient behavior. Patients preferred to focus on BP, medications, and weight conditions and paid attention to BP and medications using reminders. The diet management and questionnaires were complicated and difficult to implement and record. Competitive methods such as ranking were more likely to attract patients to pay attention to their own self-management states. Female patients with lower education level and poorly controlled BP were more likely to be highly involved in hypertension health education.

Health literacy and healthcare service utilisation in the 12-months prior to entry into residential alcohol and other drug treatment

INTRODUCTION

Health literacy refers to an individual's capacity to gather, process and understand health information, make appropriate health decisions, and engage adequately with healthcare services. Inadequate health literacy has been linked to an increase in acute healthcare utilisation. Research suggests that people living with substance use disorders also access acute healthcare services at high rates. The study investigates whether overall health literacy is related to this population's use of general healthcare services.

METHODS

A total of 568 participants were recruited from residential substance use treatment services located in NSW, Australia, as part of a randomised controlled trial; the Continuing Care Project. All participants completed a face-to face baseline questionnaire, which included the Health Literacy Questionnaire; a measure of multidimensional health literacy. Latent profile analysis was used to examine health literacy profiles, with multinominal regression analysis examining if healthcare service utilisation was related to these profiles.

RESULTS

Three profiles of health literacy were identified and termed lowest (n = 86, 15.1%), moderate (n = 338, 59.5%) and highest health literacy (n = 144, 25.4%). The sample accessed both primary and acute healthcare services at high rates. When controlling for demographic variables, there were no significant differences identified between health literacy profiles and service use.

DISCUSSION/CONCLUSIONS

This study was the first to use a multidimensional health literacy tool to examine health literacy and general healthcare service utilisation for people attending residential substance use disorder treatment. This population access high levels of healthcare services, however the role that health literacy may play in helping reduce acute healthcare use requires further investigation.

The Role of Health Literacy in COVID-19 Preventive Behaviors and Infection Risk Perception: Evidence from a Population-Based Sample of Essential Frontline Workers during the Lockdown in the Province of Prato (Tuscany, Italy)

Background: The effectiveness of pandemic control measures requires a broad understanding from the population. This study aimed to evaluate the role played by health literacy (HL) in influencing the adherence to COVID-19 preventive measures and risk perception of essential frontline workers during the lockdown period. Methods: A cross-sectional survey was conducted on a population-based sample of frontline workers from Prato Province (Italy). Data on knowledge, attitudes and practices towards COVID-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Multivariate linear regression analyses were performed. Results: A total of 751 people participated in this study, and 56% of the sample showed a sufficient level of HL. In the multivariate models, HL resulted in being positively correlated with both knowledge (beta 0.32 for sufficient HL, 0.11 for problematic HL) and attitudes (beta 0.33 for sufficient HL, 0.17 for problematic HL) towards the importance of COVID-19 preventive measures. The HL level was not associated with the adoption of preventive behaviors and COVID-19 risk perception. Conclusions: HL may play a key role in maintaining a high adherence to infection prevention behaviors and may be a factor to take into account in the implementation of public health interventions in pandemic times.

Familiarity, Attitude, and Confidence of Health Literacy Practice among Community Healthcare Providers in Taiwan

Health literacy (HL), which is a determinant of individuals’ health as well as a personal and public asset, can be improved by community healthcare providers (CHPs) with the capability of providing HL services. The purpose of this study was to explore CHPs’ familiarity with and attitudes toward HL and their confidence in implementing HL practices. A cross-sectional online survey was conducted involving a total of 104 CHPs from 20 public health centers in Taiwan. It was based on a structured questionnaire involving self-evaluation by participants. The scores for familiarity, attitudes, and confidence in implementing HL practices were mean = 4.36, SD = 1.99; mean = 7.45, SD = 1.93; and mean = 6.10, SD = 1.77 (out of 10 points), respectively. The results of the multiple regression analysis showed that the two independent variables of familiarity and attitude could predict confidence in implementing HL practices (R² = 0.57, F(2101) = 58.96, p < 0.001). The CHPs surveyed were not especially familiar with HL; thus, they recognized its importance, but they lacked confidence in implementing HL practices. Increasing practitioners’ familiarity with HL may therefore boost their confidence in implementation. The research results can serve as a reference when planning HL education and training.

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.

The Role of Health Literacy among Outpatient Caregivers during the COVID-19 Pandemic

Health literacy became an important competence during the COVID-19 pandemic. Despite outpatient caregivers being a particularly vulnerable occupational group, their health literacy has hardly been examined yet, especially during the pandemic. Hence, this study aimed to explore this field and provide first empirical insights. Data were collected based on a cross-sectional online survey among 155 outpatient caregivers. In particular, health literacy (HLS-EU-Q16), diet and physical activity, pandemic-related worries, perceived information sufficiency and stress perception were examined. Descriptive and ordinal logistic regression analyses were run to test explorative assumptions. The majority of outpatient caregivers reported high values of health literacy (69% on a sufficient level). Although no significant associations between health literacy and health behaviours or perceived information sufficiency were found, perceived information sufficiency and perceived stress (OR = 3.194; 95% CI: 1.542-6.614), and pandemic-related worries (OR = 3.073; 95% CI: 1.471-6.421; OR = 4.243; 95% CI: 2.027-8.884) seem to be related. Therefore, dissemination of reliable information and resource-building measures to reduce worries may be important parameters for improving outpatient caregivers' health. Our results provide first explorative insights, representing a starting point for further research. Considering outpatient caregivers' mobile work setting, they need to be provided with adequate equipment and comprehensible information to ensure physically and mentally healthy working conditions.

Health literacy and associated factors among undergraduates: A university-based cross-sectional study in Nepal

Health literacy is one of the most critical aspects of health promotion. Limited health literacy is also accounted for adverse health outcomes and a huge financial burden on society. However, a gap exists in the level of health literacy, especially among undergraduates. This study aimed to assess the levels of health literacy and its socio-demographic determinants among undergraduate students of Tribhuvan University, Nepal. A web-based cross-sectional survey was conducted among 469 undergraduate students from five institutes of Tribhuvan University, Nepal. The 16-item short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) was used to measure students' health literacy levels. Associated factors were examined using Chi-square tests followed by multivariate logistic regression analyses at the level of significance of 0.05. Nearly 61% of students were found to have limited health literacy (24.5% had "inadequate" and 36.3% had "problematic" health literacy). Female students (aOR = 1.6, 95% CI: 1.1-2.5), students from non-health related majors (aOR = 1.9, 95% CI: 1.2-3.0), students with unsatisfactory health status (aOR = 2.8, 95% CI: 1.7-4.5), students with poor financial status (aOR = 2.9, 95% CI: 1.2-6.8) and students with low self-esteem (aOR = 2.5, 95% CI: 1.5-4.1) were significantly more likely to have limited health literacy. The majority of the undergraduates were found to have limited health literacy. Gender, sector of study, self-rated health status, self-rated financial status, and self-esteem were significantly associated with limited health literacy. This study indicates university students should not be assumed to be health-literate and interventions to improve students' health literacy especially for those whose majors are not health-related should be implemented. Further studies using a longer version of the health literacy survey questionnaire and qualitative methods to explore more on determinants of health literacy are recommended.

Prevalence of Locomotive Organ Impairment and Associated Factors among Middle-Aged and Older People in Nan Province, Thailand

While locomotive organ impairment among older people is attracting worldwide attention, this issue has not yet been widely investigated in Thailand. This study aimed to measure locomotive organ impairment prevalence and identify the determinants of locomotive function decline among middle-aged and older people in Nan Province, Thailand. This cross-sectional study included anthropometric measurements, a two-step test to investigate locomotive function, and a structured questionnaire to obtain socio-demographic and related information. Logistic regression analysis and multiple regression analysis were used to identify the determinants of locomotive organ impairment. The study participants were aged 50–87 years old (n = 165), and 71.5% of them had begun experiencing declining locomotive function; < 6 years of school education (adjusted odds ratio: 4.46), body mass index ≥25 kg/m² (AOR: 3.06), comorbidities (AOR: 2.55), and continuous walking for <15 min (AOR: 2.51) were identified as factors associated with locomotive organ impairment. Moreover, age, knee pain, anxiety about falling in daily life, and difficulty with simple tasks were identified as factors significantly associated with exacerbated locomotive organ impairment (p < 0.05). Appropriate interventions such as guidance or follow-up and recommendations for exercises are needed to prevent locomotive organ impairment and improve treatment.

Impact of low health literacy on healthcare utilization in individuals with cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental disorders. A Danish population-based 4-year follow-up study

BACKGROUND

Previous research from the USA has shown that low health literacy is associated with higher hospitalization rates and higher rates of emergency service use. However, studies in a European context using more comprehensive health literacy definitions are lacking. The aim was to study the impact of low health literacy on healthcare utilization in a Danish context.

METHODS

In this prospective cohort study, baseline survey data from 2013 were derived from a large Danish health and morbidity survey and merged with individual-level longitudinal register data for a 4-year follow-up period. The study included people in the general population (n = 29 473) and subgroups of people with four different chronic conditions: cardiovascular disease (CVD) (n = 2389), chronic obstructive pulmonary disease (COPD) (n = 1214), diabetes (n = 1685) and mental disorders (n = 1577).

RESULTS

In the general population, low health literacy predicted slightly more visits to the general practitioner and admissions to hospital and longer hospitalization periods at 4 years of follow-up, whereas low health literacy did not predict planned outpatient visits or emergency room visits. In people with CVD, low health literacy predicted more days with emergency room visits. In people with mental disorders, difficulties in actively engaging with healthcare providers were associated with a higher number of hospital admission days. No significant association between health literacy and healthcare utilization was found for diabetes or COPD.

CONCLUSIONS

Even though Denmark has a universal healthcare system the level of health literacy affects healthcare use in the general population and in people with CVD and mental disorders.

Health literacy, health perception and related factors among different ethnic groups: a cross-sectional study in southeastern Turkey

BACKGROUND

Low levels of health literacy are associated with increased hospitalization rates, problems regarding the proper intake of medications, poor general health and increased mortality rates. It is a well-known fact that health literacy differs among ethnic groups and ethnic minorities, in particular, are known to have a low level of health literacy. The present study aimed to reveal the levels of health literacy among different ethnic groups and the affecting factors as well as the relationship between health literacy and health perceptions.

METHODS

This cross-sectional study was carried out with different ethnic groups (Kurdish, Arab, Turkish and Assyrian origin), between 18 and 65 years old in the province of Mardin in Turkey. The study was conducted with a total of 600 people. The European Health Literacy Scale-Turkish Adaptation (EHLS-TR) and Health Perception Scale (HPS) were used for measurement. Descriptive analysis, Mann Whitney U Test, Kruskal Wallis Test and Spearman correlation were used in the data analysis.

RESULTS

It was found that 80.7% of the participants had relatively low levels of health literacy. The lowest levels of health literacy were among those of Kurdish origin. There were correlations between sufficient levels of health literacy and several factors including being of Assyrian origin, being 50-65 years old, living in a nuclear family, being a secondary school graduate, having a high financial status, being retired, evaluating one's own health status as good, obtaining health information from healthcare professionals, preferring to visit a state hospital to seek medical assistance first, smoking and drinking alcohol. A positive correlation was also identified between the levels of health literacy and health perception.

CONCLUSIONS

It is essential to develop programs to increase health literacy for the public and, in particular, for the ethnic groups that are disadvantaged in many aspects in the context of health literacy.

Healthcare inequalities in emergency visits and hospitalisation at the end of life: a study of 395 019 public hospital records

OBJECTIVES

To investigate whether there were any socioeconomic disparities in utilisation of hospital care services during end of life in Hong Kong.

METHODS

Secondary data analyses were conducted using frequency of the accident and emergency (A&E) department visits and hospital admissions during the last year of life in all public hospitals from 2004 to 2014 in Hong Kong. A total of 1 237 044 A&E records from 357 853 patients, and 1 878 982 admission records from 375 506 patients were identified for analyses. In total, 395 019 unique deceased patients were identified from both datasets.

RESULTS

Regression analyses showed that comprehensive social security assistance (CSSA) recipients used A&E services 1.29 times more than the non-recipients. Being either a CSSA recipient or an elderly home resident was more likely to be admitted to hospitals and stayed longer. Elderly home residents tended to stay longer than those from the community in the earlier months during the last year of life regardless of CSSA status; however, non-elderly home residents surpassed the residents in the duration of stay at hospitals towards the later months of the last year of life. There were also significant differences in hospital utilisation across various districts of residence.

CONCLUSIONS

People of lower socioeconomic position tend to have higher emergency visits and hospitalisation during their last year of life in Hong Kong, implying the presence of health inequality during end of life. However, due to Hong Kong's largely pro-rich primary care system, the predominantly public A&E and inpatient services may inadvertently act as a mitigator of such health inequalities.

Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review

OBJECTIVES

The objectives of this review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes.

INTRODUCTION

Health literacy is defined as a person's competence in accessing, understanding, appraising and applying health information in order to make sound health decisions. A high level of health literacy is positively related to better health outcomes. However, nearly half of the American and European populations have low health literacy levels. Socioeconomically disadvantaged groups in particular present with the weakest health literacy levels, suggesting that differences in health literacy levels contribute to health disparities. Therefore, there is a need to understand the conditions under which health literacy interventions aiming at improving health-related outcomes among socioeconomically disadvantaged people can be implemented.

INCLUSION CRITERIA

This review considered studies on socioeconomically disadvantaged adults living in the community identified using the socially stratifying PROGRESS factors (Place of residence, Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital).This review considered studies evaluating the following interventions: i) targeting health literacy based on either a clinical and/or a public health approach, ii) delivered at the individual, interpersonal, community or societal level, iii) delivered by any healthcare/social work professional, and iv) using a single or multicomponent strategy. The comparator was no treatment, standard care or a variation of the intervention. All randomized and non-randomized controlled trials as well as quasi-experimental designs were included. Outcomes considered were: i) health-related quality of life and health-related outcomes, ii) health behavior outcomes, and iii) outcomes related to the access and use of healthcare services.

METHODS

A three-step strategy was conducted for primary research published up to May 2018 across seven databases without any language restriction. A search for gray literature was also conducted. Titles and abstracts were screened for assessment against the inclusion criteria. Studies that met the inclusion criteria were retrieved in full and then assessed in detail against the inclusion criteria. Critical appraisal was undertaken using the standardized critical appraisal instruments from JBI. Data were extracted from included studies using standardized data extraction tools from JBI. A meta-analysis was not possible; findings have been presented in a narrative form.

RESULTS

Twenty-one studies were included in the review. Three studies addressed the health literacy competency of understanding health information, and 18 addressed the competency of applying health information. Thirteen studies were found as effective based on a variety of health-related outcomes (mainly clinical outcomes), preventive health practices and behaviors, and health-promoting behaviors. Results enabled identification of some effective intervention operational components, including cultural appropriateness, tailoring, skills building, goal setting and active discussions. Multi-faceted interventions, combining both an information transfer medium and contact with an interventionist, appear to be more effective than single modality interventions. The use of an appropriate theoretical foundation is also an important factor for successful interventions.

CONCLUSION

To improve health-related outcomes among socioeconomically disadvantaged people, health literacy interventions are more likely to be successful if they are theory-based, are multi-faceted and use person-centered operational components such as cultural appropriateness, tailoring, skills building, goal setting and active discussions.

How does health literacy affect the utilization of basic public health services in Chinese migrants?

Previous studies have focused on the determinants of basic public health services utilization, such as socioeconomic status and mobility characteristics, rather than on health literacy. Thus, this study aimed to estimate the effect of health literacy on the utilization of basic public health services among Chinese migrants. Based on the 2016 China Migrants Dynamic Survey data (N = 2335), this study used propensity score matching approach to estimate the effect of health literacy on the utilization of basic public health services, including the establishment of health records and receipt of health education, and to explore heterogeneity in this effect based on educational attainment and urban-rural status. The findings show that high levels of health literacy increased the probability of establishing health records and receiving more health education. Also, high levels of health literacy had a positive effect on the utilization of basic public health services among Chinese migrants, especially those with less education or living in urban areas. Policy makers should more carefully consider the actual situation and needs of migrants who are living in urban areas or have less education, constructing more targeted service programs.

Health Literacy Interventions to Improve Health Outcomes in Low- and Middle-Income Countries

BACKGROUND

Health care systems in many low- and middle-income countries (LMICs) face considerable challenges in providing high-quality, affordable, and universally accessible care. Feasible solutions to these issues require health literacy (HL) interventions for people who live in LMICs. Low HL is a significant problem in many LMICs because of the low levels of general literacy and poorly resourced and functioning health systems. A comprehensive understanding of HL interventions is essential to determine whether these interventions meet the health information needs of people who live in LMICs and to develop other effective HL interventions specifically for people who live in LMICs, improve health outcomes, and reduce inequalities.

METHODS

A medical research librarian developed and implemented search strategies to identify relevant evidence. Included studies needed to contain HL in LMICs component to understand or evaluate HL interventions that target people who live in LMICs. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. Discussion or third-party adjudication resolved disagreements. The collected data include the design of the study, type of HL intervention, target audience, theoretical influences, approaches to evaluating the intervention delivered, intervention received, intervention fidelity, intervention reach, data analysis, and study outcomes.

KEY RESULTS

The reviewers systematically analyzed the data from 23 published research studies, including 20 quantitative, 1 qualitative, and 2 mixed-method studies, on HL interventions to improve the health outcomes in LMICs. The various HL interventions for different groups of the population depend on the health outcomes of the study. The reviewers identified four themes: traditional HL interventions, art-based HL interventions, interactive learning strategies, and technology-based HL interventions. The researchers of a few studies also used multicomponent interventions to improve the HL of the population.

DISCUSSION

Despite global improvements in health indicators over time, such as decreased mortality and morbidity, significant challenges remain regarding the quality of the delivery of health care in many LMICs. All of the HL interventions were effective and significantly improved the knowledge and awareness of the population. However, based on the literature review, the reviewers found significant evidence that only a limited number of HL interventions are delivered through innovative and technological learning strategies. In addition, the sustainability and scalability of these interventions is not clear. Therefore, future research on sustainability measures for effective HL interventions in LMICs is still needed. [HLRP: Health Literacy Research and Practice. 2020;4(4):e250-e266.].

Health Literacy and Media Literacy: Is There Any Relation?

BACKGROUND

The health information is an important factor for improving people's health behaviors. On the other hand, media literacy plays an important role in the search and selection of valid information and resources about health. Therefore, the present study aimed to investigate the correlation between health literacy and media literacy.

METHOD

This study was a cross-sectional study. Random cluster sampling was used to select 700 citizens in Kerman, Iran. Health literacy for Iranian adults' questionnaire and media literacy questionnaire were used to collect the data.

RESULTS

Health literacy of 53.2% of the citizens was insufficient. Media literacy of 38.6% of the citizens was moderate and it was high in 61.3%. A significant positive correlation was found between health literacy and media literacy.

CONCLUSION

The media literacy was an important determinant factor for health literacy. The development and increase of media literacy can also increase health literacy.

Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) for Arabic/French-Speaking Migrants in Southern Europe

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.

Exploring Knowledge and Experience of Health Literacy for Chinese-Speaking Nurses in Taiwan: A Cross-Sectional Study

Background: Health literacy has become the best predictor of healthcare status. However, two-thirds of health providers are unaware of patients’ health literacy. Thus, the aim of the study is to investigate factors related to Chinese-speaking nurses’ knowledge and experience of health literacy. Methods: This cross-sectional study used a web-based survey. A total of 430 nurses were recruited by stratified sampling from different levels of hospitals and community health centers in Taiwan. Primary outcome measure by Health Literacy Knowledge and Experience. Results: The participants’ overall health literacy knowledge was limited; the correct responses were 51%. The education level of the participants, job category, working years, and having attended in-service patient education programs were the predictors of knowledge of health literacy (p < 0.05); Institute, job category, and having attended in-service patient education programs were the predictors of experience of health literacy (p < 0.01). Conclusions: Participants’ education levels and In-service patient education programs are beneficial factors to improve nurses’ knowledge of health literacy. Furthermore, nursing education should emphasize on how to identify individuals’ health literacy and using readable healthcare materials to improve health education.

Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis

Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.

Exploring health literacy in Wuhan, China: a cross-sectional analysis

Background

In recent years, research on health literacy has become increasingly focused on the health care system and public health. This cross-sectional study aimed to investigate health literacy and analyse the risk factors that affect health literacy in Wuhan, China.

Methods

Multistage stratified random sampling was used to select 5304 urban and rural residents aged 15 to 69 years from 204 monitoring points in 15 districts of Wuhan. Using the Chinese Citizen Health Literacy Questionnaire (HLQ) (2018 edition), a face-to-face survey was conducted from November to December 2018. Risk factors that may affect health literacy were assessed using the Chi-square test and multivariate logistic regression models.

Results

The knowledge rate of health literacy was relatively low (19.3%). The knowledge rate of health-related behaviour and lifestyle (BAL, 17.3%) was the lowest of the three aspects of health literacy, and the knowledge rate of chronic diseases (CD, 19.0%) was the lowest of the six dimensions of health literacy. Respondents who lived in urban areas, had higher education levels, worked as medical staff, had a higher household income and did not suffer from chronic diseases were likely to have higher health literacy.

Conclusions

The health literacy levels of citizens in Wuhan are insufficient and need to improve.

Exploring the Influencing Factors of Health Literacy among Older Adults: A Cross-Sectional Survey

Background and Objectives: To investigate the health literacy (HL) among older adults in Taiwan, we referenced an existing integrated model of HL to confirm the influencing factors of HL in older adults. We propose this study to examine the personal, situational, and socioenvironmental factors influencing HL among older adults. Materials and Methods: A cross-sectional survey was conducted at a district hospital and affiliated community center in northern Taiwan from August 2016 to May 2017. This study used the Mandarin Chinese version of the European Health Literacy Survey Questionnaire (EU-Q47). We designed three models based on the three domains of HL. Model 1 assesses personal factors. Model 2 incorporates situational factors. Model 3 adds the socioenvironmental factor. Results: We recruited 161 participants aged over 65 years. Most adults in this study had limited overall HL. The final regression model revealed that age >85 years, unknown insurance status, and dominant spoken dialect of Hakka or Taiwanese were significantly associated with higher scores of HL. Conclusions: Our study results may help clinicians with early identification of older adults at high risk for poor HL and help health administrators establish geriatric policies and health education plans.

Health Literacy of Rural Population of Kazakhstan

BACKGROUND

To date, there is no data available of health literacy of the population in Kazakhstan. This study was aimed to assess the health literacy of the rural population for the development of the targeted health education programs.

METHODS

The adapted HLS-EU-Q47 survey was carried out among 1650 respondents aged 18-76 from rural settlements in Almaty region of Kazakhstan in 2013. The health literacy competences to assess, understand, appraise and apply health information on healthcare, disease prevention and health promotion were measured. The associations between the health literacy competencies and demographic and socio-economic characteristics were shown through a multiple linear regression analysis.

RESULTS

The overall health literacy rate of the rural population of Almaty region was problematic and inadequate. With regards to their age, sex, social and economic characteristics, the health literacy competencies differ according to health literacy domain. Respondents with low education level or perceived social status had respectively low health literacy scores, especially in appraising and applying information of disease prevention.

CONCLUSION

Low educated people and with lower income have lower health literacy in comparison to respondents with higher education level and higher income. Respondents with higher health literacy have higher rate of self-assessed health.

The Relationship Between Health Literacy Level and Self-Care Behaviors in Patients with Diabetes

Background

The most important factor in controlling diabetes is self-care behaviors; improving self-care behaviors is the first step in helping patients to better control and manage their diseases and health literacy is recognized as a vital and important indicator of outcomes and costs in healthcare. Therefore, the effectiveness of health-care systems requires that people have the desirable health literacy level. Therefore, this research intended to study the relationship between health literacy levels in patients with diabetes and their self-care behaviors.

Patients and Methods

This analytical cross-sectional study was conducted during two months on 400 patients with diabetes selected using the census method in diabetes clinics in Mashhad County. Information was collected through a demographic survey questionnaire, the Health Literacy Questionnaire and a self-care behavior questionnaire. Data analysis was performed using SPSS 21 and Spearman correlation coefficient, the independent t-test, and ANOVA.

Results

The total mean score for self-care was 33.52 (SD±13.27). There was a significant relationship between self-care and health literacy in this study (P <0.05) so that people with higher levels of self-care literacy had better self-care behaviors. There was also a significant relationship between education level and monthly income and self-care behaviors and health literacy (P <0.001).

Conclusion

Patients received an average score for self-care behaviors. Given the impact of health literacy on patients' self-care behaviors, and considering its inclusion in educational, therapeutic, and caregiver programs, it is possible to reduce complications in patients, and improve their quality of life, by improving their self-care behaviors. Special attention should also be paid to health literacy levels of the audience when designing the related educational programs.

Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review

While socioeconomic disparities are among the most fundamental causes of health disparities, socioeconomic status (SES) does not impact health directly. One of the potential mediating factors that link SES and health is health literacy (HL). Yet although HL can be considered a modifiable risk factor of socioeconomic disparities in health, the relationship between SES, HL and health disparities is not well understood. This study reviewed the evidence regarding the mediating role of HL in the relationship between socioeconomic and health disparities. Medline, Cinahl, Embase, PsychInfo, Eric, Web of Science, Google, Google Scholar, Mednar, Doaj and Worldcat were used to retrieve studies that specifically addressed socioeconomic and socio-demographic factors related to low HL levels, as well as the mediating role of HL in the relationship between SES and disparities in health outcomes. Selected studies were assessed for methodological quality. Sixteen published studies were retained for inclusion and content analyzed using the constant comparison method. The review indicates that disadvantaged social and socioeconomic conditions contribute to low HL levels, whereby low SES, and particularly educational attainment, is the most important determinant of HL, and that HL mediates the relationship between SES and health status, quality of life, specific health-related outcomes, health behaviors and use of preventive services. HL can be considered as a modifiable risk factor of socioeconomic disparities in health. Enhancing the level of HL in the population or making health services more accessible to people with low HL may be a means to reach a greater equity in health.

Self-Care and Medical Treatment-Seeking Behaviors of Older Adults in Rural Areas of Taiwan: Coping With Low Literacy

This study focused on ascertaining the effects of low literacy on the self-care and medical treatment-seeking behaviors of older adults. A qualitative research method was adopted in this study wherein a semistructured questionnaire was used to conduct one-on-one interviews with 35 older adults with a primary school education or less who lived in rural areas of Taiwan. The results indicated that low literacy was an evident limitation to their range of activities, and the assistance of family members was required for medical treatment seeking and medication administration. The low self-esteem attributable to low literacy had a negative influence on doctor-patient communication. Older adults had a lower awareness of illnesses and their severity, and this insufficient health literacy resulted in delayed medical treatment. In addition, older adults rarely took the initiative to receive preventive services. This study suggests integrating literacy and health education program for older adults with low literacy.