Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q)

Predictors of Intention to use Health Literacy Strategies in Patient Education among Health Care Professionals at Public Hospitals of Bahir Dar City: Application of Theory of Planned Behavior

PURPOSE

Health literacy strategies were using plain language, using visual aids, using the teach-back method, limiting the number of items provided, and providing culture-sensitive care. This study aimed to assess predictors of intention to use health literacy strategies in patient education among healthcare professionals.

DESIGN

An institutional-based cross-sectional study, theory of planned behavior.

SETTING

Bahir Dar, Northwest Ethiopia, from March 10 to April 10, 2023.

SUBJECTS

422 healthcare professionals.

MEASURES

Six items with a response range from 1 = strongly disagree to 5 = strongly agree each item was summed on a five-point Likert scale and its score range (6-30).

ANALYSIS

Linear regression, SPSS version 25.

RESULTS

A total of 389 healthcare professionals participated with a response rate of 92.18%. The overall mean intention towards health literacy strategies score was 24.02 with (SD ± 3.84). Subjective norm [(β, .231; 95% CI: .129, .333)], attitude [β, .162; 95% CI: .072, .252], perceived behavioral control [(β, .121; 95% CI: .022, .221)], having got training [(β, .125; 95% CI: .348, .530)] and knowing health literacy [(β, .251; 95% CI: .131, .371)] were factors.

CONCLUSION

The mean score of intention to use health literacy strategies was very low. Attitude, subjective norm, perceived behavioral control, training, and knowledge of health literacy strategies were predictors. Therefore, different strategies should be applied to increase the utilization of health literacy strategies.

Barriers and facilitators of cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda: a qualitative study using the integrated model of health literacy

BACKGROUND

Several rural public health facilities in East Central Uganda have sub-optimal, below 50%, levels of uptake of cervical cancer screening services among women with HIV. This is attributed to low cervical cancer screening literacy: limited ability to access, understand, appraise, and apply cervical cancer screening information. This research identified multi-level (health facility, community, interpersonal and individual) barriers, and facilitators of accessing, understanding, and applying cervical cancer screening information among rural women with HIV attending rural public health facilities in East Central Uganda to inform interventions.

METHODS

We conducted ten Focus Group Discussions with rural women aged 25-49 years with HIV attending four selected rural public health facilities: thirty women who had ever screened for cervical cancer and thirty women who had never screened for cervical cancer across different age categories. Data was collected using a guide based on the Integrated model of health literacy. Thematic analysis was used for analysis. Competences (accessing, understanding and applying cervical cancer screening information) and categories of factors (health system, community, interpersonal and individual factors) of the integrated model of health literacy were deductively derived whereas barriers and facilitators were deductively derived from women's statements.

RESULTS

Lack of communication materials and inability to access information were health facility and individual barriers of accessing cervical cancer screening information respectively. Facilitators of accessing information were access to information at health facility, community, and interpersonal levels and women's ability to access information. Barriers and facilitators of understanding cervical cancer information were related to communication materials, provision of health education and women's concentration during health education. Barriers and facilitators of applying cervical cancer screening information were related to communication and provision of cervical cancer screening services at health facility level, and interpersonal level from peers, partners and other family members as well as women's ability to: understand information and access to cervical cancer screening services at individual level.

CONCLUSIONS

This study emphasizes the influence of multi-level factors on cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda. Improving uptake of cervical cancer screening services among these women requires multi-level interventions.

A scoping review of health literacy in rare disorders: key issues and research directions

BACKGROUND

The ability to find, understand, appraise and utilise health information is crucial among individuals living with rare disorders. The aim of this study was to give a comprehensive overview of the literature on health literacy in adult persons with rare disorders.

METHODS

We applied a scoping review methodology and performed a systematic search in 2021 in bibliographic databases. Searches were conducted in Medline (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (ebsco), and ERIC (Ovid). References were sorted and evaluated for inclusion using EndNote and Covidence. This review was guided by the question "What are the characteristics of research on health literacy in rare disorders?"

RESULTS

The database searches yielded 75 eligible reports. A total of 6223 individuals with rare disorders were represented alongside 1707 caregivers. The reports in this review have included study participants representing a total of 80 different rare disorders with unique ORPHA and ICD-10 codes. The results revealed that persons with rare disorders often exhibit gaps in health literacy through a lack of knowledge and access to information related to self-management, their own diagnosis and health, as well as daily coping and social rights. In addition, the importance of aid and information from healthcare personnel and the significance of getting social support from others in the same situation were accentuated.

CONCLUSION

This review emphasizes the importance of reinforcing health literacy among persons with rare disorders through peer support and education. This is the first review to give a comprehensive and state-of-the-art overview of literature investigating health literacy among persons with rare disorders and offers a basis for further research.

Development of a health literacy scale for COVID-19 prevention among pregnant women in Thailand

COVID-19 infection among pregnant women results in more severe symptoms and higher mortality rates. No comprehensive health literacy for protection against COVID-19 among pregnant women has been available for general use in Thailand. This cross-sectional study aimed to develop and examine an instrument for measuring health literacy of prevention COVID-19 infection among pregnant women (HLS-P). A total of 321 pregnant women aged older than 20 years were participated in this study, Selected through multistage cluster sampling, between September 2021 and January 2022. Data were collected using structured questions that included sociodemographic characteristics and the health literacy scale for protecting against COVID-19 (HLS-P) developed by the researchers. The content and construct validity of the health literacy scale were examined. Exploratory factor analysis performed with principal component analysis and Varimax rotation. Confirmatory factor analysis was conducted using IBM SPSS AMOS 26. The model fitting was evaluated using several indices namely root mean square error of approximation, normed fit index, comparative fit index, and goodness-of-fit index. The reliability of the scale was evaluated using Cronbach's alpha and item total correlation. As a results of exploratory factor analysis of the scale, 31 items were loaded which indicated a 6-factors for the scale that collectively explained 62.59% of total variance. Confirmatory factor analysis also indicated a good fit to the six latent structures with root mean square error of approximation 0.03, normed fit index 0.94, comparative fit index 0.97, and goodness-of-fit index 0.91. Internal consistency reliability was satisfactory with Cronbach's alpha coefficient of 0.94 and the item-total correlation between 0.34 and 0.86. The overall scale was sufficiently reliable. As a result, the HLS-P is a reliable and relevant measure for assessing health literacy in pregnant women. Thus, this scale is profoundly used as an evaluation tool for measuring health literacy among pregnant women, providing critical information for healthcare professionals and policymakers about the health literacy needs and capacity of service receivers.

Effect of mothers' health literacy on early childhood allergy prevention behaviours: results from the KUNO-Kids health study

BACKGROUND

Parents can engage in several behaviours with regard to early childhood allergy prevention (ECAP). These can be related to diet of mother/child and the modification of the home environment; not all of them are justified by current evidence. Previous studies showed that parental health literacy (HL) is related to favourable health behaviours directed at the child. This study aimed to investigate the causal effect of mothers' HL on ECAP behaviours and to test different moderators of this effect.

METHODS

One thousand six hundred sixty-two mothers participating in the KUNO-Kids health study in the area of Regensburg, Germany were surveyed on HL (assessed via the health care scale of the Health Literacy Survey-EU questionnaire, HLS-EU-Q47) and ECAP behaviours implemented during pregnancy and the child's first year of life. Patterns in ECAP behaviours were identified by latent class analysis. Multinomial regression modelling was performed with HL as exposure, ECAP as outcome variable, allergy risk, parental competence and bonding, anxiety and depression as moderators as well as potentially confounding variables.

RESULTS

We identified three classes of ECAP behaviours (class 1: "breastfeeding " N = 871; class 2: "allergen-avoidance " N = 490; class 3: "mixed behaviours " N = 301). In univariable as well as fully adjusted regression models, compared to class 1, class 2 was negatively, and class 3 was not associated with HL. None of the tested moderating variables altered the association between HL and ECAP significantly.

CONCLUSIONS

We found an effect of mothers' HL on ECAP behaviours: lower HL of mothers increased allergen-avoiding behaviour directed at their child, while decreasing the chance of exclusive breastfeeding. Improving HL could contribute to the implementation of recommended ECAP behaviours in families, especially to the reduction of allergen-avoiding behaviours.

Evaluating cancer patient-reported experience measures against health literacy best practices

PURPOSE

Positive patient experiences can lead to better adherence to cancer treatment and greater patient health outcomes. The primary aim of this descriptive study was to determine whether commonly used cancer PREMs have been developed according to health literacy best practices. The secondary and third aims were to examine the development of PREMs and to assess their comprehensiveness against principles of patient-centered care.

METHODS

To assess adherence to best practice literacy principles regarding readability and understandability of commonly used cancer PREMs, three validated readability calculators and a validated instrument were utilized. To better understand how PREMs were developed, data about survey items, patient involvement, and expert consultation were collected. Finally, the Picker framework was used to evaluate the comprehensiveness of PREMs against principles of patient-centered care.

RESULTS

Thirty-five PREMs studies met inclusion criteria for the study. The mean reading grade level of cancer PREMs was 9.7 (SD = 0.75, range = 8.2-11.2) with best practice recommendation being a grade 6 reading grade level. Twenty-eight PREMs were rated on understandability, with a mean score of 74% (SD = 10.6, range = 46-93%, with optimal score of greater than 80%). The mean number of items across PREMs was 49 (SD = 31, range = 13-136). Recommendations for the number of items to include in a questionnaire is 25-30 items. Most PREMs (n = 33, 94.3%) asked ≥ 1 double-barreled question. All PREMs addressed ≥ 2 patient-centered care principles.

CONCLUSION

Cancer PREMs included in this study did not meet evidence-informed thresholds for readability and understandability. As such, it is possible that there may be gaps in how we understand the care experiences of low health literacy populations. Future development of PREMs should engage patients with low health literacy to ensure their perspectives are accurately captured and that PREMs are designed to meet the needs of all patients.

Health literacy in patients participating in cardiac rehabilitation: A prospective cohort study with pre-post-test design

Background and aims

Adherence to recommendations regarding medical treatment and healthy behaviour serve as a significant challenge for patients experiencing a cardiac event. Optimizing the patients' health literacy (HL) may be crucial to meet this challenge and has gained increased focus the last decade. Despite cardiac rehabilitation (CR) being a central part of the treatment of patients experiencing a cardiac event, such programs have not been evaluated regarding HL. Therefore, the aim of this study was to describe and evaluate HL in patients participating in CR.

Methods

A prospective cohort study with pre-post-test design of patients participating in CR. Data were collected at program admission and completion (August 2017-June 2018). Patients from three different CR-programs were included. Descriptive and inferential statistics were applied to describe and evaluate HL and change in HL across categories of demographical variables and type of rehabilitation.

Results

In total, 113 patients attending CR were included. A statistically significant increase in HL was observed from pre-to post-CR (mean change: 2.24 ± 3.68 (p < 0.001)). Patients attending 12-weeks outpatients CR-program had statistically significant higher HL, both at pre- and post-CR, compared to those attending one-week residential CR.

Conclusions

Participation in CR statistically significantly improves HL. Overall, judging health information was found as the most difficult aspect of HL, both at pre- and post-CR. This should be emphasized in secondary prevention to overcome barriers related to adherence to medical treatment and healthy behaviour.

The relationship between risk and prevention awareness of infectious diseases and health literacy among prisoners

OBJECTIVE

This study aimed to explore the intricate relationship between the health literacy and the awareness of risks and prevention awareness of infection disease among prisoners.

STUDY DESIGN

A cross-sectional descriptive study was conducted among 1350 prisoners at an L Type Closed Penal Execution Institution in Turkey, using comprehensive criteria to ensure the inclusion of a diverse participant pool.

METHOD

Data was collected via face-to-face interviews using the "personal information form," "health literacy scale (HLS)," and "communicable diseases risk awareness and protection Scale (CDRAPS)." Both scales exhibited high reliability. Statistical analyses, including Pearson correlation and linear regression, were conducted to evaluate the relationships between the dimensions of these scales.

RESULTS

The study was completed with 1031 prisoners. The participants' mean age was 38.65 with a majority being single (69.2%) and high school graduates (46.3%). A weak positive correlation (r = 0.448, P = 0.000) was observed between the CDRAPS (mean score 135.98 ± 24.00) and the HLS (mean score 89.85 ± 22.30), indicating health literacy explained a 20% variance in communicable diseases risk awareness and prevention. Furthermore, a significant relationship was established considering multiple variables including age, marital and educational status, family health personnel presence, smoking and alcohol use, and comorbidities, showing a combined effect on disease risk awareness and prevention (R2 = 0.203, β = 0.458, P = 0.000).

CONCLUSION

These findings highlight the importance for governments and policy makers to implement preventive and educational programs that are focused on public health, aiming to increase prisoners' health literacy and awareness of infectious diseases.

The Significance of Physician-Patient Communication on Telemedicine Patients' Health Outcomes: Evidence from Indonesia

The importance of physician-patient communication on patient health outcomes has been globally known. Poor communication in clinical settings, including in telemedicine visits, has been identified as a key barrier to successful medical consultation. This barrier is even more prevalent among people from linguistically and culturally diverse communities. This study investigated the influence of physician-patient communication on telemedicine patient health outcomes in Indonesia, a developing country with great linguistic and cultural diversity. This study utilized secondary data from a telemedicine utilization survey conducted during the coronavirus disease 2019 (COVID-19) pandemic. Socioeconomic factors and communication features were included as predictors of patients' health improvement. Logistic regressions were utilized to examine the significance of the communication features on patients' health. The analysis results indicated that five communication features including the adequacy of consultation length, a timely physician response, the provision of an explanation of the medication and possible side effects, the patient's ability to utter their physical condition and opinion regarding medication goals, and the patient's ability to comprehend physician explanations and instructions were significantly associated with the patient's health outcomes. Physicians and healthcare providers should focus on the provision of communication features revealed in this study to elevate the likelihood of improved health conditions in telemedicine patients.

Socioeconomic status as a risk factor for SARS-CoV-2 infection in pregnant women

OBJECTIVES

Due to the association between COVID-19 and adverse pregnancy outcomes, pregnant women are considered to be a vulnerable patient group. Studies have shown that low socioeconomic status (SES) is a risk factor for SARS-CoV-2 infection. COVID-19 and low SES are likely to have a synergistic adverse effect. This study aimed to evaluate the socioeconomic background, indicated by self-reported SES, educational level, and financial situation, in pregnant women who were positive for SARS-CoV-2.

METHODS

A case-control study was conducted, including all pregnant women with positive SARS-CoV-2 PCR tests at Kepler University Hospital Linz between May 2020 and August 2021 (n=150) and a control group matched 1:1 relative to gestational age at birth (n=150). Data were collected using written questionnaires and medical records from the hospital information system.

RESULTS

Lower self-reported socioeconomic status (p=0.029) and lower education level (p=0.003) were detected in the COVID group. Mothers in the COVID group were significantly younger (p=0.024). However, after adjustment for educational attainment, younger age was not confirmed as a risk factor for SARS-CoV-2 infection during pregnancy (p=0.326). The social gradient was not explained by the assumed mediators and confounders.

CONCLUSIONS

These findings confirm an association between lower socioeconomic status and the risk of SARS-CoV-2 infection during pregnancy. Since both socioeconomic factors and COVID-19 impose negative effects on pregnancy outcomes, health inequalities should be taken into consideration when implementing SARS-CoV-2 prevention measures and when providing health care for pregnant women from disadvantaged communities.

Alignment of Patient Information Leaflets with the Health Literacy Skills of Future End-Users: Are We on the Same Page?

Effective health communication will not be possible if the messages directed to patients do not adapt to their health literacy skills. In this sense, if the Patient Information Leaflets (PILs) are not understood properly, they will not fulfill their purpose. Secondary education aims to develop students' fundamental skills, including reading comprehension, which should align with future patients. This study assesses reading comprehension of commonly used PILs among secondary education students. An observational cross-sectional study involved 590 Spanish secondary school students from March to June 2022. They read 3 original PILs and completed a questionnaire about medication use information. The European health literacy survey questionnaire (short version) and sociodemographic data were collected. The average correct answer rate was only 51%, with just 14.58% understanding when to take ibuprofen, results that fell significantly below the minimum 80% threshold required by the European Union. Age, gender, and cultural background didn't significantly impact comprehension. In conclusion, health literacy skills acquired in secondary education are insufficient for understanding current PILs. Educational reform is necessary to improve students' ability to comprehend medication instructions and enhance PILs for effective communication. At the same time, our work highlights that current PILs need to be redesigned to reduce the cognitive burden imposed on patients.

Nursing Students' Health Literacy and Strategies to Foster Patients' Health Literacy

Health literacy can be defined as an individual's competence to use knowledge and information to maintain and improve health. Research has shown the crucial importance of health literacy in everyday life. Nurses play an important role in fostering patients' health literacy. But there is a lack in research on nurses' health literacy and how it influences their work. Therefore, this study aims to determine nursing students' health literacy and find out whether this group assessed that there was a change in their health literacy before and after the COVID-19 pandemic. In addition, this study aims to find out whether there is a relation between nursing students' assessments of their health literacy and their assessments of whether and how they use strategies to foster their patients' health literary in everyday work. We conducted a longitudinal study with two points of measurement, before the COVID-19 pandemic (N = 112) and after (N = 304). Nursing students filled out an online questionnaire using validated scales. To analyze the data, we used descriptive statistics, correlation analysis, and Welch's t-test. The results show that before the COVID-19 pandemic, the nursing students assessed their health literacy as quite high, and after the COVID-19 pandemic, they found it difficult to access (t = 17.881; p < 0.001; Cohen's d = 0.46), understand (t = 16.404; p < 0.001; Cohen's d = 0.56), appraise (t = 15.429; p < 0.00; Cohen's d = 0.47), and apply health-related information (t = 13.761; p < 0.001; Cohen's d = 0.54). Implications of our study concern nurses' vocational education and training in which nurses must learn about health literacy and strategies to foster their patients' health literacy.

Parents' comprehensive health literacy and child health after attending extended home visiting in Swedish multicultural settings-A case-comparison study

BACKGROUND

Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively.

OBJECTIVES

This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC).

MATERIALS AND METHODS

This quasi-experimental study used a case-control sampling method to recruit first-time parents through two CHC centres in Stockholm (2017-2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15-18 months old. HLS-EU-Q16 assessed parents' CHL. Children's medical records (0-18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non-parametric tests.

RESULTS

No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0-18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011).

CONCLUSIONS

Postnatal home visiting interventions practicing proportional universalism and family-centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long-term follow-up are suggested to explore associations between parents' CHL and child health.

TRIAL REGISTRATION

As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).

Translation and cross-cultural adaptation of the Chinese version of the HLS-EU-Q47

The development of health literacy in China is relatively slow, and there are fewer health literacy scales, which is difficult to measure. Therefore, this study aims to promote the development of health literacy in China through the translation and application of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). The scale was translated into Chinese, back-translated, culturally adapted and finally subjected to psychometric evaluation. A multi-stage stratified sampling method was used to select 2504 residents to test the reliability and validity of a questionnaire on health literacy. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the validity of the results, and the back consistency was calculated by Cronbach's alpha coefficient. The EFA revealed that health care, disease prevention and health promotion explained 78.68% of the total variance in health literacy. The scale and its subscales demonstrated strong internal consistency, with high Cronbach's alpha coefficients ranging from 0.947 to 0.983. CFA confirmed the three-factor model's goodness-of-fit for the Chinese population. The dimensions of healthcare, disease prevention and health promotion showed high convergent validity with an average variance extracted values ranging from 0.52 to 0.60 and composite reliability values ranging from 0.94 to 0.96. The reliable and valid Chinese version of the HLS-EU-Q47 (HLS19-Q47-CN) developed and evaluated in this study is an important tool for assessing health literacy levels in the Chinese population. Furthermore, as this tool has global applicability, it has the potential to assess health literacy levels across different countries, enabling practical international comparisons.

Teamwork Competencies and Their Influence on Health Literacy and Other Health Variables

The ability to work in a team is a skill of special relevance for multiple facets of life, increasing performance and optimizing the process in any task. This work aimed to study whether teamwork skills were related to different health variables. The sample consisted of 671 military personnel from the Spanish Army. The instrument is composed of the Health Literacy Questionnaire-the Teamwork Skills Questionnaire, and Rosenberg's self-esteem scale. The study concludes that the level of teamwork skills of the military is high, as well as their level of health literacy and their self-perception of health. However, their self-esteem is medium. Teamwork competencies are positively associated with a higher level of health literacy, with a high self-perception of their health, with the level of physical activity and negatively with self-esteem and the number of hospital admissions.

Health Literacy and Its Association with the Adoption of the Mediterranean Diet: A Cross-Sectional Study

Health literacy (HL) is a crucial factor influencing health-related decisions, including dietary patterns. The Mediterranean diet is widely recognized as one of the healthiest eating patterns. This study aims to explore the association between HL levels among adults in socially vulnerable contexts and their adoption of the Mediterranean diet. Conducted as part of a cluster-randomized trial in primary schools, the research involved 557 parents of children aged 6 to 10 who consented to participate. HL was assessed using the HLS questionnaire, while adoption of the Mediterranean diet was evaluated using the MEDAS questionnaire. Participants also provided anthropometric and sociodemographic data via a questionnaire, from which BMI was calculated (weight/height2). Education level was categorized as higher education or lower and professional status was classified based on occupational categories. Generalized linear models and logistic regression were employed for analysis. The findings indicate a direct association between HL level and adoption of the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035, p < 0.001), underscoring the influence of HL on dietary choices. Specifically, the healthcare dimension of HL emerges as pivotal in shaping dietary behaviors, particularly towards the Mediterranean diet. These results underscore the importance of policies and programs aimed at enhancing HL, especially among socially vulnerable populations. Prioritizing public health interventions to improve HL is critical for promoting better dietary decision-making.

Physical Education Teachers' Health Literacy: First Evidence from Lithuania

BACKGROUND

Promotion of health literacy is an important goal in the context of promoting whole school health. Physical education teachers are of particular importance in achieving this goal. However, very limited empirical studies have addressed the health literacy of physical education teachers. This research aimed to test the structural validity and reliability of the HLS19-Q12, to measure health literacy among physical education teachers, and to evaluate associations of health literacy with health- and lifestyle-related indicators.

METHODS

We conducted a cross-sectional study of Lithuanian physical education teachers. The participants completed a self-administered online survey that collected information on socio-demographics and health literacy (HLS19-Q12 for general health literacy and the optional package HLS19-DIGI to measure digital health literacy) as well as health behavior.

RESULTS

A total of 332 participants completed the survey. The HLS19-Q12 demonstrated acceptable internal consistency (Cronbach's α of 0.73 and McDonald's ω of 0.75) and satisfactory structural validity (CFI = 0.924, TLI = 0.917, RMSEA = 0.081). Participants had an average score of 85.09 (SD = 17.23) when using the HLS19-Q12, with 19.3% and 48.8% displaying excellent and sufficient levels of health literacy, respectively. Regression analyses revealed that a higher level of health literacy was significantly associated with better health evaluation (β = 0.15, p < 0.01), but no significant association was found with other health behavior and lifestyle indicators.

CONCLUSIONS

Overall, the results suggest that teachers' general health literacy is relatively high. Our findings highlight the importance of conducting more in-depth studies to pursue the understanding of the whole school teachers' health literacy.

Development and validation of a health literacy scale for family caregivers of older people with chronic illness

BACKGROUND

Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness.

METHODS

Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined.

RESULTS

A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01).

CONCLUSION

This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals.

Health literacy - study protocol for LiSa cohort study

BACKGROUND

Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, whether at home, at the workplace, in the community, marketplace, healthcare sector, or the political arena. The main aim of this project is to measure health literacy in the adult population living in the municipality of Leiria over the next 10 years. As secondary objectives it is intended to characterize anxiety and depression, metabolic risk and health behaviors in the same population and over the same period.

METHODS

This is a prospective cohort study that collects data on HL, anxiety and depression, health characteristics, health behavior and sociodemographic data. The study population will be composed by adults (≥ 18 years old) who are non-institutionalized and living in private households in Leiria. The random sample is stratified by gender and age groups. A face-to-face interview will be conducted with the Computer Assisted Personal Interview at baseline. Follow-up will be carried out every 2 years via telephone call. The association between independent variables and health literacy is examined by means of variance analysis with measurement repetition, and taking into consideration follow-up.

DISCUSSION

The LiSa project is a population-based study, derived from a random sampling technique that will allow the analysis of health outcomes in a representative sample of the population of the municipality of Leiria. The LiSa study will be a valuable resource for epidemiological research, as it will provide fundamental information to improve public health policies regarding health literacy in Portugal.

TRIAL REGISTRATION

Clinical trials: NCT05558631 (registered on 26/09/2022).

Psychometric properties of the health literacy instrument in Brazil (HLS-EU-BR47)

BACKGROUND

Health literacy (HL) is a key component of health promotion and sustainability and contributes to well-being. Despite its global relevance, HL is an under-researched topic in South America but is now debuting its exploration in Brazil. To leverage its benefits for South America, the mere translation of validated tools into Portuguese is insufficient. Rather, it is necessary to examine their validity. This study aims to assess the psychometric properties of the European Health Literacy Questionnaire (HLS-EU-BR47) using the Item Response Theory (IRT) in a population-based sample of adults in Brazil.

METHODS

A cross-sectional online study was conducted across Brazil and included 1028 participants aged 18 years and above (80% women). Cronbach's alpha, McDonald's omega, factor analysis, graded responses model, Item Characteristic Curve, HL levels based on this, HL standard calculation, IRT, and regular score correlation were computed.

RESULTS

The instrument exhibit high reliability (Cronbach's alpha 0.95). Factor analysis yielded one factor. IRT was appropriate for data analysis because it allowed quality evaluation of items and constructed a scale to quantify HL. The 47 items and latent features of respondents in the same unit of measurement are positioned in the construction of the HLS-EU-BR47 instrument. The percentages of individuals at each HL level, calculated using IRT, were found to be comparable to those obtained through the standard computation, e.g., 3.2% of people reported very low HL versus 10.8% inadequate HL, 56.2% reported low HL versus 39.5% problematic HL, 31.1% had moderate HL versus 30.1% sufficient HL, and 9.5% had high HL versus 19.7% with excellent HL. The mean HL scores were comparable between women and men (33.9 vs. 33.7, P = 0.36).

CONCLUSION

This study provides new evidence of the validity of a widely used HL instrument for the population of South America (in this case, Brazil). This tool can be utilized by citizens, health professionals, and regional/national policymakers to inform the development of initiatives to assess and improve the HL of individuals, groups, and communities. Further studies are needed to confirm and extend the findings and to explore the influence of local cultures and practices in the vast Brazilian territory on HL.

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

BACKGROUND

The escalating prevalence of diabetes, with its multifaceted complications, poses a pressing challenge for healthcare systems globally. In response, the advent of continuous glucose monitoring (CGM) systems, offering technological solutions for daily diabetes management, presents significant opportunities. However, the widespread adoption faces several barriers, linked both to the technological configuration of the devices and to the psychological dimension of patients. Therefore, this study aims to apply and test a theoretical model that investigates the antecedents of the intention to use Continuous Glucose Monitoring systems.

METHODS

The research model was built to unveil the impacts of psychological factors, functional components and rational constructs derived from the Technology Acceptance Model (TAM) on CGM systems sustained adoption. To ensure the comparability of results, we have collected data from people who had used Dexcom ONE Dexcom (San Diego, CA) for the first time for at least one month. Employing Structural Equation Modelling (SEM) techniques, the hypothesized relationships among constructs were assessed.

RESULTS

The analyses confirmed the positive correlation of rational factors to the Intention to Use. Subjective Norm, intended as the physicians' influence, is positively correlated with the Perceived Usefulness. Trend Arrows, albeit being negatively correlated with Perceived Usefulness, have a positive correlation on Perceived Ease Of Use, reinforcing its mediating effect towards Perceived Usefulness. Among psychological factors, Trust in the CGM technology positively correlates with Intention to Use. Health Literacy is negatively correlated to the Intention to Use.

CONCLUSIONS

These findings contribute to theoretical and managerial understanding, providing recommendations to enhance the adoption of CGM systems like Dexcom ONE.

Safety Data Sheets as a Hazard Communication Tool: An Assessment of Suitability and Readability

Background

Safety data sheets (SDSs) are hazard communication materials that accompany chemicals/hazardous products in the workplace. Many SDSs contain dense, technical text, which places considerable comprehension demands on workers, especially those with lower literacy skills. The goal of this study was to assess SDSs for readability, comprehensibility, and suitability (i.e., fit to the target audience).

Methods

The Suitability Assessment of Materials (SAM) tool assessed SDSs for suitability and readability. We then amended the SAM tool to further assess SDSs for comprehensibility factors. Both the original and amended SAM tool were used to score 45 randomly selected SDSs for content, literacy demand, graphics, and layout/typography.

Results

SDSs performed poorly in terms of readability, suitability, and comprehensibility. The mean readability scores were Flesch-Kincaid Grade Level (9.6), Gunning Fog index (11.0), Coleman-Liau index (13.7), and Simple Measure of Gobbledygook index (10.7), all above the recommended reading level. The original SAM graded SDSs as "not suitable" for suitability and readability. When the amended SAM was used, the mean total SAM score increased, but the SDSs were still considered "not suitable" when adding comprehensibility considerations. The amended SAM tool better identified content-related issues specific to SDSs that make it difficult for a reader to understand the material.

Conclusions

In terms of readability, comprehensibility, and suitability, SDSs perform poorly in their primary role as a hazard communication tool, therefore, putting workers at risk. The amended SAM tool could be used when writing SDSs to ensure that the information is more easily understandable for all audiences.

Health literacy in cancer care: A systematic review

PURPOSE

Health literacy (HL) is a set of knowledge and skills that enables individuals to interpret and act upon health information, which is essential for health equity. There is a growing body of evidence in the field of HL in cancer care but there is, to our knowledge, no systematic review that explores the association between sociodemographic factors and HL among patients with cancer. The aim of this study was therefore to conduct a systematic review of the existing literature that assesses HL levels and the relationship between HL and sociodemographic factors in an adult cancer population.

METHODS

This is a systematic review and its protocol was registered in PROSPERO (ID: CRD42021164071). The study was conducted in accordance with the PRISMA statement. The literature search, from December 2009 to September 2023, was made in six databases, AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science Core Collection.

RESULTS

Fifteen studies were included in the review. The included studies used nine different measurement tools for assessing HL. In the included studies between 11.9 % and 86 % had limited HL. We identified a relationship between limited HL and annual income, education level, ethnicity, living in rural areas and multiple comorbidities.

CONCLUSION

The results indicate that limited HL is prevalent in the cancer population and should be acknowledge in everyday practice to meet health equity. Our awareness about sociodemographic factors and its association with HL, may enhance adherence to cancer treatment and quality of life, and lower physical and emotional distress.

Caring for elderly substance users: Challenges, dilemmas and recommendations

Aim: To investigate the challenges and barriers in Danish care professionals' work in relation to elderly citizens who use substances. Method: The study draws on data from a "going along" study of care professionals' encounters with citizens as well as interviews with professionals. This was conducted in two smaller, rural municipalities in Denmark. Findings: Providing adequate care for elderly citizens who use substances can be highly challenging. This is due to a multitude of factors, especially (1) the complexity of their health conditions, (2) contradictory logics of care (autonomy vs. healthy living), (3) citizens often unpredictable behaviours, (4) lack of cooperation between welfare systems and, not least, (5) lack of knowledge and education among healthcare professionals. Conclusions: There is a need for more specialised procedures locally, the appointment of local "experts", better cooperation between sectors and easier accessible training and information on the group on a national level.

Linking patient-centered communication with cancer information avoidance: The mediating roles of patient trust and literacy

OBJECTIVES

This study, drawing on the pathway mediation model developed by Street and his colleagues (2009) that links communication to health outcomes, explores how patient-centered communication affects cancer information avoidance.

METHODS

Data was gathered through online access panel surveys, utilizing stratified sampling across Germany, Switzerland, the Netherlands, and Austria. The final sample included 4910 non-cancer and 414 cancer patients, all receiving healthcare from clinicians within the past year.

RESULTS

The results demonstrated that patient-centered communication is directly associated with reduced cancer information avoidance, especially among cancer patients. Additionally, this association is indirectly mediated through patient trust and healthcare literacy.

CONCLUSION

The findings provide empirical evidence that reveals the underlying mechanism linking clinician-patient communication to patient health information behavior.

PRACTICE IMPLICATIONS

The potential of clinician-patient communication in addressing health information avoidance is highlighted by these findings. Future interventions in healthcare settings should consider adopting patient-centered communication strategies. Additionally, improving patient trust and literacy levels could be effective in reducing cancer information avoidance.

Painkiller intake and problematic health literacy in sport and music students - A cross-sectional study

Previous works have suggested a high prevalence of painkiller intake (PI) among sport students but also improved health literacy (HL) for sports-active students than for sports-inactive students. Since health-related content also forms part of the sport science curriculum, the study focuses on these seemingly paradoxical results. Music students who are also physically active through their instrumental practice, who act in an area with increased PI and who have no health-related teaching content in their curriculum composed the comparison group. Therefore, this study investigated the prevalence of PI and HL in cohorts of sport (n = 222; 54.5% female) and music students (n = 89; 67.4% female) using a cross-sectional online survey in Lower Saxony, Germany. The hypothesis tests were validated by calculating frequentist and Bayesian statistics. The results show that 50.9% of sport and 28.1% of music students exhibit PI concerning their study programs, often for prophylactical purposes and in the presence of low HL levels. The weak negative correlation between PI and HL was not statistically confirmed and requires further research with improved test power. Regarding the possible health consequences of an inconsiderate PI, target group-specific prevention is indicated to increase general health awareness and HL.

Revisiting the symptom iceberg based on the Danish symptom cohort - Symptom experiences and healthcare-seeking behaviour in the general Danish population in 2022

Introduction

Healthcare-seeking behaviour may change over time, and some groups are more likely to avoid relevant help seeking, which possibly contributes to social inequity in health. Thus, we developed an expansion of and follow-up to the Danish Symptom Cohort (DaSC) from 2012 and formed the DaSC II, which encompassed a population-based questionnaire study investigating symptoms and healthcare-seeking behaviour. In this paper, we describe the conceptual framework, development and content validity of the questionnaire and a responder analysis of the participants in the DaSC II. We present the symptom iceberg in the Danish general population by estimating the prevalence of symptoms and proportion of contacts to general practitioners (GPs) in 2022. Moreover, we discuss differences in healthcare-seeking behaviour with reference to the 2012 DaSC.

Methods

100,000 randomly selected Danish citizens aged ≥20 years, along with the 44,713 respondents from the 2012 cohort, were invited to participate in a survey. The questionnaire was pilot and field tested prior to distribution. Descriptive statistics were used to estimate symptom prevalence and proportion of GP contacts, and to execute the respondent analysis.

Results

Nine out of ten respondents reported at least one symptom within the preceding four weeks and reported an average of 4.6 symptoms. One in four symptoms were presented to a GP. The highest proportion of GP contacts was found for haematuria (63.3 %) and shortness of breath (51.8 %). For several symptoms, differences between the sexes were found in relation to both prevalence and GP contacts. The proportion of GP contacts was higher in 2022 than in 2012 and was most pronounced for general, frequently experienced symptoms and to a lesser extent for cancer alarm symptoms.

Conclusion

Many symptoms go unreported, which may delay relevant diagnosis; more research on certain symptom categories and population subgroups is needed. Future studies based on the DaSC II form a basis for interventions targeting symptom awareness, healthcare-seeking behaviour and social equity in society and health.

Study protocol: Examining sexual and reproductive health literacy in Mexican American young women using a positive deviance approach

Health literacy is generally low in marginalized groups, leading to delays in accessing care, poor health outcomes, and health disparities. Yet, some individuals in these groups demonstrate higher health literacy and better health outcomes. These exceptional cases exemplify 'positive deviance' because they have found ways to be successful where others have not. Identifying the methods, practices, and resources that these individuals have used to gain health literacy and healthcare access may have generalized application to improve health literacy, access to care, and health outcomes. Using the Integrated Model of Health Literacy, the main objectives of this study are to (1) identify facilitators, barriers, and strategies to gain sexual and reproductive health literacy and healthcare access and (2) to explore each of the core domains of health literacy as they relate to successful access of sexual and reproductive healthcare services among individuals identified as positive deviants. For the purposes of this mixed methods community engaged study, positive deviants are defined as Mexican American young women aged 18-29 years old living in Rural Western New York who have accessed sexual and reproductive healthcare within the past year. A community advisory committee will be formed to provide community-engaged guidance and support for the recruitment of participants. Positive deviants will participate in a survey and semi-structured interview. Data collection and analysis will be simultaneous and iterative. Results will provide evidence of positive deviant methods, practices, and strategies to gain health literacy and access to sexual and reproductive healthcare. Findings may reveal characteristics and patterns in the relationship of health literacy and healthcare access that can inform interventions to improve health literacy and make healthcare more accessible for this demographic group and context.

Spanish and Catalan Versions of the eHealth Literacy Questionnaire: Translation, Cross-Cultural Adaptation, and Validation Study

BACKGROUND

The rise of digital health services, especially following the outbreak of COVID-19, has led to a need for health literacy policies that respond to people's needs. Spain is a country with a highly developed digital health infrastructure, but there are currently no tools available to measure digital health literacy fully. A well-thought-through questionnaire with strong psychometric properties such as the eHealth Literacy Questionnaire (eHLQ) is important to assess people's eHealth literacy levels, especially in the context of a fast-growing field such as digital health.

OBJECTIVE

This study aims to adapt the eHLQ and gather evidence of its psychometric quality in 2 of Spain's official languages: Spanish and Catalan.

METHODS

A systematic cultural adaptation process was followed. Data from Spanish-speaking (n=400) and Catalan-speaking (n=400) people were collected. Confirmatory factor analysis was used to confirm the previously established factor structure. For reliability, the Cronbach α and categorical ω were obtained for every subscale. Evidence of convergent and discriminant validity was provided through the correlation with the total score of the eHealth Literacy Scale. Evidence based on relations to other variables was evaluated by examining extreme values for educational level, socioeconomic level, and use of technology variables.

RESULTS

Regarding the confirmatory factor analysis, the 7-factor correlated model and the 7 one-factor models had adequate goodness-of-fit indexes for both Spanish and Catalan. Moreover, measurement invariance was established between the Spanish and Catalan versions. Reliability estimates were considered adequate as all the scales in both versions had values of >0.80. For convergent and discriminant validity evidence, the eHealth Literacy Scale showed moderate correlation with eHLQ scales in both versions (Spanish: range 0.57-0.76 and P<.001; Catalan: range 0.41-0.64 and P<.001). According to the relationship with external variables, all the eHLQ scales in both languages could discriminate between the maximum and minimum categories in level of education, socioeconomic level, and level of technology use.

CONCLUSIONS

The Spanish and Catalan versions of the eHLQ appear to be psychometrically sound questionnaires for assessing digital health literacy. They could both be useful tools in Spain and Catalonia for researchers, policy makers, and health service managers to explore people's needs, skills, and competencies and provide interesting insights into their interactions and engagement regarding their own experiences with digital health services, especially in the context of digital health growth in Spain.

Health literacy and asthma: An update

The US Department of Health and Human Services has defined health literacy (HL) as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Structural and social determinants of health lead to low HL in approximately 36% of adults in the United States, where this condition is most prevalent in racial and ethnic minorities, economically disadvantaged communities, and immigrants with limited English proficiency. In turn, low HL can worsen asthma outcomes through direct effects (eg, nonadherence to or incorrect use of medications) and indirect effects (eg, an unhealthy diet leading to obesity, a risk factor for asthma morbidity). The purpose of this update is to examine evidence from studies on low HL and health and asthma outcomes published in the last 12 years, identify approaches to improve HL and reduce health disparities in asthma, and discuss future directions for research in this area under the conceptual framework of a socioecological model that illustrates the multifactorial and interconnected complexity of this public health issue at different levels.

Health literacy in adult patients with atopic dermatitis: A cross-sectional study

Background

Health literacy (HL) is defined as the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate health decisions. Patients with limited HL are less likely to manage chronic diseases appropriately.

Objective

We sought to assess the prevalence of limited HL in patients with atopic dermatitis (AD) and its association with other patient-reported outcomes.

Methods

A cross-sectional questionnaire-based study was conducted at a tertiary referral center for AD. Patients diagnosed with AD by a dermatologist between 2019 and 2021 were identified from medical records. Perception-based HL was assessed by the European Health Literacy Survey Questionnaire 16 and performance-based HL by the Newest Vital Sign. Patients completed the Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and Atopic Dermatitis Control Tool to measure AD severity, quality of life, and AD disease control, respectively.

Results

In total, 322 patients were included (response rate, 48.3%). On the basis of the European Health Literacy Survey Questionnaire 16, 32.4% had limited HL (8.4% inadequate and 24.0% problematic), which was associated with impaired quality of life. According to the Newest Vital Sign, 20.3% had inadequate HL, which was associated with older age.

Conclusions

Up to one-third of the patients with AD showed signs of limited HL, which was associated with impaired health-related quality of life and older age. Further research should evaluate the influence of inadequate HL on health outcomes and focus on strategies to improve organizational HL to eventually enhance patient-centered care.

The explanation of educational disparities in adiposity by lifestyle, socioeconomic and mental health mediators: a multiple mediation model

BACKGROUND

The inverse association between education and obesity was previously found in numerous studies. This study aims to assess several possible mediators in the educational disparities in adiposity. We hypothesize the potential mediating role of lifestyle, socioeconomic, and mental health factors in the association between education and adiposity.

METHODS

Cross-sectional population-based sample from Czechia included 2,154 25-64 years old subjects (54.6% women). Education was classified as high, middle, and low. Adiposity was assessed as a latent variable based on body fat percentage, BMI, waist circumference, and visceral fat. The mediation potential of unhealthy dietary behavior, alcohol intake, smoking, sedentary behaviors, income, stress, depression, and quality of life was assessed in age-adjusted sex-specific multiple mediation models.

RESULTS

The negative direct effect of education on adiposity was statistically significant at 5% level of significance in both sexes. For men, the indirect effect was statistically significant via sedentary behavior (β = 0.041; 95% CI [0.025-0.062]) with a mediation ratio of 23.7%. In women, the indirect effect was statistically significant via dietary risk (β = -0.023, 95% CI [-0.037, -0.013]), alcohol intake (β = -0.006; 95% CI [-0.014, -0.001]), sedentary behavior (β = 0.012, 95% CI [0.004,0.023]), income (β = -0.022; 95% CI [-0.041, -0.004]), and mental health (β = -0.007; 95% CI [-0.019, -0.001]). The total mediation ratio in women was 30.5%.

CONCLUSIONS

Sedentary behaviors had mediating role in the association between education and adiposity in both sexes, with more important role in men. In addition, unhealthy diet and lower income partially mediated the educational gradient in adiposity in women.

Impact of health and digital health literacy on quality of life following radical prostatectomy for prostate cancer: prospective single-center cohort study

PURPOSE

The importance of health literacy (HL) and digital health literacy (e-HL) in promoting healthy behavior and informed decision making is becoming increasingly apparent. This study aimed to assess the effects of HL and e-HL on the quality of life (QoL) of men who underwent radical prostatectomy (RP) for localized prostate cancer.

MATERIALS AND METHODS

This prospective observational study included 104 patients who underwent RP for localized prostate cancer. HL and e-HL were evaluated using the validated eHealth Literacy Scale and European Health Literacy Survey Questionnaire Short Form before RP. We evaluated patients' physical, psychological, social, and global QoL using the validated EORTC QLQ-C30 8 weeks after RP. The exclusion criterion was any difficulties in language and comprehension. We employed one-way ANOVA to compare continuous variables across groups in univariate analysis and used MANOVA for exploring relationships among multiple continuous variables and groups in the multivariate analysis.

RESULTS

Multivariate analyses showed that poorer e-HL and HL were associated with being older (p = 0.019), having less education (p < 0.001), and not having access to the internet (p < 0.001). Logistic regression analysis revealed significant associations between improved e-HL (p = 0.043) and HL (p = 0.023), better global health status, and higher emotional functioning (p = 0.011). However, the symptom scales did not differ significantly between the e-HL and HL groups.

CONCLUSION

Our study showed a positive association between self-reported HL/e-HL and QoL, marking the first report on the impact of HL/e-HL on the QoL in men who underwent RP for clinically localized prostate cancer.

Health information-seeking behavior in patients with coronary artery disease: Activating methods

INTRODUCTION

Coronary artery disease (CAD) has a high mortality rate worldwide, and continuous health behavior practice and careful management are required owing to risks such as rapid changes in symptoms and emergency hospitalization. The utilization of health-related information is an important factor for long-term disease management in patients with CAD. For this purpose, an understanding of health information-seeking behavior is needed first.

METHODS

This study analyzed data from the 2021 Korea Medical Panel Survey, and logistic regression analysis was conducted to confirm the factors influencing the health information-seeking behavior of patients with CAD.

RESULTS

The health information-seeking behavior of patients with CAD differed according to demographic characteristics, and differences in preferred information use were confirmed. Finally, it was identified that insufficient levels of health literacy were a major reason for CAD patients not engaging in health information-seeking behaviors (OR, 0.17; 95% CI, 0.09-0.33; p < 0.001).

CONCLUSION

This study suggests that to improve health information-seeking behaviors, the application of education and intervention programs to increase the level of health literacy is necessary.

Evaluation of Parents' Use of a Child Health Care Information App and Their Health Literacy: Cross-Sectional Study

Background

Recently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents' health literacy.

Objective

This study aims to evaluate whether parents' use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children.

Methods

Participants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits.

Results

In total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non-app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non-app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non-app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non-app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables.

Conclusions

This study showed a significant association between parents' use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children's health care. Future studies are needed to evaluate the association between app use and emergency room visits.

Health literacy and household financial loss on malaria treatment for children under five in Ghana: a patients' perspective

BACKGROUND

Inadequate health literacy increases medical costs and leads to poor health outcomes. However, there is a paucity of empirical evidence of such associations in sub-Saharan Africa. This study investigates how the household cost of malaria in children under five in Ghana varies based on different levels of health literacy.

METHODS

A cross-sectional survey involving 1270 caregivers of children under five was conducted. The survey included health literacy questionnaire and several pieces of sociodemographic and behavioural variables.

RESULTS

We created seven caregiver health literacy profiles by scoring nine dimensions. The mean total cost for managing malaria among respondents was US$20.29 per episode. The total household cost for caregivers with high health literacy (Profile 1) (US$24.77) was higher than all other profiles, with the lowest cost (US$17.93) among the low health literacy profile (Profile 6). Compared with Profile 4, caregivers with high health literacy (Profile 1) spent more on managing malaria in children, while those with the lowest health literacy (Profile 7) spent less.

CONCLUSION

The current study presents a snapshot of malaria treatment costs, and argues that low health literacy may lead to increased costs due to possible reinfections from delayed healthcare use. There is a need for longitudinal studies to understand causal relationship between health literacy and household expenses on malaria treatment to inform policy development and interventions.

LAY SUMMARY

This study explores the impact of caregiver health literacy levels on the cost of managing malaria incidents in children under five in Ghana. High health-literate caregivers incurred the highest total household cost at US$24.77, with US$17.93 incurred by lower health-literate caregivers per malaria episode.

Compliance with COVID-19 Physical Distancing Mandates in Oman: The Role of Health Literacy and Internal Health Locus of Control

BACKGROUND

Research indicates that the effectiveness of coronavirus disease 2019 (COVID-19) physical distancing mandates is influenced by several individual factors, including health literacy; internal health locus of control (IHLOC), the belief that physical distancing can reduce COVID-19 risk; social norms; self-efficacy; and perceptions of the benefits and barriers associated with distancing. However, further investigation is needed to understand the links between these factors and compliance intentions.

OBJECTIVE

This study investigates the mechanism linking these factors with the intentions to comply with physical distancing mandates.

METHODS

A total of 759 participants (Mean age = 29.13, standard deviation [SD] = 8.33; 68.5% women) were surveyed online from September 2020 to October 2020. Data were analyzed using ANOVA (analysis of variance) and structural equation modeling.

KEY RESULTS

Health literacy was associated with more perceived benefits (β = .175, p = .001), greater self-efficacy (β = .193, p < .001), and less perceived barriers (β = -.391, p < .001). IHLOC was significantly associated with greater perceived benefits (β = .156, p = .007) and self-efficacy (β = .294, p < .001). Family descriptive norms were significantly associated with fewer perceived barriers (β = -.276, p < .001), while injunctive norms were associated with more perceived benefits (β = .202, p = .001) and higher self-efficacy (β = .299, p < .001). Intentions to adhere to physical distancing mandates were significantly associated with past compliance (β = .427, p < .001) and perceived barriers (β = -.205, p < .001) and benefits (β = .295, p < .001). Post-hoc mediation analyses revealed several small yet significant indirect effects, highlighting the complex pathways shaping adherence intentions.

CONCLUSIONS

This study identifies how health literacy, IHLOC, social norms, perceived benefits and barriers, and self-efficacy intricately shape intentions to comply with physical distancing mandates. These findings offer valuable implications for public health policy and interventions. [HLRP: Health Literacy Research and Practice. 2024;8(2):e69-e78.].

Attitude towards consent-free research use of personal medical data in the general German population

Background

The design of appropriate consent procedures for the secondary use of personal health data is a key concern of current medical research. In Germany, the concept of 'data donation' has recently come into focus, defined as a legal entitlement to the research use of personal medical data without prior consent, combined with an easy-to-exercise right of the data subjects to opt-out.

Methods

Standardized online interviews of 3,013 individuals, representative of the German online population, were conducted in August 2022 to determine their attitude towards data donation for medical research.

Results

A majority of participants supported a consent-free data donation regulation, both for publicly funded (85.1%) and for private medical research (66.4%). Major predictors of a positive attitude towards data donation included (i) sufficient appreciation of the respective kind of research (i.e. public or private), (ii) a reciprocity attitude that patients who benefit from research have a duty to support research, and (iii) sufficient trust in data protection and data control.

Conclusion

People's attitude towards data donation to medical research is generally positive in Germany and depends upon factors that can be curbed by legislation and internal rules of procedure. Worthy of note, designing data donation in the form of an opt-out regulation does not necessarily mean that the paradigm of informedness has to be abandoned. Rather the process of information provision must be shifted towards the creation of basic knowledge in the general population about the risks and benefits of data-intensive medical research ('health data literacy').

Socio-demographic, agricultural, and personal protective factors in relation to health literacy among farmers from all regions of Thailand

Introduction

Farmers are vulnerable to adverse health effects from pesticide exposure due to their health literacy (HL). Therefore, this study aims to investigate HL among farmers in four main regions of Thailand, investigating socio-demographics, agricultural, and personal protective factors to their HL.

Methods

This cross-sectional design study was conducted on 4,035 farmers from January to July 2023. The European Health Literacy Survey Questionnaire-47 items were used to measure HL.

Results

Thai farmers had a mean HL score of 34.7 ± 8.7, and the farmers in the North region of Thailand had the highest frequency of limited HL (75.8%). Socio-demographic factors that were associated with HL included gender, region of living, marital status, education level, co-morbidity, and number of family members. Agricultural factors associated with HL included planting status, working hours on farm, spraying pesticides, harvesting crops, pesticide use of >1 type, access information from government officers, access information from posters/brochures, information from online multimedia, and access information from neighbors. Personal protective factors that were associated with HL included wearing a hat, goggles, a rubber apron, and a long-sleeved shirt.

Discussion

Our study recommends that strategies and interventions to enhance the HL of farmers should be focused on the target populations, which include men, widows, or divorced, those with low levels of education, those who have co-morbidities, and those who applied pesticides of more than 1 type and improper personal protective equipment (PPE) use. The primary emphasis needs to be on the North region of Thailand, making that the target area to improve health equity in Thailand. These efforts would enhance the HL of farmers and sustainably improve pesticide safety behavior. Additionally, there is an urgent need for supportive measures aimed at altering on-farm practices and promoting education on alternative pest management strategies, particularly non-chemical crop protection, to ensure sustainable agriculture.

Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults

Background

Declining cognitive function (CF) and physical function (PF) relate to poorer health-related quality of life (HRQoL) in older adults. As health literacy (HL) facilitates health information utilization, it may mediate links between functionality and HRQoL appraisals. This study examined HL as an intermediary between joint CF and PF contributions and HRQoL in Hong Kong older adults.

Methods

490 older adults aged 50-80 years completed assessments from March to July 2021. Health Literacy Survey Questionnaire Short Form 12 questions (HLS-SF12), Montreal Cognitive Assessment (MoCA), Senior Fitness Test (SFT) and 12-Item Short-Form Health Survey version 2 (SF-12v2) were used to assess HL, CF, PF and HRQoL, respectively. Path analysis tested a model with HL mediating CF/PF predictors and HRQoL outcome.

Results

Results for direct effects indicated that CF significantly associated with PF (β = 0.115, SE = 0.012, p < 0.001), PF significantly connected to HL (β = 0.101, SE = 0.022, p < 0.001), and HL significantly related to HRQoL (β = 0.457, SE = 0.049, p < 0.001). Meanwhile, PF significantly linked to HRQoL directly (β = 0.156, SE = 0.025, p < 0.001) as well as indirectly (β = 0.046, 95% CI [0.028, 0.067]). Significant mediating effect of HL was found on the relationship of PF and HRQoL.

Conclusion

Findings confirm CF and PF joint impacts on HL and HRQoL in older adults, elucidating HL's mediating role in translating functionality levels into HRQoL. Fostering enduring health knowledge access may thus buffer effects of age-related declines on well-being. Results can inform interventions leveraging this pathway to promote resilient trajectories.

The impact of health literacy on uterine fibroid awareness, diagnosis, and treatment in the United States: a mini literature review

Limited health literacy is a social health determinant leading to poor health outcomes. General and health literacy correlate and can impact diagnosis and treatment understanding. Limited literacy can lead to women receiving more significant rates of invasive surgical treatment, including hysterectomies. This review explores the impact of health literacy levels on uterine fibroid awareness, diagnosis, and treatment. PubMed, CINAHL, and Academic Search Premier searched articles published between January 1, 2012, and December 31, 2022. The keywords uterine fibroids, fibroids, myomas, leiomyomas, and health literacy were used. A total of four articles were returned. Increased rates of hysterectomies were found among participants with low income and education, as well as those with limited health literacy. Hysterectomies are the removal of the uterus and thus removes a woman's right to have children. While increased efforts are needed to understand the impact of health literacy levels on disparities and inequities in uterine fibroid diagnosis and treatment, there is still a need for targeted patient education and community-based education that ensures patient understanding of the diagnosis and treatment options for uterine fibroids.

Developing a capacity-building intervention for healthcare workers to improve communication skills and awareness of hard of hearing and D/deaf patients: results from a participatory action research study

BACKGROUND

Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals' experiences in healthcare and improve their capacity to communicate with these populations.

METHODS

This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention.

RESULTS

Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients.

CONCLUSIONS

Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs' perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

Diet, Food Intake, and Exercise Mixed Interventions (DEMI) in the Enhancement of Wellbeing among Community-Dwelling Older Adults in Japan: Systematic Review and Meta-Analysis of Randomized Controlled Trials

This systematic review and meta-analysis discusses the available data on the efficacy of diet, food intake, and exercise mixed interventions (DEMI) for community-dwelling older adults in Japan and assesses the evidence level. We searched the literature regarding the research questions using electronic and hand-searching methods. To ensure the reliability and quality of the evidence, we used the Cochrane risk of bias tool and GRADE system. All studies included DEMI; other interventions included group activities, health education, and community participation. All interventions were categorized into three classifications, namely "Diet and food intake", "Exercise", and "Other". Programs included lectures, practical exercises, group activities, consulting, and programs that could be implemented at home. By comparing groups and measuring outcomes at various time points, most studies reported positive results regarding the impact of the interventions. Specifically, usual gait speed, Food Frequency Questionnaire Score, and Diet Variety Score demonstrated significant improvement. Additionally, three studies demonstrated improvement in frailty. This review suggests that DEMI resulted in improvements in some outcome variables. However, the efficacy of all variables was not fully examined. The results of the meta-analysis revealed positive outcomes for some variables, although the evidence level for these outcomes was considered moderate.

Public health literacy in primary users in western Turkey

BACKGROUND

Public health literacy (PHL) is a novel perspective on health literacy (HL). Differing from HL's individualist approach, PHL is concerned with public health events and promoting health in the whole society.

OBJECTIVES

To evaluate PHL, a newly developed concept, and related factors.

METHODS

In this cross-sectional study, people who visited primary healthcare centers in urban and rural settings were recruited using a questionnaire that includes Public Health Literacy Knowledge Scale (PHLKS) and Adult Health Literacy Scale (AHLS). Out of four Primary Healthcare Centers (PMCs) in western Turkey selected randomly, one PMC was located in a rural setting, while three PMCs were located in an urban setting. Multiple linear regression was used to determine the predictors for PHL.

RESULTS

The study group consisted of 1672 people, of which 55.3% were male. The mean age was 40.94 ± 15.22. The median score (min-max) from PHLKS was 13.0 (0-17). Multiple linear regression showed that income level had a negative impact on PHL. Higher education, fondness for reading, hospital admission and HL, however, increased PHL levels. Additionally, living in an urban area and not having auditory problems were positively associated with PHL.

CONCLUSIONS

Participants had a moderate level of PHL. Improving PHL should be a priority to tackle global and local problems that have an adverse effect on community health. To increase community engagement in public health events, people with low education and HL levels should be targeted in future training programs.

Analysis and Forecast of Birth Related Indicators in Selected Balkan and Eastern European Countries

Background

Health indicators are often used for a variety of purposes, including program management, resource allocation, monitoring of country progress, performance-based payment, and global reporting. Real progress in health towards the United Nations Millennium Development Goals and other national health priorities is vitally dependent on stronger health systems. We aimed to analyse the progress of "birth related indicators" of selected countries of Balkan and Eastern Europe and to forecast their values in the future.

Methods

This research report article represents a descriptive data analysis of selected health indicators, extracted from European Health for All database (HFA-DB) and EuroStat. Indicators of interest were analysed for 17 countries in observational period from 1990 to 2019. The data were analysed using a linear trend estimate and median operation and interquartile range 25th-75th percentile were used for better comparison of each country. Forecasting analysis to year 2025 was performed by combining Excel analysis and SPSS program.

Results

Number of all live births to mothers aged under 20 is decreasing in almost all examined countries, while live births to mother over 35 is mostly increasing. Total fertility rate is also mainly decreasing in almost all countries of interest for our investigation, as well as the crude birth rate. Estimated infant mortality per 1000 live births is decreasing in all observed countries.

Conclusion

Population aging is becoming more pronounced, while current birth-related indicators have negative tendencies; this problem will obviously continue over time.

The effect of the training provided to primiparous pregnant women based on the model on pregnancy risk perception and health literacy

The purpose of this study was to assess the impact of health education based on the health belief model (HBM) on the perception of risk in pregnancy and health literacy in primiparous pregnant women to maintain and improve their health. The study was carried out with 82 pregnant women who were in the second trimester. The number of samples was calculated using the G-Power program version 3.1.7. The number of samples was found 44 for the education group and 44 for the control group with a confidence interval of 95 percent, a margin of error of 5 percent, a large Cohen d effect size value (0.5), and a power of 80 percent. Randomization was performed using the envelope method to determine the interventional and control groups. The training prepared in line with the SIM was presented to the participants in the education group. 2 sessions per week, a total of 4 times. "Personal Information Form," Health Literacy Scale (HLS), and Perception of Pregnancy Risk Questionnaire (PPRQ) were used as data collection tools. The mean of the risk perception of the pregnant toward the baby posttest score was 9.95 ± 13.30 in the education group, and 23.35 ± 21.41 in the control group (p = .001). The mean health literacy scale posttest score was 103.52 ± 19.77 in the education group and 93.5 ± 19.02 in the control group, and it was found to be statistically significantly higher in the health literacy education group than in the control group (p = .027). This study found that educating pregnant women using the health belief model reduces their risk perception and boosts their degree of health literacy.

Health literacy and pandemic coping in Leisure Time Monitors

INTRODUCTION

Health literacy allows us to make appropriate decisions about our self-care and to use health services appropriately, therefore, it conditions people's health.

OBJECTIVES

The aim of this study was to describe the level of health literacy of leisure time monitors and the influence of self-perception of health in times of pandemic.

STUDY DESIGN

We used a cross-sectional observational design with non-probabilistic purposive sampling among leisure time monitors in the Autonomous Community of Galicia (Spain).

METHOD

For this purpose, the HLS-EU-Q47 questionnaire measuring health literacy and a questionnaire measuring perception of COVID-19 were used.

RESULTS

The results verify that the monitors consider that the pandemic affects their daily life, that it will be a situation that will last for a long time, and they are very worried. The low level of health literacy of the leisure time monitors is also confirmed.

CONCLUSIONS

Therefore, it seems urgent to evaluate the existing training programme and to include health education contents in this programme, given the involvement of leisure time monitors in the training of children and adolescents.

Parents' understanding of medication at discharge and potential harm in children with medical complexity

OBJECTIVE

Children with medical complexity (CMC) are among the most vulnerable patient groups. This study aimed to evaluate their prevalence and risk factors for medication misunderstanding and potential harm (PH) at discharge.

DESIGN AND SETTING

Cross-sectional study at a tertiary care centre.

STUDY POPULATION

CMC admitted at Medical University of Vienna between May 2018 and January 2019.

INTERVENTION

CMC and caregivers underwent a structured interview at discharge; medication understanding and PH for adverse events were assessed by a hybrid approach.

MAIN OUTCOME MEASURES

Medication misunderstanding rate; PH.

RESULTS

For 106 included children (median age 9.6 years), a median number of 5.0 (IQR 3.0-8.0) different medications were prescribed. 83 CMC (78.3%) demonstrated at least one misunderstanding, in 33 CMC (31.1%), potential harm was detected, 5 of them severe. Misunderstandings were associated with more medications (r=0.24, p=0.013), new prescriptions (r=0.23, p=0.019), quality of medication-related communication (r=-0.21, p=0.032), low level of education (p=0.013), low language skills (p=0.002) and migratory background (p=0.001). Relative risk of PH was 2.27 times increased (95% CI 1.23 to 4.22) with new medications, 2.14 times increased (95% CI 1.10 to 4.17) with migratory background.

CONCLUSION

Despite continuous care at a tertiary care centre and high level of subjective satisfaction, high prevalence of medication misunderstanding with relevant risk for PH was discovered in CMC and their caregivers. This demonstrates the need of interventions to improve patient safety, with stratification of medication-related communication for high-risk groups and a restructured discharge process focusing on detection of misunderstandings ('unknown unknowns').

Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =- 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

The validity of the distress thermometer in patients with musculoskeletal tumors

Background

Visits to an outpatient cancer clinic represent a challenging situation for patients, which can trigger anxiety and helplessness in those affected. It is important to identify patients with high psychological distress as early as possible in order to provide them with supportive psychological interventions. The aim of this study was to validate the Distress Thermometer (DT), a widely used screening for distress, in a cohort of patients with musculoskeletal tumors and to explore associations between distress, treatment satisfaction and health literacy.

Methods

All patients presenting to a University outpatient clinic for musculoskeletal cancers were asked to complete a set of questionnaires including the DT), the Hospital Anxiety and Depression Scale (HADS) as a comparison scale, the Patient Satisfaction with Comprehensive Cancer Care (SCCC) and European Health Literacy Survey Questionnaire (HLS-EU-Q16).To assess the sensitivity and specificity of the DT in a cohort of patients with musculoskeletal tumors, we compare the performance of the DT in relation to an established screener for anxiety and depression using receiver operating characteristics (ROC) analyses.

Results

A total of 120 patients (age 58 ± 18, 51% female) were analyzed. Patients reported a mean DT of 5.0 (SD 2.3, range, 0 to 10). Eighty-six patients (71.7 %) had a DT score ≥ 5 indicating moderate or severe psychological distress.The mean total HADS score (scale 0 to42 points) was 11.7 (SD 7.6, range, 0 to 32) with a HADS score of ≥ 15 in 29.2% of patients. The DT correlated moderately with anxiety and depression (HADS total r = 0.48, p < 0.001), while the correlation with depression (HADS-D, r = 0.47, p < 0.001) was stronger than with anxiety (HADS-A, r = 0.38, p < 0.001).For a DT score ≥ 5, ROC analysis yielded a sensitivity of 71.4% and a specificity of 75.3% for detecting moderate or severe psychological distress (HADS ≥ 15, AUC 0.782).The REPERES-G, collected from a subgroup (n = 49), showed high treatment satisfaction with a median score of 132 (min 90, max 163). Especially the "satisfaction with medical aspects of treatment" (REPERES-G medical aspects) showed a moderate correlation with the DT (r = 0.51, p < 0.001) a strong correlation with anxiety and depression (HADS total, r = 0.69, p < 0.001).

Conclusion

About three in four patients with musculoskeletal tumors have relevant psychological distress. A visual analogue scale can only be a rough guide for identifying patients in need of psychological support, with a sensitivity of 71.4 % and a specificity of 75.3 %. A strong relationship between patient and care team was associated with lower patient psychological distress.Consequently, screening tools cannot replace detailed discussion and personal contact, especially in the treatment of malignant diseases.