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Matsuo R, Fujita K, Miyazono M, Miyasaka K, Yamanaka T, Yakushiji K, Nagai A. Validating the short-version European Health Literacy Survey Questionnaire for community-dwelling older adults in Japan. Health Promot Int 2024; 39:daae105. [PMID: 39180352 DOI: 10.1093/heapro/daae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024] Open
Abstract
The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is available in multiple languages, and shortened versions have also been developed. This study aimed to examine the reliability and validity of the short version of the questionnaire (HLS-Q12) developed for community-dwelling older adults in Japan. The HLS-Q12 was developed using 12 of the 47 items of the Japanese version of the HLS-EU-Q47. In this study, the survey was conducted by distributing self-administered questionnaires to community-dwelling individuals aged 65 years and older who consented to participate; their responses were collected by mail. The correlation between the HLS-Q12 and the HLS-EU-Q47 was tested to assess criterion validity. To test construct validity, nine novel hypotheses were proposed. We also conducted a confirmatory factor analysis of the HLS-Q12. Based on a resurvey after 5-7 days, test-retest reliability was examined using interclass correlation coefficients (ICCs) and Bland-Altman analysis. In total, 118 individuals provided valid responses to the questionnaire. The Spearman rank correlation coefficient between the HLS-Q12 and the HLS-EU-Q47 was r = 0.98 (p < 0.001), and eight of the nine hypotheses were supported. The ICC was 0.96 (p < 0.001), and the 95% limit of agreement was -0.26 ± 5.9, suggesting no systematic error. Thus, the Japanese version of the HLS-Q12 was found to be reliable with high criterion validity and reproducibility. Hence, the HLS-Q12 is a useful scale for measuring health literacy among older adults in Japan.
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Affiliation(s)
- Rika Matsuo
- Department of Nursing, School of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Kimie Fujita
- Division of Health Sciences, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Mami Miyazono
- Department of Nursing, School of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Keiko Miyasaka
- Department of Nursing, School of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Tomi Yamanaka
- Department of Nursing, School of Nursing, Fukuoka Nursing College, Fukuoka, Japan
| | - Kanako Yakushiji
- Division of Health Sciences, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Atsushi Nagai
- The Regional Liaison Center for Fukuoka Dental College-Fukuoka Nursing College-Fukuoka College for Health Science, Fukuoka Dental College, Fukuoka, Japan
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Joshi H, Kalauni BR, Bhusal K, Bhandari R, Subedi A, Bhandari B. Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional study. PLoS One 2024; 19:e0304816. [PMID: 38829843 PMCID: PMC11146733 DOI: 10.1371/journal.pone.0304816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
Health literacy (HL) is crucial in achieving the Sustainable Development Goal of reducing one-third of premature mortality by 2030 from Non-Communicable Diseases (NCDs) and improving Universal Health Coverage. Low health literacy is linked to poor health outcomes, and evidence shows that levels of limited HL are high, even among highly educated individuals. This study aims to assess HL levels and related factors among patients with NCDs at Tribhuvan University Teaching Hospital (TUTH) in Nepal. A cross-sectional survey was conducted at TUTH among 303 patients with NCDs with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Hypertension, Epilepsy, Asthma and Cancer who came for follow-up from December 2022 to February 2023. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (divided into nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors of HL. The mean ±SD age of the respondents was 47.4±16.18 years. More than half of the respondents were female (56.1%). The patients had higher HL in all HL domains except 'Navigating the healthcare system'. Educational status was significantly associated with six out of nine HL domains. Co-morbidity, attendance at health-related seminars, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among patients with NCDs. This highlights the need for a comprehensive approach to address identified gaps in HL, considering its multifaceted and composite nature and promoting interventions to improve HL in high-risk populations.
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Affiliation(s)
- Hari Joshi
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Bhoj Raj Kalauni
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Kiran Bhusal
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rabindra Bhandari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Aastha Subedi
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Buna Bhandari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States of America
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Miyazaki T, Futohashi T, Baba H. 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. Geriatrics (Basel) 2024; 9:32. [PMID: 38525749 PMCID: PMC10961817 DOI: 10.3390/geriatrics9020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
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.
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Affiliation(s)
- Takaaki Miyazaki
- Department of Rehabilitation, Tokyo University of Technology, 5-23-22 Nishikamata Ota-Ku, Tokyo 144-8535, Japan;
| | - Toshihiro Futohashi
- Department of Rehabilitation, Tokyo University of Technology, 5-23-22 Nishikamata Ota-Ku, Tokyo 144-8535, Japan;
| | - Hiroki Baba
- Department of Rehabilitation, Heisei Yokohama Hospital, 550 Totsukamach Totsuka-Ku, Yokohama 244-0003, Japan;
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Suzuki T, Mizuno A, Yasui H, Noma S, Ohmori T, Rewley J, Kawai F, Nakayama T, Kondo N, Tsukada YT. Scoping Review of Screening and Assessment Tools for Social Determinants of Health in the Field of Cardiovascular Disease. Circ J 2024; 88:390-407. [PMID: 38072415 DOI: 10.1253/circj.cj-23-0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Despite the importance of implementing the concept of social determinants of health (SDOH) in the clinical practice of cardiovascular disease (CVD), the tools available to assess SDOH have not been systematically investigated. We conducted a scoping review for tools to assess SDOH and comprehensively evaluated how these tools could be applied in the field of CVD. METHODS AND RESULTS We conducted a systematic literature search of PubMed and Embase databases on July 25, 2023. Studies that evaluated an SDOH screening tool with CVD as an outcome or those that explicitly sampled or included participants based on their having CVD were eligible for inclusion. In addition, studies had to have focused on at least one SDOH domain defined by Healthy People 2030. After screening 1984 articles, 58 articles that evaluated 41 distinct screening tools were selected. Of the 58 articles, 39 (67.2%) targeted populations with CVD, whereas 16 (27.6%) evaluated CVD outcome in non-CVD populations. Three (5.2%) compared SDOH differences between CVD and non-CVD populations. Of 41 screening tools, 24 evaluated multiple SDOH domains and 17 evaluated only 1 domain. CONCLUSIONS Our review revealed recent interest in SDOH in the field of CVD, with many useful screening tools that can evaluate SDOH. Future studies are needed to clarify the importance of the intervention in SDOH regarding CVD.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital
- Leonard Davis Institute for Health Economics, University of Pennsylvania
| | - Haruyo Yasui
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Satsuki Noma
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Jeffrey Rewley
- Leonard Davis Institute for Health Economics, University of Pennsylvania
- The MITRE Corporation
| | - Fujimi Kawai
- Department of Academic Resources, St. Luke's International University
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University
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Lin YC, Yan HT. Dietary Sodium Restriction and Frailty among Middle-Aged and Older Adults: An 8-Year Longitudinal Study. Nutrients 2024; 16:580. [PMID: 38474709 DOI: 10.3390/nu16050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Frailty is a common geriatric syndrome. However, there is little information about the relationship between dietary sodium restriction (DSR) and frailty in later life. This study aimed to elucidate the relationship between DSR and frailty in middle-aged and older adults. The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, including 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. DSR was evaluated by assessing whether the participants were told by a physician to reduce or avoid sodium intake from food. Three indices were used to measure frailty: the Study of Osteoporotic Fractures (SOF) index, the Fried index, and the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) index. Individuals with DSR were more likely to report frailty compared with those with non-DSR (SOF: adjusted odds ratio [AOR] = 1.82, 95% confidence interval [CI] = 1.46-2.27; Fried: AOR = 2.55, 95% CI = 1.64-3.98; FRAIL: AOR = 2.66, 95% CI = 1.89-3.74). DSR was associated with a higher likelihood of SBF (AOR = 2.61, 95% CI = 1.61-4.22). We identified a temporal trajectory in our study, noting significant participant reactions to both short- and mid-term DSR. Future research should address the balance between frailty risk and cardiovascular risk related to DSR.
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Affiliation(s)
- Yu-Chun Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung City 40447, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung City 40402, Taiwan
| | - Huang-Ting Yan
- Institute of Political Science, Academia Sinica, Taipei City 11529, Taiwan
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Nakajima R, Komoriya M, Watanabe F. Is health literacy of adolescent athletes' parents whose children belonged to sports clubs related to their children's intention to receive medications, vaccines, supplements, and energy drinks? A cross-sectional study. BMC Public Health 2024; 24:257. [PMID: 38254028 PMCID: PMC10804555 DOI: 10.1186/s12889-024-17746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Adolescent athletes' values regarding health behaviors, including their attitudes toward doping, are largely derived from those of their parents. Therefore, clarifying the factors that affect parents' intentions regarding their children's medicine intake and nutrition can help elucidate the process of forming values of healthy behaviors in young athletes. METHODS Between March 8 and March 9, 2021, an online questionnaire survey was conducted via an Internet research company; data from 2,000 residents in Japan were collected. Participants were male and female residents aged 30-59 years with children in elementary or high school and belonging to sports clubs. The survey items included respondent's and child's basic information, respondent's health literacy, and level of sports in which the respondent and child were (or are) engaged. Respondents were also asked if they would like their children to receive prescription drugs, over-the-counter drugs, herbal medicines, vaccines, supplements, or energy drinks. Logistic regression analysis was performed to analyze the relationship between respondents' basic information and health literacy and their intention to receive prescription and over-the-counter drugs, herbal medicines, vaccines, supplements, and energy drinks. RESULTS Higher parental health literacy was associated with higher children's willingness to receive prescription drugs (odds ratio [OR] = 1.025, 95% confidence interval [CI]: 1.016-1.035), over-the-counter drugs (OR = 1.012, 95% CI: 1.003-1.021), prescription herbal medicines (OR = 1.021, 95% CI: 1.021-1.030), over-the-counter herbal medicines (OR = 1.012, 95% CI: 1.003-1.021), and vaccines (OR = 1.025, 95% CI: 1.016-1.035). Conversely, the children's intention to receive energy drinks (OR = 0.990, 95% CI: 0.980-1.000) decreased significantly. As the child's athletic level increased, parents' willingness for their children to receive oral prescription medicines decreased (OR = 0.886, 95% CI: 0.791-0.992) and that to receive supplements (OR = 1.492, 95% CI: 1.330-1.673) and energy drinks significantly increased (OR = 1.480, 95% CI: 1.307-1.676). CONCLUSION Health literacy of adolescent athletes' parents is associated with their children's willingness to receive medicines. Healthcare providers should counsel parents of adolescent athletes to allow their children to receive necessary drug treatments and prevent doping violations caused by supplement intake.
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Affiliation(s)
- Rie Nakajima
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, 7-7-1 Narashinodai, 274-8555, Funabashi-shi, Chiba, Japan.
| | - Michihiro Komoriya
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, 7-7-1 Narashinodai, 274-8555, Funabashi-shi, Chiba, Japan
| | - Fumiyuki Watanabe
- Department of Pharmacy Practice in Primary Care, Nihon University School of Pharmacy, 7-7-1 Narashinodai, 274-8555, Funabashi-shi, Chiba, Japan
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Salwa M, Islam S, Tasnim A, Al Mamun MA, Bhuiyan MR, Choudhury SR, Amin MR, Haque MA. Health Literacy Among Non-Communicable Disease Service Seekers: A Nationwide Finding from Primary Health Care Settings of Bangladesh. Health Lit Res Pract 2024; 8:e12-e20. [PMID: 38329843 PMCID: PMC10849776 DOI: 10.3928/24748307-20240119-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/14/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. OBJECTIVE Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. METHODS In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. KEY RESULTS Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. CONCLUSIONS NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12-e20.].
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Affiliation(s)
| | | | | | | | | | | | | | - M. Atiqul Haque
- Address correspondence to M. Atiqul Haque, PhD, Room No: 343, Block B, Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, Bangladesh;
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Kannengießer L, Ulbrich R, Hasenpusch C, Hrudey I, Walter S, Stallmann C, Swart E, March S. [Determinants of the utilization of cancer screening among older adults in Saxony-Anhalt-What is the influence of health literacy?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:45-56. [PMID: 38085357 PMCID: PMC10776466 DOI: 10.1007/s00103-023-03806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND In order to preserve health and thus social participation, it is important for older people to make health-related decisions, such as those regarding the use of a secondary prevention service like cancer screening. National and international studies show that various predictors determine cancer screening participation. The aim of this study is to determine the cancer screening utilization of older people in a structurally weak region. METHODS In 2021, a cross-sectional study in each of two urban and rural communities in Saxony-Anhalt surveyed individuals aged 55 years and older about determinants, reasons, and barriers to preventive service use (n = 954). Binary logistic regression analysis is used to analyze determinants of cancer screening use. RESULTS Three quarters of the study population (76.6%) self-reported participating in a cancer screening service at least once. The multivariable analyses demonstrate factors that influence the utilization of cancer screening. Age, partial knowledge on cancer screening, cancer screening as a benefit offered by a statutory health insurances' bonus program, experience with cancer in the immediate environment, thoughts about one's own health, and the feeling of security that participation gives are factors that significantly influence the use of cancer screening. Descriptively, the physician's recommendation is the strongest factor for participation. CONCLUSION The analyses show that cancer screenings are generally well received by older people in Saxony-Anhalt, but participation in them is not related to health literacy. In keeping with the National Cancer Plan, older people should generally be supported in making an informed decision, for example, through target-group-specific physician education.
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Affiliation(s)
- Lena Kannengießer
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Ruben Ulbrich
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Claudia Hasenpusch
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Ilona Hrudey
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Svenja Walter
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg (Sachsen-Anhalt), Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Stefanie March
- Fachbereich Soziale Arbeit, Gesundheit und Medien, Hochschule Magdeburg-Stendal, Magdeburg (Sachsen-Anhalt), Deutschland
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Okazawa Y, Kizaki H, Suzuki N, Osaka W, Hori S. Influence of Participation in a Medical-Themed Science Café on Patient Activation. Patient Prefer Adherence 2023; 17:3093-3106. [PMID: 38045110 PMCID: PMC10693243 DOI: 10.2147/ppa.s424460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose This study aims to investigate the impact of a Science Café (SC) dealing with medical topics on participants' patient activation (PA), a concept that refers to patients' involvement in managing their own health, working with their healthcare providers, and maintaining their health. Material and Methods Semi-structured interviews were conducted with patients who had participated in a medical SC (n = 10) to identify the medical SC-associated factors that influenced PA. Through a questionnaire of medical SC participants (n = 23), the impact on PA and correlations with relevant psychological measures were quantitatively assessed. Results The interviews revealed three factors: "Experience & acceptance of chronic conditions", "Features of medical SC" and "Changes as a result of participation." The questionnaire results showed a positive correlation between PA and resilience and a negative correlation with decision regret. Conclusions Participation in a medical SC by people with illnesses can improve PA by improving knowledge and skills for self-management and increasing self-awareness of illness in a supportive environment. The study highlights the potential benefits of using medical SC as a strategy for healthcare providers to improve PA and health outcomes.
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Affiliation(s)
- Yuta Okazawa
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, 105-8512, Japan
| | - Hayato Kizaki
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, 105-8512, Japan
| | | | - Wakako Osaka
- Keio University Faculty of Nursing and Medical Care, Tokyo, 160-8582, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, 105-8512, Japan
- Patient Salon Association, Tokyo, Japan
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Klinger J, Berens EM, Schaeffer D. Health literacy and the role of social support in different age groups: results of a German cross-sectional survey. BMC Public Health 2023; 23:2259. [PMID: 37974154 PMCID: PMC10652531 DOI: 10.1186/s12889-023-17145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Scholars demand more focus on context-related factors of health literacy as the management of health information is seen as a social practice. One prominent factor is social support that is expected to be particularly relevant for persons vulnerable for low health literacy. It was shown that health literacy can differ across the life span and especially older people have been demonstrated to be vulnerable for low health literacy. Therefore, health literacy and the relation of social support on health literacy in different age groups should be investigated. METHODS In a German nationwide survey 2,151 adults were interviewed face-to-face. General comprehensive health literacy was measured with the HLS19-Q47 which differentiates single steps of health information management - access, understand, appraise, and apply. Social support was measured with the Oslo 3 Social Support Scale. Bivariate and multivariate analyses were performed for all respondents and for five age groups. RESULTS Health literacy is relatively low in all age groups but particularly low among old-old people (76 + years). Also, the youngest adults (18-29 years) have slightly lower health literacy than middle-aged adults. On average, health literacy is higher among people with higher social support but this association varies between age groups. It tends to be quite strong among younger adults (18-45 years) and young-old persons (65-75 years) but is weak among older middle-aged (46-64 years) and old-old persons. The association also differs between steps of information management. It is stronger for accessing and applying information but there are differences in age groups as well. CONCLUSIONS Social support is a relevant aspect to improve individuals' health literacy and therefore should be addressed in interventions. However, it is necessary to differentiate between age groups. While both young adults and particularly old-old persons are challenged by health information management, young adults can strongly profit from social support whereas it can barely compensate the low health literacy of old-old persons. In addition, different challenges in information management steps in different age groups need to be considered when designing health literacy interventions. Thus, target group specific services and programs are needed.
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Affiliation(s)
- Julia Klinger
- Institute of Sociology and Social Psychology, University of Cologne, 50931, Cologne, Germany
| | - Eva-Maria Berens
- Ethics Committee, Bielefeld University, 33501, Bielefeld, Germany
| | - Doris Schaeffer
- School of Public Health, Bielefeld University, 33501, Bielefeld, Germany.
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Jane Ling MY, Ahmad N, Aizuddin AN. Risk perception of non-communicable diseases: A systematic review on its assessment and associated factors. PLoS One 2023; 18:e0286518. [PMID: 37262079 DOI: 10.1371/journal.pone.0286518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is increasing. Risk perception of NCDs is an important factor towards the uptake of preventive health interventions. There are various questionnaires assessing risk perception of NCDs, but no internationally standardized questionnaire has been available. Identification of factors associated with risk perception of NCDs may facilitate the development of targeted interventions. This systematic review aims to identify available questionnaire assessing risk perception of NCDs and the factors associated with risk perception of NCDs. METHODS The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original article published in English between 2012 and 2021. Quality appraisal of the eligible articles was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using content analysis. RESULTS A total of 86 studies were included. We found a variety of questionnaires assessing risk perception of NCDs, with many differences in their development, domains, items and validity. We also identified several personal, sociopsychological and structural factors associated with risk perception of NCDs. LIMITATIONS Most of the included studies were of cross-sectional design, and therefore the quality of evidence was considered low and exhibit a high risk of bias. The role of publication bias within this systematic review should be acknowledged as we did not include grey literature. Additionally, language bias must be considered as we only included English-language publications. CONCLUSION Further development and testing of available questionnaire is warranted to ensure their robustness and validity in measuring risk perception of NCDs. All the identified factors deserve further exploration in longitudinal and experimental studies.
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Affiliation(s)
- Miaw Yn Jane Ling
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Awwad O, AlMuhaissen SA, Al-Kharouf M, Al-Nashwan A, Abdeljalil M, Al-Qerem W. Validation of the Arabic Version of the Health Literacy (HLS-Q12) Questionnaire in chronically ill patients. Health Promot Int 2023; 38:7150746. [PMID: 37133881 DOI: 10.1093/heapro/daad037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Health literacy (HL) is an essential component of public health. Few tools are used to measure HL in Arabic-speaking countries, essentially the Short Test of Functional Health Literacy in Adults and the Single Item Literacy Screener. The new 12-item version of the European Health Literacy Survey Questionnaire (HLS-Q12), has not been validated in the Arabic language. This study aimed to translate the English version of HLS-Q12 into Arabic, test its structure and explain any variance in HLS-Q12 scores, allowing its use in Arabic-speaking healthcare contexts. A forward-backward translation was adopted. Reliability was assessed using Cronbach's α. Confirmatory factor analysis (CFA) and Rasch Model evaluated the model fit of the Arabic version of HLS-12. The effects of different patient-related variables on HLS-Q12 scores were tested using linear regression. A total of 389 patients visiting the site hospital outpatient clinics participated in the study. HLS-Q12 mean ± SD score was 35.8 ± 5.0, 50.9% of the participants showed an intermediate HL score. Good reliability (α = 0.832) was observed. CFA confirmed the scale unidimensionality. Rasch analysis indicated HLS-Q12 items to be within the fit acceptable thresholds except for Item 12. The only item that displayed unordered response categories was Item 4. Most of the items were considered relatively easy by respondents. Linear regression revealed age, education, healthcare-related education and income to have effects significantly different from zero on HLS-Q12 score. Interventions targeting the most health-disparate groups of individuals with characteristics contributing to lower HL, are needed.
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Affiliation(s)
- Oriana Awwad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Suha A AlMuhaissen
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Mohammad Al-Kharouf
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Ayat Al-Nashwan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Mariam Abdeljalil
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Pien LC, Cheng WJ, Chang WP, Chen SR, Chou KR, Wang CH. Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study. BMC Geriatr 2023; 23:233. [PMID: 37072708 PMCID: PMC10111682 DOI: 10.1186/s12877-023-03927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults. METHODS We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T). RESULTS The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL. CONCLUSIONS Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.
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Affiliation(s)
- Li-Chung Pien
- College of Nursing, Post-Baccalaureate Program in Nursing, Taipei Medical University, Taipei, 110301, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, 116079, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, 116079, Chinese Taipei
| | - Wan-Ju Cheng
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, 350401, Taiwan
- Department of Public Health, China Medical University, Taichung, 406040, Taiwan
- Department of Psychiatry, China Medical University, Taichung, 404332, Taiwan
| | - Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235041, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Xing Street, Taipei, 110301, Taiwan
| | - Su-Ru Chen
- College of Nursing, Post-Baccalaureate Program in Nursing, Taipei Medical University, Taipei, 110301, Taiwan
| | - Kuei-Ru Chou
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235041, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Xing Street, Taipei, 110301, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, 116079, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, 110301, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, 110301, Taiwan
| | - Chia-Hui Wang
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Xing Street, Taipei, 110301, Taiwan.
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Hirooka N, Kusano T, Kinoshita S, Aoyagi R. Association of Health Literacy With the Prevalence of Cardiovascular Diseases and Their Risk Factors Among Older Japanese Health Management Specialists. Gerontol Geriatr Med 2023; 9:23337214231189059. [PMID: 37492034 PMCID: PMC10363860 DOI: 10.1177/23337214231189059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
In this study, we aimed to determine the association between health literacy and the development of cardiovascular diseases (CVDs), among an older population. This cross-sectional study was conducted among Japanese health management specialists (N = 593). Higher levels (communicative and critical) of health literacy and CVD risk factors (diabetes mellitus, hypertension, dyslipidemia, and obesity) were measured. The mean patient age was 71.3 years. Logistic regression analyses showed statistically significant associations between higher levels of health literacy and the prevalence of CVDs (β coefficient = -.091, p < .05) and metabolic risk factors (β coefficient = -.084, p < .01). There was a statistically significant association between health literacy and the count of CVDs (and its risk factors) (β coefficients of Poisson regression = -.036, p < .05). The results show health literacy to be fundamentally related to low prevalence of cardiovascular diseases and their associated metabolic risk factors.
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Smith GD, Ho K, Lee A, Lam L, Chan S. Dementia literacy in an ageing world. J Adv Nurs 2022; 79:2167-2174. [PMID: 36582068 DOI: 10.1111/jan.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/27/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
AIMS This discursive article aims to capture and explore the most pertinent nursing aspects of dementia literacy (DL). BACKGROUND Older people constitute a rapidly increasing proportion of the global population, experiencing higher risk of developing chronic disease, including dementia. It is important that older adults receive and understand reliable health-related information, as age-related changes may affect the level of health literacy in an older person. It has been suggested that older adults may have poorer health literacy than younger adults, associated with poorer health outcomes. Health literacy, how people receive, interpret and act on health information, play a significant role in dementia-related disorders, both as a possible predicter of onset of dementia and as a potential modifier of cognitive decline. Dementia literacy constitutes one aspect of health literacy in relation to nursing care, related to knowledge of dementia-related disorders and approaches towards older people with dementia. DESIGN This discursive article explores the importance of DL for the nursing profession, including dementia-related assessment, education and interventions. METHOD This article is informed by analysis of relevant descriptive and empirical literature and policy documents related to DL, an increasingly important aspect of dementia-related nursing care. Valid assessment tools that can accurately assess aspects an individuals' DL are examined; these have the potential to help nurses detect dementia-related symptoms. With early detection and prevention of dementia, older people may have better chance of benefiting from evolving treatment options. CONCLUSION Greater attention needs to be given to the issue of DL in older people, especially in terms of nursing assessment and care. Globally, increased DL-related education is urgently required to improve knowledge of this concept; this includes public awareness initiatives to better understanding this chronic condition. IMPLICATION NURSING PRACTICE Enhancing DL has the potential to empower older people to have greater access to healthcare services and to make more informed decisions about their health care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a discursive article.
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Affiliation(s)
- Graeme Drummond Smith
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, Hong Kong
| | - Ken Ho
- Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Allen Lee
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Linda Lam
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
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Minamitani M, Mukai T, Yamashita H, Katano A, Miyashita M, Nakagawa K. Development of Japanese Cancer Intelligence Quotient to Measure Cancer Literacy and Knowledge among Japanese Laypersons. JMA J 2022; 5:446-457. [PMID: 36407076 PMCID: PMC9646290 DOI: 10.31662/jmaj.2022-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/11/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Health literacy has been identified an essential factor in leading a healthy lifestyle. Because some cancer prevention and screening methods have been established, we believe that identifying disadvantaged populations with low literacy regarding cancer is crucial. Thus, in this study, we aim to create a self-administered cancer-specific health literacy scale to be administered to Japanese laypersons. METHODS Using definitions from previous studies, we constructed a scale named the Japanese Cancer Intelligence Quotient (JCIQ) for both literacy (JCIQ-L) and knowledge (JCIQ-K) aspects. We generated potential items for both aspects, extracted appropriate ones using two-step online surveys, and compared the JCIQ and cancer-preventive behaviors and cancer-screening intentions, both of which we set as alternative indicators of the right attitude and practice toward cancer by performing a multiple regression analysis from another web survey. RESULTS Between April and May 2020, we conducted three-step surveys online. After conducting the two-step surveys for thousands of people, we extracted 12 literacy questions and 22 knowledge questions using factor analysis and the correct answer ratio of every item. In the final investigation of 3,094 people, a multiple regression analysis found that the JCIQ-L and JCIQ-K were significant factors in terms of predicting both behaviors (JCIQ-L:β = 0.07, p < 0.001, JCIQ-K:β = 0.05, p < 0.01) and willingness (JCIQ-L:β = 0.04, p < 0.05, JCIQ-K:β = 0.17, p < 0.001) after adjusting for participant characteristics (e.g., gender, age, income level, employment status). CONCLUSIONS We developed the first reliable scale for measuring cancer literacy and knowledge of Japanese laypersons.
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Affiliation(s)
- Masanari Minamitani
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan
| | - Tomoya Mukai
- Graduate Schools for Law and Politics, The University of Tokyo, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Keiichi Nakagawa
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan
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Schäfer I, Menzel A, Herrmann T, Oltrogge JH, Lühmann D, Scherer M. Patient satisfaction with computer-assisted structured initial assessment facilitating patient streaming to emergency departments and primary care practices: results from a cross-sectional observational study accompanying the DEMAND intervention in Germany. BMC PRIMARY CARE 2022; 23:213. [PMID: 35999511 PMCID: PMC9397153 DOI: 10.1186/s12875-022-01825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 08/13/2022] [Indexed: 11/23/2022]
Abstract
Background Patient numbers in emergency departments are on the rise. The DEMAND intervention aims to improve the efficacy of emergency services by computer-assisted structured initial assessment assigning patients to emergency departments or primary care practices. The aims of our study were to evaluate patient satisfaction with this intervention and to analyse if reduced patient satisfaction is predicted by sociodemographic data, health status or health literacy. Methods We conducted a cross-sectional patient survey in emergency departments and co-located primary care practices. Each intervention site was planned to participate for two observation periods, each with a duration of one full week. Study participants were recruited by the local staff. The patients filled out a written questionnaire during their waiting time. Patient satisfaction was assessed by agreement to four statements on a four point Likert scale. Predictors of patient satisfaction were identified by multilevel, multivariable logistic regression models adjusted for random effects at the intervention site level. Results The sample included 677 patients from 10 intervention sites. The patients had a mean age of 38.9 years and 59.0% were women. Between 67.5% and 55.0% were fully satisfied with aspects of the intervention. The most criticised aspect was that the staff showed too little interest in the patients’ personal situation. Full satisfaction (“clearly yes” to all items) was reported by 44.2%. Reduced patient satisfaction (at least one item rated as “rather yes”, “rather no”, “clearly no”) was predicted by lower age (odds ratio 0.79 for ten years difference, 95% confidence interval 0.67/0.95, p = 0.009), presenting with infections (3.08,1.18/8.05,p = 0.022) or injuries (3.46,1.01/11.82,p = 0.048), a higher natural logarithm of the symptom duration (1.23,1.07/1.30,p = 0.003) and a lower health literacy (0.71 for four points difference, 0.53/0.94,p = 0.019). Conclusions The patients were for the most part satisfied with the intervention. Assessment procedures should be evaluated a) regarding if all relevant patient-related aspects are included; and whether patient information can be improved b) for patients with strong opinions about cause, consequences and treatment options for their health problem; and c) for patients who have problems in the handling of information relevant to health and healthcare. Trial registration German Clinical Trials Register (https://www.drks.de/drks_web/setLocale_EN.do) no. DRKS00017014. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01825-5.
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Evaluation of the effectiveness of a health literacy education program during the pandemic. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1121841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tolabing MCC, Co KCD, Mendoza OM, Mira NRC, Quizon RR, Tempongko MSB, Mamangon MAM, Salido ITO, Chang PW. Prevalence of Limited Health Literacy in the Philippines: First National Survey. Health Lit Res Pract 2022; 6:e104-e112. [PMID: 35522857 PMCID: PMC9126056 DOI: 10.3928/24748307-20220419-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy (HL) is the ability to access, understand, appraise, and apply health information across the three domains of the health continuum: health care, disease prevention, and health promotion. It is needed for people to effectively manage their health. Information on population HL level is useful for crafting appropriate and targeted interventions to improve HL. OBJECTIVE The aim of this study was to describe the HL level of Filipino people at the national and subnational levels. METHODS A cross-sectional survey was conducted between 2018 and 2019 with 2,303 randomly selected Filipino people age 15 to 70 years, using an adapted Asia version of the European Health Literacy Survey Questionnaire-47. Prevalence estimates for limited HL and the corresponding 95% confidence interval (CI) were computed at the national and subnational levels. KEY RESULTS The nationwide prevalence of limited HL was 51.5% (95% CI, [49.5%, 53.6%]), while sub-national prevalence estimates ranged from 48.2% to 65.4%. The prevalence varied across HL dimensions, with difficulty in access to information having the highest level. Similarly, prevalence across domains was variable; health care-related HL had the highest prevalence of limited HL. The HL levels for different dimensions and domains also varied across subnational groups. CONCLUSION Many Filipino people had limited HL, and prevalence estimates varied across HL dimensions, HL domains, subnational groupings, and sociodemographic characteristics. The results highlight the need for targeted interventions focusing on subgroups with limited HL and on dimensions and domains where Filipino people have limited HL. [HLRP: Health Literacy Research and Practice. 2022;6(2):e104-e112.] Plain Language Summary: The National Health Literacy Survey is the first nationwide survey on the prevalence of HL in the Philippines, involving 2,303 randomly selected Filipino residents age 15 to 70 years. Many Filipino people have limited HL, and the prevalence of HL varies across the components of HL, subnational groupings, and sociodemographic characteristics, highlighting the need for targeted interventions.
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Affiliation(s)
- Ma. Carmen C. Tolabing
- Address correspondence to Ma. Carmen C. Tolabing, MPH, DrPH, College of Public Health, University of the Philippines Manila, 625 Pedro Gil Street, Ermita, 1000 Manila, Philippines;
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Hassan L, Efremov L, Großkopf A, Kartschmit N, Medenwald D, Schott A, Schmidt-Pokrzywniak A, Lacruz ME, Tiller D, Kraus FB, Greiser KH, Haerting J, Werdan K, Sedding D, Simm A, Nuding S, Kluttig A, Mikolajczyk R. Cardiovascular risk factors, living and ageing in Halle: the CARLA study. Eur J Epidemiol 2022; 37:103-116. [PMID: 34978665 PMCID: PMC8791893 DOI: 10.1007/s10654-021-00824-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
The CARLA study (Cardiovascular Disease, Living and Ageing in Halle) is a longitudinal population-based cohort study of the general population of the city of Halle (Saale), Germany. The primary aim of the cohort was to investigate risk factors for cardiovascular diseases based on comprehensive cardiological phenotyping of study participants and was extended to study factors associated with healthy ageing. In total, 1779 probands (812 women and 967 men, aged 45–83 years) were examined at baseline (2002–2005), with a first and second follow-up performed 4 and 8 years later. The response proportion at baseline was 64.1% and the reparticipation proportion for the first and second follow-up was 86% and 77% respectively. Sixty-four percent of the study participants were in retirement while 25% were full- or partially-employed and 11% were unemployed at the time of the baseline examination. The currently running third follow-up focuses on the assessment of physical and mental health, with an intensive 4 h examination program, including measurement of cardiovascular, neurocognitive, balance and gait parameters. The data collected in the CARLA Study resulted in answering various research questions in over 80 publications, of which two thirds were pooled analyses with other similar population-based studies. Due to the extensiveness of information on risk factors, subclinical conditions and evident diseases, the biobanking concept for the biosamples, the cohort representativeness of an elderly population, and the high level of quality assurance, the CARLA cohort offers a unique platform for further research on important indicators for healthy ageing.
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Affiliation(s)
- Lamiaa Hassan
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ljupcho Efremov
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Anne Großkopf
- University Clinic and Outpatient Clinic for Cardiac Surgery, Middle German Heart Centre at the University Hospital Halle, Halle, Germany
| | - Nadja Kartschmit
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Artjom Schott
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andrea Schmidt-Pokrzywniak
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maria E Lacruz
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Clinical Computing Center - Data Integration Center, University Hospital Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Karin H Greiser
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl Werdan
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Simm
- University Clinic and Outpatient Clinic for Cardiac Surgery, Middle German Heart Centre at the University Hospital Halle, Halle, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Tajdar D, Schäfer I, Lühmann D, Fertmann R, Steinberg T, van den Bussche H, Scherer M. The Link Between Health Literacy and Three Conditions of Metabolic Syndrome: Obesity, Diabetes and Hypertension. Diabetes Metab Syndr Obes 2022; 15:1639-1650. [PMID: 35651900 PMCID: PMC9150919 DOI: 10.2147/dmso.s363823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Health literacy (HL) intervention could be a potential prevention strategy to reduce the risk of metabolic syndrome (MS), but the association between low HL and MS is controversial. Therefore, the aim of this study was to investigate whether low HL is associated with obesity, diabetes, and hypertension, considering them as one cluster. METHODS We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. The 1349 eligible subjects were 18-60 years old. The European Health Literacy Questionnaire (HLS-EU-Q16) was used to assess HL. Depending on the reported number of metabolic syndrome conditions (CMS), four groups were categorized as follows: "0", any "1", any "2" and "3" CMS. Ordered logistic regression was used to analyze the relationship between HL level (independent variable) and the reported number of CMS (dependent variable) adjusted for age, gender and education. RESULTS 63.9% of subjects (n=862) reported having "0", 25.7% (n=346) only "1", 8.2% (n=111) only "2" and 2.2% (n=30) "3" of the three CMS. In the group with sufficient HL, rates of "1," "2," or "3" CMS were lower than in the group with problematic or inadequate HL. Subjects with inadequate HL showed a 1.62-fold higher risk of having a higher number of CMS than subjects with sufficient HL (OR 1.62; 95% CI 1.13 to 2.31). The risk increased with each life year (OR 1.05; 95% CI 1.04 to 1.06), and was higher in persons with low education (OR 2.89; 95% CI 2.08 to 4.01) than in highly educated persons. Women showed lower risk (OR 0.73; 95% CI 0.58 to 0.91) than men. CONCLUSION Lower HL was associated with a higher number of MS conditions. Our findings suggest that HL intervention on health-promoting behaviors could help reduce MS risk in people with limited HL.
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Affiliation(s)
- Daniel Tajdar
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
- Correspondence: Daniel Tajdar, Department of Primary Care at Hamburg University Medical Center, Building W37 Martinistraße 52, Hamburg, 20246, Germany, Tel +4940741052400, Fax +4940741040225, Email
| | - Ingmar Schäfer
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
| | - Dagmar Lühmann
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
| | - Regina Fertmann
- Hamburg Authority for Work, Health, Social Affairs, Family and Integration, Hamburg, Germany
| | - Tim Steinberg
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
| | | | - Martin Scherer
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
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Teles M, Kaya S. Health literacy of cardiology patients: determinants and effects on patient outcomes. SOCIAL WORK IN HEALTH CARE 2021; 60:656-673. [PMID: 34877925 DOI: 10.1080/00981389.2021.2014615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
Health literacy is important for the management of chronic cardiovascular diseases. Comprehensive studies related to health literacy of cardiac patients are limited. The aims of this study were to determine the determinants of health literacy and its effects on patient outcomes in cardiology patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q- 47 items) was applied to 530 patients who presented to cardiology polyclinics of a university hospital in Ankara. Correlation coefficients, univariate and multi-linear regression analyses were used in the study. Determinants of health literacy were sex, education level, place of residence and perception of social status (p < .05). Although adjustments were made based on relevant control variables in multivariate analyses, health literacy was found to affect 14 of 26 patient outcomes within the scope of the study (p < .05). Higher education level and perception of social status, residing in the city center and being female were among the determinants of high health literacy. Higher health literacy was associated with more positive patient outcomes. Health literacy affected health behaviors and risks, drug use habits, health status, use of preventive health services and patient satisfaction.
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Affiliation(s)
- Mesut Teles
- Niğde Zübeyde Hanım School of Health, Department of Health Management, Niğde Ömer Halisdemir University, Turkey
| | - Sıdıka Kaya
- Faculty of Economics and Administrative Sciences, Department of Health Care Management, Hacettepe University, Ankara, Turkey
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Abd-Rahim SNH, Mohamed-Yassin MS, Abdul-Razak S, Isa MR, Baharudin N. The Prevalence of Limited Health Literacy and Its Associated Factors among Elderly Patients Attending an Urban Academic Primary Care Clinic in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179044. [PMID: 34501632 PMCID: PMC8430857 DOI: 10.3390/ijerph18179044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022]
Abstract
Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence of limited HL levels and its associated factors among elderly patients in an urban academic primary care clinic in Selangor, Malaysia. A cross-sectional study was conducted among 413 elderly patients (≥60 years old) who attended this academic primary care clinic between January 2020 and January 2021. Sociodemographic data, clinical characteristics, and health literacy scores were collected. Descriptive statistics (median with interquartile ranges (IQR), frequency, and percentages) and multiple logistic regression were utilized. The prevalence of limited HL in our population was 19.1% (95% CI: 15.3, 23). The middle-old (70–79 years) and very-old (≥80 years) age groups were more likely to have limited HL (aOR 4.05; 95% CI: 2.19, 7.52 and aOR 4.36; 95% CI: 1.02, 18.63, respectively). Those with at least secondary school education (aOR 0.06; 95% CI: 0.02, 0.24) and those who found medical information via the internet/television (aOR 0.21; 95% CI: 0.05, 0.93) had lower odds of having limited HL. In conclusion, having limited HL levels was not common among elderly patients in this primary care clinic. Further studies involving rural and larger primary care clinics in Malaysia are required to support these findings.
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Affiliation(s)
- Siti Nur Hidayah Abd-Rahim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
- Correspondence: ; Tel.: +60-36-126-4655
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh 47000, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Pusat Perubatan UiTM, Kampus Sungai Buloh, Sungai Buloh 47000, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Malaysia;
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Malaysia; (S.N.H.A.-R.); (S.A.-R.); (N.B.)
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The Sociodemographic Determinants of Health Literacy in the Ethnic Hungarian Mothers of Young Children in Eastern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115517. [PMID: 34063905 PMCID: PMC8196676 DOI: 10.3390/ijerph18115517] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022]
Abstract
Parental health literacy is a decisive factor for child health and quality of life. Children of parents with limited health literacy are at increased risk of illness and longer recovery periods. The research at the Quality of Life Research Centre is aimed at studying the health literacy of ethnic Hungarian mothers in Eastern Europe (Hungary, Slovakia, Romania) as well as at assessing its socioeconomic and demographic antecedents. The sample size is 894 mothers. Our standardized online questionnaire includes the HLS-EU-16 and the BHLS questions, with the latter intended to screen for inadequate health literacy. Predictors of health literacy in mothers are socioeconomic status, age and partnership status. A key finding is the improvement of health literacy with age. Assessing the association of partnership status and health literacy is a novelty in this region. Our analysis reinforces the role of socioeconomic capital, widely recognized to be associated with health literacy in general and with parental health literacy in particular. Results indicate the necessity of improving caregiver health literacy with a range of health promotional activities in Eastern Europe, especially among mothers with low socioeconomic status. The hardships of young mothers and single mothers should also be considered in this respect.
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Tajdar D, Lühmann D, Fertmann R, Steinberg T, van den Bussche H, Scherer M, Schäfer I. Low health literacy is associated with higher risk of type 2 diabetes: a cross-sectional study in Germany. BMC Public Health 2021; 21:510. [PMID: 33726714 PMCID: PMC7962353 DOI: 10.1186/s12889-021-10508-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 02/25/2021] [Indexed: 01/01/2023] Open
Abstract
Background Low health literacy is believed to be associated with behaviours that increase the risk of type 2 diabetes. But there is limited knowledge on the relation between health literacy (HL) and diabetes risk, and whether improving HL could be a potential prevention strategy. Therefore, the main purpose of this study was to examine the link between HL and diabetes risk among non-diabetic adults. Methods We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. One thousand, two hundred and fifty-five non-diabetic subjects aged 18–60 years were eligible. The German Diabetes Risk Score (GDRS, ranging 0 to 123 points) was used to determine the individual risk of type 2 diabetes. The short version of the European Health Literacy Questionnaire (HLS-EU-Q16, ranging 0 to 16 points) was applied to assess the individual self-reported HL. Subjects were asked to self-estimate their diabetes risk, which was then compared with the calculated GDRS. Descriptive statistics were calculated to investigate group differences in the GDRS and self-estimated diabetes risk. Linear as well as logistic regression models were performed to analyse potential influencing variables of the GDRS as well as incorrect self-estimated diabetes risk. In three nested statistical models for each outcome, these analyses were adjusted for age, gender, educational level and the presence of chronic conditions. Results According to the criteria of the GDRS, 996 (79.4%) subjects showed “low risk”, 176 (14.0%) “still low risk”, 53 (4.2%) “elevated risk”, and 30 (2.4%) “high to very high risk” to develop type 2 diabetes within the next 5 years. In the statistical models including all control variables, subjects with “inadequate HL” scored 2.38 points higher on the GDRS (95% CI 0.378 to 4.336; P = 0.020) and had a 2.04 greater chance to estimate their diabetes risk incorrectly (OR 2.04; 95% CI 1.33 to 3.14; P = 0.001) compared to those with “sufficient HL”. Conclusion The risk of type 2 diabetes is increased in people with inadequate self-reported HL. People with high diabetes risk and inadequate HL might be provided with educational programs to improve diabetes knowledge and reduce behavioural risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10508-2.
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Affiliation(s)
- Daniel Tajdar
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany.
| | - Dagmar Lühmann
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
| | - Regina Fertmann
- Hamburg Authority of Health and Consumer Protection, Hamburg, Germany
| | - Tim Steinberg
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
| | | | - Martin Scherer
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany
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Baccolini V, Rosso A, Di Paolo C, Isonne C, Salerno C, Migliara G, Prencipe GP, Massimi A, Marzuillo C, De Vito C, Villari P, Romano F. What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:753-761. [PMID: 33403622 PMCID: PMC7947142 DOI: 10.1007/s11606-020-06407-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 12/07/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe. METHODS PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies. RESULTS The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07). DISCUSSION We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies. PROSPERO REGISTRATION CRD42019133377.
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Affiliation(s)
- V Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. .,Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - A Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Local Health Unit Roma 2, Rome, Italy
| | - C Di Paolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Salerno
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - G Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - G P Prencipe
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - A Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - P Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - F Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Konopik N, Kaspar R, Penger S, Oswald F, Himmelsbach I. Advancing health literacy measurement in old age. Health Promot Int 2021; 36:1310-1323. [PMID: 33462608 DOI: 10.1093/heapro/daaa137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health literacy is described as a domain of competence across the life-span, gaining particular prominence in light of age-associated health restrictions. However, no specific measurement approach has been proposed for old age. The aim of this study is to augment the existing HLS-EU-Q16 scale (16 items) by items sensitive to age-specific aspects of health literacy to ensure validity and reliability for use in old age. In a first step, the HLS-EU-Q16 was administered in a sample of 463 individuals aged 72 - 92 years. Psychometric properties were evaluated using confirmatory factor analysis and item-response-theory item fit statistics. Scale reliability was found to be poor in this population segment. In a second step, age-specific items were developed based on qualitative in-depth interviews with older persons. In a third step, we tested if the additional set of age-specific items was able to enhance a valid and reliable measurement of health literacy in a second sample of older adults (N = 107, 49 - 91 years). With the inclusion of an eight-item add-on, it was possible to measure health literacy in old and very old age with both high validity and satisfying precision (reliability = 0.80). The study contributes to a population-specific measurement of health literacy.
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Affiliation(s)
- Nadine Konopik
- Nursing Science, Catholic University of Applied Sciences, Freiburg, Germany.,Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Roman Kaspar
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany.,Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Germany
| | - Susanne Penger
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Frank Oswald
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany.,Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Ines Himmelsbach
- Institute of Applied Research, Catholic University of Applied Sciences, Freiburg, Germany
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Abstract
Abstract
Inefficient health service utilisation puts pressure on health systems and may cause such negative individual consequences as over-medicalisation or exacerbation of health problems. While previous research has considered the key relevance of health literacy (HL) for efficient use of health services, the results of that research have been somewhat inconclusive. Possible reasons for diverging results of prior research may be grounded in different measurement concepts of HL and the disregarding of age-specific effects. This paper analyses the association between individuals’ HL typology based on a two-dimensional concept and indicators of health service utilisation measured by registered data covering the number of doctor visits and medication costs. Our results confirm a significant interaction effect between age and HL typology. The age-related increase in health service utilisation is strongest for individuals with the combination of high subjective HL but low health-related knowledge, while the smallest increase is for individuals with the constellation of high subjective HL combined with high health-related knowledge. Individuals with specific constellations of HL (that is, individuals with high subjective HL but low health-related knowledge) are associated with reduced service utilisation in younger ages but higher service utilisation in later stages of life, compared to other groups. These results are likely to be attributed to a higher external health-related locus of control and more traditional paternalistic role expectations in such groups.
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Schaeffer D, Griese L, Berens EM. Gesundheitskompetenz von Menschen mit chronischer Erkrankung in Deutschland. DAS GESUNDHEITSWESEN 2020; 82:836-843. [DOI: 10.1055/a-1276-0418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund Menschen mit chronischen Erkrankungen (MmcE) sind mit vielfältigen Anforderungen der Krankheitsbewältigung und der Versorgungsnutzung konfrontiert. Entsprechend hoch ist ihr Bedarf an Information und auch an Gesundheitskompetenz (GK). Während das Thema international seit längerem die Aufmerksamkeit der Forschung findet, fehlen für Deutschland bislang Untersuchungen zur GK von MmcE.
Ziel und Methode Ziel der vorliegenden Analyse ist es, die GK von MmcE in Deutschland vertiefend zu analysieren. Dazu wurden Querschnittsdaten von insgesamt 499 MmcE des deutschen Gesundheitskompetenzsurveys (HLS-GER) genutzt. Die GK wurde mit dem European Health Literacy Survey Questionnaire (HLS-EU-Q 47) erfasst. Potenzielle Unterschiede bei der Verteilung von GK wurden nach Geschlecht, Alter, Sozialstatus, finanzielle Ressourcen, Bildungsniveau und literale Fähigkeiten (gemessen mit dem Newest Vital Sign (NVS)) und krankheitsbezogenen Merkmalen (Krankheitsanzahl und -dauer) mittels Chi-Quadrat Test geprüft. Ebenso wurde der Einfluss dieser Faktoren auf GK bei MmcE mittels multipler logistischer Regression untersucht.
Ergebnisse 72,7% der MmcE weisen eine geringe GK auf. Dabei variiert die GK stark nach den untersuchten Bereichen Krankheitsbewältigung/-versorgung, Prävention und Gesundheitsförderung. Ein niedriger Sozialstatus (Odds Ratio (OR): 4,4 [1, 8; 10, 7]), geringe finanzielle Ressourcen (OR: 2,0 [1,2; 3,1]), limitierte literale Fähigkeiten (OR: 2,7 [1,4; 5,0]) sowie ein mittleres Bildungsniveau (OR: 0,5 [0,3; 0,9]) sind in der multiplen logistischen Regression mit geringer Gesundheitskompetenz assoziiert. Krankheitsanzahl und -dauer zeigen keinen signifikanten Zusammenhang mit geringer GK.
Schlussfolgerung Die Analyse liefert erste Erkenntnisse für Deutschland, die künftig der Vertiefung bedürfen. Sie liefern aber schon jetzt wichtige Hinweise für die Interventionsentwicklung. Erforderlich ist es, zielgruppenspezifische Interventionen zur Stärkung der persönlichen GK von MmcE zu entwickeln, die sich speziell an chronisch Erkrankte mit niedrigem Sozialstatus, geringen finanziellen Ressourcen und eingeschränkter Literalität richten. Um Stigmatisierungen zu vermeiden, ist es wichtig, dass Interventionen zugleich auf die Reduktion bestehender Anforderungen in der Lebensumwelt zielen und die Suche, Aneignung und Verarbeitung von Information erleichtern und damit zur Verringerung von Ungleichheiten beitragen.
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Affiliation(s)
- Doris Schaeffer
- Fakultät für Gesundheitswissenschaften, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Universität Bielefeld, Bielefeld
| | - Lennert Griese
- Fakultät für Gesundheitswissenschaften, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Universität Bielefeld, Bielefeld
| | - Eva-Maria Berens
- Fakultät für Gesundheitswissenschaften, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Universität Bielefeld, Bielefeld
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Bas-Sarmiento P, Poza-Méndez M, Fernández-Gutiérrez M, González-Caballero JL, Falcón Romero M. Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) for Arabic/French-Speaking Migrants in Southern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218181. [PMID: 33167475 PMCID: PMC7663905 DOI: 10.3390/ijerph17218181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022]
Abstract
Improving health literacy (HL) is critical for addressing health inequalities. Low literacy rates are believed to be more prevalent in ethnic minorities, which may have an impact on people's health. For measures to be implemented in this regard, HL must be evaluated to obtain specific indicators. Our aim, therefore, was to develop a version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which is recommended to be used with vulnerable populations, suited to Arabic/French-speaking migrants who reside in south-eastern Spain, and to explore its psychometric properties for assessing health literacy in this population. A cross-sectional survey was carried out in a convenient sample of 205 migrants. The structural validity was calculated by a confirmatory factorial analysis (CFA), which suggested appropriate adjustment indicators, and which indicated that the three-dimensional model is adequately adjusted to the data obtained in the study. The coefficient omega showed high internal consistency in the three HL dimensions (health care, disease prevention, and health promotion). Concurrent validity presented a significant correlation with the Newest Vital Sign test (r = 0.390; p < 0.001). The multigroup CFA showed that the heterogeneity of the sample used was not a problem for establishing the structural validity of the scale. The Arabic/French version showed good construct validity.
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Affiliation(s)
- Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University Institute of Research in Social Sustainable Development (INDESS), University of Cadiz, 11009 Cadiz, Spain;
| | - Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, Faculty of Nursing, University of Cadiz, 11207 Cadiz, Spain;
| | - Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University Institute of Research in Social Sustainable Development (INDESS), University of Cadiz, 11009 Cadiz, Spain;
- Correspondence: ; Tel.: +34-956-028-122
| | - Juan Luis González-Caballero
- Department of Statistics and Operational Research, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain;
| | - María Falcón Romero
- Department of Socio-Sanitary Sciences, University of Murcia, 30100 Murcia, Spain;
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Schiavone S, Attena F. Measuring Health Literacy in Southern Italy: A cross-sectional study. PLoS One 2020; 15:e0236963. [PMID: 32760150 PMCID: PMC7410250 DOI: 10.1371/journal.pone.0236963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Health Literacy (HL) is an important determinant of individual health. Limited HL is an increasing problem affecting the general population. This study aims to assess the level of HL in patients attending outpatient medical facilities in general medicine located in Naples and Caserta and investigate the association of HL with health behaviours and health status. MATERIALS AND METHODS The study involved patients attending outpatient medical facilities in general medicine. The questionnaire had four sections-the sociodemographic information, the 16-items version of the European Health Literacy Survey questionnaire, the general self-efficacy scale (GSE) and the health status scale (EQ-VAS). Univariate and multivariate analyses were performed to investigate the sociodemographic determinants of HL. The Pearson correlation coefficients were determined to compare HL with health behaviours (GSE) and health status (EQ-VAS). RESULTS The study showed that 61.6% of 503 patients had a low level of HL. After the multivariate analysis, HL was found to be higher among patients with higher education level and general self-efficacy score ≥30. There were no differences in HL between the age groups and people with or without chronic diseases. HL was stronger correlated with GSE than with EQ-VAS (0.53 vs 0.27). CONCLUSION This is the first study on HL for Southern Italy. It showed a low level of HL. As the sample was not representative of the reference population, we cannot derive a corresponding conclusion for the general population of Southern Italy. Therefore, more data in Italy are needed to plan actions for improving HL.
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Affiliation(s)
- Sara Schiavone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Attena
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- * E-mail:
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Lu M, Hravnak M, Ma J, Lin Y, Zhang X, Shen Y, Xia H. Prediction of Changes in Adherence to Secondary Prevention Among Patients With Coronary Artery Disease. Nurs Res 2020; 69:E199-E207. [DOI: 10.1097/nnr.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Health Literacy and Active Transport in Austria: Results from a Rural Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041404. [PMID: 32098147 PMCID: PMC7068285 DOI: 10.3390/ijerph17041404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/17/2022]
Abstract
Health literacy (HL) has been determined for the general population and for subgroups, though the relationship between HL and active transport in rural areas was not explored. The aim of our study is to investigate HL among citizens in an Austrian rural region and to explore the associations between HL and active transport. This cross-sectional telephone survey included 288 adults (171 women) with a mean age of 57.8 (SD 0.9). HL was assessed using the HLS-EU-Q16 questionnaire. Active transport was measured as the minutes per week spent on walking or cycling from A to B. After descriptive analysis, the association between HL and active transport was assessed using linear regression models. The mean HL score for all participants was 37.1 (SD 7.7). Among all subjects, 6.9% showed inadequate HL, 25.7% problematic HL, 38.9% sufficient HL, and 28.5% excellent HL. HL was significantly higher among citizens with high education (p = 0.04) and training/employment in healthcare (p = 0.001). Active transport was not associated with HL (p = 0.281). Active transport in rural areas might be influenced by other predictors like distance to work, street connectivity, and accessible facilities for walking and biking. This needs to be explored further for rural areas.
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Duplaga M. Determinants and Consequences of Limited Health Literacy in Polish Society. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020642. [PMID: 31963834 PMCID: PMC7014389 DOI: 10.3390/ijerph17020642] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/05/2020] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
Background: Health literacy (HL) is perceived as one of the most important concepts for modern health promotion activities to be successful. The research undertaken in the context of HL usually focuses on its antecedents and consequences, either for specific groups of patients or society or for the whole population. Objectives: The main aim of this study was to assess the antecedents and consequences of limited health literacy (HL) in a nationally representative sample of the Polish population. Methods: The analysis was carried out on the data obtained from a sample of 1000 Polish citizens through a telephone-based survey undertaken using a short, 16-item questionnaire developed within the European Health Literacy Project (HLS-EU). The total HLS score was calculated according to the guidelines published by the HLS-EU project. Chi2 test and logistic regression models were used for the analysis of the relationships between the variables. Results: The mean HL score (standard deviation) in the study sample was 12.99 (3.11). HL was related to age, marital and vocational status. Limited HL was associated with a lower self-assessment of health (OR, 95% CI: 2.52, 1.54–4.13), the prevalence of obesity and disability (1.71, 1.13–2.57, and 1.92, 1.25–2.94, respectively), less frequent physical activity (0.70, 0.49–0.99), a lower consumption of fruits and vegetables (0.47, 0.34–0.65), and with more frequent hospitalisations (2.02, 1.38–2.95). Conclusions: The assessment of HL using the16-item HLS-EU questionnaire may be a useful tool to enable health behaviours and utilisation of health care resources by society to be predicted.
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Affiliation(s)
- Mariusz Duplaga
- Department of Health Promotion and e-Health, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegorzecka Str. 20, 31-531 Krakow, Poland
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Gustafsdottir SS, Sigurdardottir AK, Arnadottir SA, Heimisson GT, Mårtensson L. Translation and cross-cultural adaptation of the European Health Literacy Survey Questionnaire, HLS-EU-Q16: the Icelandic version. BMC Public Health 2020; 20:61. [PMID: 31937293 PMCID: PMC6961374 DOI: 10.1186/s12889-020-8162-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health literacy (HL) is defined as the knowledge and competences of people to meet the complex demands of health in modern society. It is an important factor in ensuring positive health outcomes, yet Iceland is one of many countries with limited knowledge of HL and no valid HL measurement. The aim of this study was to translate the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16) into Icelandic, adapt the version, explore its psychometric properties and establish preliminary norms. METHODS The HLS-EU-Q16 translation model included three steps: 1) translation-back-translation of HLS-EU-Q16 including specialists' review (n = 6); 2) cognitive interviewing of lay people (n = 17); and 3) psychometric analysis with survey participants. The HLS-EU-Q16 includes 16 items, with scores ranges from zero (low/no HL) to 16 (high HL). Statistics included were descriptive, internal consistency measured by Cronbach's α, exploratory factor analysis, and multivariate linear regression. RESULTS After the translation and cognitive interviewing, 11 of the HLS-EU-Q16 items were reworded to adapt the instrument to Icelandic culture while maintaining their conceptual objectives. Survey participants were 251. Internal consistency of the translated and adapted instrument was α = .88. Four factors with eigenvalues > 1.0 explained 62.6% of variance. Principal component analysis with Oblimin rotation presented four latent constructs, "Processing and Using Information from the Doctor" (4 items, α = .77), "Processing and Using Information from the Family and Media" (4 items, α = .85), "Processing Information in Connection to Healthy Lifestyle" (5 items, α = .76), and "Finding Information about Health Problems/Illnesses" (3 items, α = .73). Lower self-rated health was an independent predictor of lower HL (β = -.484, p = .008). Preliminary norms for HL ranged from five to 16 (M 13.7, SD ± 2.6) with 72.5% with sufficient HL (score 13-16), 22% with problematic HL (score 9-12) and 5.5% with inadequate HL (score 0-8). CONCLUSIONS The Icelandic version of HLS-EU-Q16 is psychometrically sound, with reasonably clear factor structure, and comparable to the original model. This opens possibilities to study HL in Iceland and compare the results internationally. The translation model introduced might be helpful for other countries where information on HL is missing based on lack of validated tools.
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Affiliation(s)
| | - Arun K Sigurdardottir
- Faculty of Health Science, University of Akureyri, Solborg, Nordurslod 2, 600, Akureyri, Iceland.,Akureyri Hospital, Eyrarlandsvegi, 600, Akureyri, Iceland
| | - Solveig A Arnadottir
- Department of Physical Therapy, Faculty of Medicine, University of Iceland, Saemundargotu 2, 102, Reykjavik, Iceland
| | - Gudmundur T Heimisson
- Faculty of Psychology, University of Akureyri, Solborg, Nordurslod 2, 600, Akureyri, Iceland
| | - Lena Mårtensson
- Health and Rehabilitation at Institute of Neuroscience and Physiology, University of Gothenburg, 455, Arvid Wallgrens Backe, hus 2, 405 30, Gothenburg, Sweden
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Abstract
Aim: The aim of this study was to investigate the health literacy and cognitive functions of individuals age 65 and over and the relationship between them. Method: The research was conducted between September 2016 and February 2017, among individuals age 65 and over, at the Family Health Center. The participants were given the Health Literacy Survey - European Union (HLS-EU) scale and the Mini-Mental Test. Results: In this sampling, health literacy was found as "problematic or inadequate" in 85.1% of the elderly population. Among the health literacy issues, rate of "problematic-inadequate" results was 63.5% in benefiting from health services, 86.9% in protection from diseases, and 87.6% in improvement of health. The issues that older persons feel most inadequate were adult vaccinations and periodic examinations and they felt sufficient in terms of what to do in emergency cases. Conclusion: The older population needs support in health literacy issues particularly related to judgments. It would be appropriate to set up a standard care algorithm in older people.
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Affiliation(s)
- Hayri Bozkurt
- Department of Family Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital , Bursa , Turkey
| | - Hakan Demirci
- Department of Family Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital , Bursa , Turkey
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Lu M, Xia H, Ma J, Lin Y, Zhang X, Shen Y, Hravnak M. Relationship between adherence to secondary prevention and health literacy, self-efficacy and disease knowledge among patients with coronary artery disease in China. Eur J Cardiovasc Nurs 2019; 19:230-237. [PMID: 31595771 DOI: 10.1177/1474515119880059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Adherence to secondary prevention is an indispensable part of the management of patients with coronary artery disease. Finding patient factors affecting their adherence behaviours is important for improving the treatment effect and limiting further disease progression. Aims: To examine the association between health literacy, self-efficacy, disease knowledge and adherence to secondary coronary artery disease prevention in patients in China. Methods: In this cross-sectional study, 598 patients with coronary artery disease were enrolled in two tertiary hospitals in China during a hospitalisation for receiving percutaneous coronary intervention. Patient-reported data were collected on demographics, health literacy, self-efficacy, disease knowledge and adherence to secondary coronary artery disease prevention (medication-taking and heart-healthy lifestyle (exercise, reducing/eliminating alcohol intake and smoking, low salt and fat diet, stress reduction)). Chi-squared tests and regression analyses were performed. Results: The proportions of recalled self-report of adherence to medication-taking and a heart-healthy lifestyle immediately prior to the coronary artery disease hospitalisation were 84.7% and 53.2%, respectively. In logistic regression, health literacy, self-efficacy and disease knowledge was significantly associated with non-adherence to secondary coronary artery disease prevention. Limited health literacy demonstrated a 1.61-fold odds for non-adherence to a heart-healthy lifestyle. Each score increase of self-efficacy and disease knowledge had 0.98-fold odds and 1.05-fold odds of non-adherence to a heart-healthy lifestyle. Conclusions: Adherence to medication-taking was relatively good in Chinese patients prior to coronary artery disease hospitalisation, but adherence to heart-healthy lifestyle behaviours should be improved. Health literacy, self-efficacy and disease knowledge should be taken into account when intervening to improve secondary coronary artery disease prevention.
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Affiliation(s)
- Minmin Lu
- School of Nursing, Fudan University, China
| | - Haiou Xia
- School of Nursing, Fudan University, China
| | - Jianying Ma
- Zhongshan Hospital, Affiliated to Fudan University, China
| | - Ying Lin
- Zhongshan Hospital, Affiliated to Fudan University, China
| | - Xian Zhang
- Zhongshan Hospital, Affiliated to Fudan University, China
| | - Yunzhi Shen
- Huashan Hospital, Affiliated to Fudan University, China
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Garcia-Codina O, Juvinyà-Canal D, Amil-Bujan P, Bertran-Noguer C, González-Mestre MA, Masachs-Fatjo E, Santaeugènia SJ, Magrinyà-Rull P, Saltó-Cerezuela E. Determinants of health literacy in the general population: results of the Catalan health survey. BMC Public Health 2019; 19:1122. [PMID: 31420029 PMCID: PMC6698033 DOI: 10.1186/s12889-019-7381-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia’s population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health. Methods This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level. Results The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women (p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32–3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42–3.15, p < 0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34–4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities. Conclusions Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.
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Affiliation(s)
- Oriol Garcia-Codina
- Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Dolors Juvinyà-Canal
- Research Group Health and Health Care, University of Girona, Plaça de Sant Domènec, 3, 17004, Girona, Spain.
| | - Paloma Amil-Bujan
- Chronicity Prevention and Care Programme, Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Carmen Bertran-Noguer
- Research Group Health and Health Care, University of Girona, Plaça de Sant Domènec, 3, 17004, Girona, Spain
| | - María Asunción González-Mestre
- Chronicity Prevention and Care Programme, Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Eulàlia Masachs-Fatjo
- Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Sebastià J Santaeugènia
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Chronic Care Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain
| | - Pilar Magrinyà-Rull
- Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
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Hochhauser M, Brusovansky M, Sirotin M, Bronfman K. Health literacy in an Israeli elderly population. Isr J Health Policy Res 2019; 8:61. [PMID: 31291986 PMCID: PMC6621944 DOI: 10.1186/s13584-019-0328-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/13/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Health literacy is important for patients' comprehension of the health and medical messages conveyed to them and their meaning for them so that they can better manage their health. The aim of the study was to examine the level of health literacy within the elderly population. The hypothesis was that health literacy would be inadequate, and related to demographic variables. METHOD Sixty men and women over the age of 65 who volunteered to participate in the study completed a 13-item health literacy questionnaire. RESULTS Overall, the level of health literacy among the participants was mostly inadequate. They reported difficulty in reading medical material in Hebrew and understanding the doctor, thus requiring assistance (20%); difficulty in reading medical documents, completing medical forms and understanding medical terms; difficulty in reading the leaflet attached to medications (33%), test results (40%) and medical information written in English (66%) and difficulty searching the internet for information (53.3%). The level of health literacy was associated with education while the best profile for adequate health literacy was for those who spoke Hebrew and completed secondary education. CONCLUSIONS Medical teams have an obligation to be alert and attentive to the level of health literacy of elderly patients and to modify communication and information to an accommodating degree, so that elderly patients can better manage their health.
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Affiliation(s)
- Michal Hochhauser
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ramat Hagolan 65, 4070000 Ariel, Israel
| | | | | | - Katerina Bronfman
- Loewenstein Hospital, Rehabilitation center in Ra’anana, Ra’anana, Israel
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Burchard R, Oikonomoulas V, Soost C, Zoremba M, Graw JA. Indicated trauma emergency department utilization – A comparison between patients’ self-assessment and professional evaluation. Int Emerg Nurs 2019; 44:30-34. [DOI: 10.1016/j.ienj.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 02/10/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
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Health Literacy of Pre-Service Teachers from Farhangian University: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2019. [DOI: 10.5812/intjsh.82028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lu M, Ma J, Lin Y, Zhang X, Shen Y, Xia H. Relationship between patient's health literacy and adherence to coronary heart disease secondary prevention measures. J Clin Nurs 2019; 28:2833-2843. [PMID: 30938879 DOI: 10.1111/jocn.14865] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/18/2019] [Accepted: 03/23/2019] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the relationship between health literacy (HL) and adherence to secondary coronary heart disease (CHD) prevention behaviours in patients in China. BACKGROUND Adherence of patients to secondary CHD prevention behaviours is important in order to slow or reverse disease progression. The relationship between HL and adherence is varied across populations and warrants further research in order to inform nurses caring for such patients how to direct their teaching. DESIGN A descriptive cross-sectional design. METHODS A total of 598 patients with CHD were recruited during hospitalisation for a myocardial revascularization procedure at either of two tertiary hospitals in China. Data were collected by self-report on demographics, HL and adherence to secondary CHD prevention behaviours (medication-taking and heart-healthy lifestyle) prior to this admission. HL was measured by the short version of European Health Literacy Survey Questionnaire (HLS-EU-Q16), while adherence was measured with the Medical Outcomes Study Specific Adherence Scale (MOS-SAS). Descriptive, chi-square test and regression analyses were conducted. The study was reported based on STROBE checklist. RESULTS Overall, 74.5% of the patients had limited HL. Adherence rates to medication-taking and heart-healthy lifestyle were 84.7% and 53.2%, respectively. HL was not significantly associated with medication adherence, but in regression models patients with limited HL demonstrated significantly increased odds for nonadherence to heart-healthy lifestyle (OR 1.69). CONCLUSION HL was not significantly associated with medication adherence but was related to heart-healthy lifestyle adherence. RELEVANCE TO CLINICAL PRACTICE Nurses should assess the health literacy of discharging patients with CHD and focus on patients with limited health literacy to improve heart-healthy lifestyle behaviours, and not just taking medications.
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Affiliation(s)
- Minmin Lu
- School of Nursing, Fudan University, Shanghai, China
| | - Jianying Ma
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Ying Lin
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xian Zhang
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunzhi Shen
- Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Haiou Xia
- School of Nursing, Fudan University, Shanghai, China
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Title: Brief Implicit Association Tests of Stigmatizing Attitudes, Awareness of Mental Distress and Label-Avoidance: A Study in People with Depressive Symptoms. Community Ment Health J 2019; 55:507-518. [PMID: 30694419 DOI: 10.1007/s10597-019-00372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
This study aims to develop and implement brief implicit association tests (BIATs) assessing stigmatizing attitudes towards mental illness, awareness of mental distress and self-identification as having a mental illness. We recruited 229 people (age range 18-80 years) with currently untreated depressive symptoms. In addition to BIATs, explicit measures assessed depression severity, contact experience and self-identification as having a mental illness. BIATs showed good feasibility. Age and educational differences were observed for each BIAT. Regarding depression severity, people with mild depression severity showed stronger implicit label-avoidance. Novel BIATs proved feasible and future research should investigate the predictive value of implicit measures on help seeking in people with mental illness.
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Eronen J, Paakkari L, Portegijs E, Saajanaho M, Rantanen T. Assessment of health literacy among older Finns. Aging Clin Exp Res 2019; 31:549-556. [PMID: 30578457 PMCID: PMC6439255 DOI: 10.1007/s40520-018-1104-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/14/2018] [Indexed: 01/30/2023]
Abstract
Aims This study examined the feasibility of the HLS-EU-Q16 (in Finnish) for use among older Finns and whether the health literacy score correlates with indicators of health and functioning. Methods To determine the feasibility of the instrument, we first conducted a focus group discussion with nine participants. For the quantitative analyses, we used data from the AGNES cohort study, collected between October 2017 and April 2018 at the University of Jyväskylä in Finland. 292 75-year-old Finnish men and women were interviewed face-to-face in their homes. Health literacy was measured with the HLS-EU-Q16 and health literacy score, ranging from 0 to 50, computed. The reproducibility of the instrument was test-retested. Chi-square tests were used to compare health literacy scores between participants by different socioeconomic variables, and Spearman correlation coefficients were calculated to study the associations of health literacy with cognition, depressive symptoms, chronic conditions, life-space mobility and physical performance. Results The mean health literacy score for all participants was 35.05 (SD 6.32). Participants who rated their financial situation and self-rated health as very good had the highest health literacy scores (38.85, SD 5.09 and 39.22, SD 6.77, respectively). Better health literacy was associated with better cognitive status, fewer depressive symptoms and chronic conditions, higher life-space mobility and better physical performance. Conclusions The HLS-EU-Q16 is a feasible measure for research purposes among older Finns. The associations between health literacy and indicators of health and functioning need to be more closely investigated in larger samples with a wider age-range.
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Effect of an mHealth Intervention to Improve Health Literacy in Immigrant Populations: A Quasi-experimental Study. Comput Inform Nurs 2019; 37:142-150. [PMID: 30531321 DOI: 10.1097/cin.0000000000000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health literacy is a social determinant of the basic health of populations and is especially important to enhancing and developing the empowerment of migrant populations. To evaluate the effectiveness of an mHealth intervention to improve the cognitive and social skills that enable migrants to access and use health services, we developed a quasi-experimental design to encompass a single group of enrolled immigrants (N = 93). They completed preintervention and postintervention questionnaires of the European Health Literacy Survey Questionnaire, the self-created questionnaire HL-APP-Q14 (Health Literacy App Questionnaire), and a practical simulation test. Health literacy improved significantly after the intervention, increasing from a problematic level (mean, 9.55 [SD, 4.35]) to a sufficient level (mean, 14.03 [SD, 2.68]). Differences were statistically significant for males and females as well as for participants of all nationalities, except the Chinese group. The application e_SaludAble empowered the migrant participants through the improvement of their health literacy.
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Mohammadi F, Seifollahzadeh S, Motalebi S, Amirzadeh Iranagh J, Mafi M. Predictors of health literacy in community-dwelling elderly. SOCIAL HEALTH AND BEHAVIOR 2019. [DOI: 10.4103/shb.shb_27_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rouquette A, Nadot T, Labitrie P, Van den Broucke S, Mancini J, Rigal L, Ringa V. Validity and measurement invariance across sex, age, and education level of the French short versions of the European Health Literacy Survey Questionnaire. PLoS One 2018; 13:e0208091. [PMID: 30521552 PMCID: PMC6283623 DOI: 10.1371/journal.pone.0208091] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023] Open
Abstract
Background Short versions of the European Health Literacy Survey (HLS-EU) questionnaire are increasingly used to measure and compare health literacy (HL) in populations worldwide. As no validated versions of these questionnaires have thus far appeared in French, this study aimed to study the psychometric properties of the French translation of the 16- and 6-item short versions (HLS-EU-Q16 and HLS-EU-Q6), including their measurement invariance across sex, age, and education level. Methods A consensual French version of the HLS-EU-Q16 and HLS-EU-Q6 was developed by following the current recommendations for transcultural questionnaire adaptation. It was then completed by 317 patients recruited in waiting rooms of general practitioners in the Paris area (France). Structural validity was studied with the Rasch model for the HLS-EU-Q16 and confirmatory factorial analysis (CFA) for the HLS-EU-Q6. Concurrent and convergent validity, respectively, were assessed by scores on the Functional Communicative Critical Health Literacy (FCCHL) questionnaire and the physicians’ evaluations of their patient’s HL. Results The 16 items of the HLS-EU-Q16 were Rasch homogenous but meaningful differential item functioning (DIF) was found across sex, age, and/or education level for eight items. The CFA model fit for the HLS-EU-Q6 was poor. The overall scores for both HLS-EU short versions correlated poorly with the FCCHL scores. Similarly, HL levels defined using either short-version score did not agree with physicians’ HL assessments. Conclusion The French version of the HLS-EU-Q16 has acceptable psychometric properties, despite meaningful DIF for age, sex and education level and a poor discriminative power among subjects with average to high HL level. We recommend its use to measure HL in populations with sufficient reading skills to discriminate between subjects with low to average HL. Also, sensitivity analyses should be performed to evaluate the potential measurement bias due to DIF. Our results did not demonstrate the validity of the HLS-EU-Q6.
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Affiliation(s)
- Alexandra Rouquette
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, Le Kremlin-Bicêtre, France
| | - Théotime Nadot
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Pierre Labitrie
- Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Le Kremlin-Bicêtre, France
| | | | - Julien Mancini
- Aix-Marseille Univ, INSERM, IRD, UMR1252, SESSTIM, “Cancers, Biomedicine & Society” group, Marseille, France
- APHM, Timone Hospital, Public Health Department (BIOSTIC), Marseille, France
| | - Laurent Rigal
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Université Paris-Saclay, Univ. Paris-Sud, General Practice Department, Le Kremlin-Bicêtre, France
- Institut National d’Etudes Démographiques (INED), Paris, France
- * E-mail:
| | - Virginie Ringa
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Institut National d’Etudes Démographiques (INED), Paris, France
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Diederichs C, Jordan S, Domanska O, Neuhauser H. Health literacy in men and women with cardiovascular diseases and its association with the use of health care services - Results from the population-based GEDA2014/2015-EHIS survey in Germany. PLoS One 2018; 13:e0208303. [PMID: 30521588 PMCID: PMC6283547 DOI: 10.1371/journal.pone.0208303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health literacy (HL), defined as the ability to access, understand, appraise and apply health information, offers a promising approach to reduce the development of cardiovascular diseases (CVD) and to improve the management of CVD in populations. DESIGN We used data from nationwide cross-sectional German Health Update (GEDA2014/2015-EHIS) survey. 13,577 adults ≥ 40 years completed a comprehensive standardized paper or online questionnaire including the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). METHODS We compared participants with and without CVD with regard to their HL. We also analyzed the association between HL level and health care outcomes among individuals with CVD, i.e. frequency of general practitioner or specialist consultations, hospitalization and treatment delay. RESULTS The percentage of "problematic" or "inadequate" HL, defined as "not sufficient" HL, was significantly higher in individuals with CVD compared to without CVD (men 41.8% vs. 33.6%, women 46.7% vs. 33.4%). Having CVD was independently associated with "not sufficient" HL after adjusting for age, education, income, health consciousness and social support (adjusted OR: men 1.36, women 1.64). Among participants with CVD, individuals with "inadequate" HL were more likely to have more than 6 general practitioner consultations (49.3% vs. 28.7%), hospitalization (46.6% vs. 36.0%) in the last 12 months and to experience delay in getting health care because of long waiting lists for an appointment (30.7% vs. 18.5%) compared to participants with "sufficient" HL. CONCLUSION "Problematic" or "inadequate" HL is independently associated with CVD and health care use. This is a challenge and an opportunity for both CVD prevention and treatment.
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Affiliation(s)
- Claudia Diederichs
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Susanne Jordan
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Olga Domanska
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
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Juul L, Rowlands G, Maindal HT. Relationships between health literacy, motivation and diet and physical activity in people with type 2 diabetes participating in peer-led support groups. Prim Care Diabetes 2018; 12:331-337. [PMID: 29559207 DOI: 10.1016/j.pcd.2018.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
AIMS To investigate associations between health literacy (HL) and diet and physical activity, and motivation and diet and physical activity in Danish people with type 2 diabetes. METHODS We used a cross-sectional design including 194 individuals with type 2 diabetes participating in peer-led support groups provided by the Danish Diabetes Association between January-December 2015. The participants completed a questionnaire at the first meeting including; The Summary of Diabetes Self-Care Activities (SDSCA) measure, The Treatment Self-Regulation Questionnaire (TSRQ) (Self-Determination Theory) measuring type of motivation, and two HL scales: The HLS-EU-Q16, and the Diabetes Health Literacy scale (Ishikawa, H). Data were analyzed using linear regression models adjusting for age, gender, educational level, diabetes duration, motivation and HL. RESULTS The adjusted β (95%CI) showed that autonomous motivation and functional HL were associated with following recommended diet: autonomous motivation; 0.43 (0.06; 0.80) and functional HL; 0.52 (0.02; 1.00). Autonomous motivation was related to following physical activity recommendations; β (95%CI) 0.56 (0.16; 0.96). CONCLUSIONS This study indicates that, for people with type 2 diabetes, functional HL and autonomous motivation may be important drivers for following diet recommendations, and autonomous motivation may be the most important factor for following recommendations regarding physical activity. These concepts may therefore be highly relevant to address in interventions to people with type 2 diabetes. Different interventions are suggested.
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Affiliation(s)
- Lise Juul
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark; Department of Clinical Medicine, Danish Centre for Mindfulness, Aarhus University, Denmark.
| | - Gill Rowlands
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark; Institute of Health and Society, University of Newcastle, UK
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark; Steno Diabetes Center, Health Promotion Research, Copenhagen, Denmark
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Uemura K, Yamada M, Okamoto H. Effects of Active Learning on Health Literacy and Behavior in Older Adults: A Randomized Controlled Trial. J Am Geriatr Soc 2018; 66:1721-1729. [DOI: 10.1111/jgs.15458] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Kazuki Uemura
- Department of Liberal Arts and Sciences, Faculty of Engineering; Toyama Prefectural University; Imizu Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences; University of Tsukuba; Tokyo Japan
| | - Hiroshi Okamoto
- Department of Liberal Arts and Sciences, Faculty of Engineering; Toyama Prefectural University; Imizu Japan
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