The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

Levels of Health Literacy and Associated Factors Among Adults in a Rural Municipality of Nepal: A Cross-sectional Study

Health literacy is crucial in maintaining good health and well-being, yet community-based studies on health literacy in Nepal are scarce. This study aimed to assess the level of health literacy and identify associated factors among adults in Rasuwa, Nepal. A community-based cross-sectional study was conducted among 253 adults aged above 18 years residing in Kalika Rural Municipality, Rasuwa. Data were collected through face-to-face interviews using the Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Multivariable logistic regression was used to evaluate independent correlates of health literacy levels. The mean ± SD age of participants was 46.3 ± 16 years. Only about a quarter (23.3%) of participants had adequate health literacy. The participants aged ≤ 45 years (aOR:1.9,95% CI: 1.0-3.6), people who perceived their health status as satisfactory (aOR: 3.1,95% CI: 1.5-6.3), had satisfactory self-rated financial status (aOR: 2.9,95% CI: 1.5-5.5), had satisfactory level of self- related esteem (aOR = 2.7,95% CI: 1.2-6.2), had a stable income (aOR = 1.9, 95% CI:1.0-3.5) were more likely to demonstrate adequate health literacy level. Conversely, illiterate participants (aOR: 0.1, 95% CI: 0.04-0.4) and those engaged in agriculture (aOR: 0.49, 95% CI: 0.2-0.9) had lower odds of having adequate health literacy. This study highlights inadequate health literacy status among approximately three-quarters of the participants. Factors such as age, self-rated health status, financial stability, self-esteem, and income were associated with health literacy levels. These findings underscore the importance of addressing socio-economic and individual factors in promoting health literacy initiatives, particularly targeting vulnerable populations, to improve overall health outcomes and healthcare utilization.

Effectiveness of art-based health education on anemia and health literacy among pregnant women in Western Nepal: A randomized controlled trial

OBJECTIVE

As Nepalese pregnant women vary widely in literacy levels and cultural backgrounds and are reluctant to make decisions about their health, general interventions are insufficient to improve maternal anemia. This study aimed to assess the effectiveness of "face-to-face health education using educational material created using pictures, photos, and nomograms" in reducing anemia and improving health literacy.

METHODS

A total of 156 Nepalese pregnant women with hemoglobin (Hb) levels below 11.0 g/dl were divided into three groups: the education group received three sessions of face-to-face health education using art-based material unaffected by literacy skills; the distribution group received material used in the education group; and the control group underwent general perinatal checkups. Hb levels and health literacy scores were assessed at baseline early pregnancy (8-12 weeks) and late pregnancy (36-40 weeks). A Nepalese version of the 14-item Health Literacy Scale (HLS-14) was developed to assess health literacy.

RESULTS

The post-intervention three-group comparison showed a statistically significant difference (P < 0.042) in mean Hb levels after the intervention. Dunnett's test showed a statistically significant difference (P < 0.044) between the education and control groups but no significant difference between the distribution and control groups (P = 0.972). No significant differences in health literacy (total scores and subscales) were observed among the three groups before the intervention in the Kruskal-Wallis test and after the intervention (although there was a trend towards improvement). Total health literacy scores before and after the intervention were statistically significantly different for the total group and all three groups (P<0.001). Only the education group showed statistically significant differences in functional (P<0.012), communication (P<0.004), and critical (P<0.014) literacy subscale scores.

CONCLUSION

Continuous face-to-face health education using literacy material significantly reduced anemia and improved health literacy among Nepalese pregnant women.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN-CTR), URL: https://www.umin.ac.jp/ctr/ (Registration number: UMIN000049603).

Health-related word recognition and pronunciation by patients in Gauteng, South Africa in English and native languages

BACKGROUND

 Low health literacy has been found to affect people's ability to take care of their own health and follow the principles of disease prevention. Incomprehension of health education and healthcare instructions may lead to poor health outcomes.

AIM

 The aim of the study was to describe and compare a sample of primary healthcare patient's ability to recognise and pronounce health-related words in English and in his or her native language.

SETTING

 The study was conducted in 12 primary healthcare (PHC) clinics in Gauteng, South Africa.

METHODS

 A prospective, quantitative, comparative research design using a survey method was used to assess the ability to recognise and pronounce health-related words of 401 respondents using the REALM-R (SA) tool.

RESULTS

 Most respondents were 18-29 years (32%) and 30-49 years (53%) old. More than half (54%) of the respondents have completed grade 12 schooling. Adequate English health-related word recognition and pronunciation levels were at 19.5%, while native health-related word recognition and pronunciation levels were far better, ranging between 55.6% and 97.0%.

CONCLUSION

 Respondents showed better word recognition and pronunciation of the health-related words in their native language than in English. Providing health information in the patient's native language and on their level of understanding may therefore improve patient health outcomes.Contribution: The study is the first of its kind to determine word recognition and pronunciation of health-related words in English and a native language of South African PHC patients. Knowing this may assist healthcare professionals to give health education and instructions on the patient's level of understanding.

Impact of Pharmacist-Led Intervention on Adherence to Inhalers, Inhalation Technique, and Disease Control Among Asthma/COPD Patients in a Resource Limited Center: An Interventional Study

Background

Asthma and Chronic obstructive pulmonary disease (COPD) are chronic respiratory conditions characterized by airflow obstruction and respiratory symptoms. Adherence to prescribed inhaler therapy and correct inhalation technique are essential for effective disease management and optimal disease control. However, non-adherence and incorrect inhalation technique are common challenges faced by patients with asthma and COPD, leading to suboptimal treatment outcomes and increased healthcare burden.

Purpose

To study the impact of a pharmacist-led intervention on inhaler adherence, inhalation technique, and disease control among patients with asthma and COPD.

Patients and Methods

A pre-post interventional design assessed the effects of pharmacist-led intervention on inhaler adherence, inhalation techniques, and disease control in asthma and COPD patients at Dhulikhel Hospital in Nepal. Inclusion criteria: adult patient clinically diagnosed with asthma or COPD patients of all genders. The intervention comprised counseling patients with aids like videos, and informational leaflets. Impact was measured using checklist method for inhalation technique, the Test of Adherence to Inhaler (TAI) questionnaire for adherence to inhaler, and "Asthma Control Test (ACT)" or "COPD Assessment Test (CAT)" for disease control.

Results

The pharmacist-led intervention significantly increased adherence to inhalers, evidenced by a notable rise in the proportion of patients with good adherence (P<0.001). Sporadic, deliberate, and unwitting noncompliance pattern also improved significantly after the intervention (P<0.001, P<0.001 and P=0.001). Inhalation technique exhibited substantial improvement after intervention (P<0.001). The analysis indicated significant moderate negative correlations between "TIA" and "CAT" [ρ=-0.31; P=0.01], and between "inhalation technique score" and "CAT score" [ρ=-0.31; P=0.01] suggesting that as adherence to inhaler usage and inhalation technique improve, CAT scores tend to decrease, indicating reduced disease impact on the patient.

Conclusion

This study shows the potential efficacy of pharmacist-led intervention in enhancing adherence to inhaler, inhalation technique, and disease control in respiratory conditions such as asthma and COPD.

Advancing opioid stewardship in low-middle-income countries: challenges and opportunities

The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs.

Job satisfaction among midwives in low and middle-income countries: A protocol for systematic review and meta-analysis

Objectives

The main objective of this study is to assess the level of midwives' job satisfaction in low- and middle-income countries.

Methods

A comprehensive literature search will be carried out using the following databases: Google Scholar, PubMed/Medline, Embase, CINHAL, SCOPUS, Web of Science, and Science Direct. This systematic review and meta-analysis will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All identified observational studies reporting the level of job satisfaction among midwives in low- and middle-income countries will be considered. The extracted quantitative data will be analyzed using STATA version 17. Heterogeneity among the included studies will be assessed through the I2 test statistics. Finally, a random-effects meta-analysis model will be computed to estimate the pooled level of job satisfaction among midwives. Furthermore, publication bias will be assessed using a funnel plot and Egger's regression test, and sensitivity analysis will be conducted to evaluate the stability of the overall effects in the presence of outliers. The protocol has been registered in the PROSPERO-International Prospective Register of Systematic Reviews, with the registration number CRD42023400122.

Conclusion

This systematic review and meta-analysis will be an important source to identify the level of job satisfaction among midwives working in the health facilities of low- and middle-income countries. Researchers, stakeholders, and healthcare systems also use these and managers to determine why midwives' levels of job satisfaction are high or low compared to other studies in the future.

Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model

BACKGROUND

Health literacy is the important for the prevention of non-communicable disease to make informed health decisions, and practice healthy and protective behaviours. Therefore, application of socioecological model to this study aimed to identify multilevel factors on health literacy among patients and develop scientific health communication interventional strategies to improve health literacy on non-communicable disease prevention and care.

OBJECTIVE

To explore barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public Hospitals, Northeast Ethiopia, 2023.

METHOD

In this study phenomenological study design was conducted from February 5 to 30/2023.We have used purposive sampling technique to select study participants from chronic follow up clinics. Data were collected using in-depth interview and focused group discussion in which audio was recorded, transcribed verbatim and translated to English. Thematic analysis was performed with atlas ti. 7 software.

RESULT

In this study four main themes with seven subthemes were developed. The main themes were factors at the organizational, community, interpersonal, and intra-personal factors. The poor knowledge, lack of enough money for transportation and medication at the hospital were identified as barrier to get early diagnosis and treatment. Some participants explored that they have no any support from family or others. The cultural norms like weeding and funeral ceremonies enforce patients to consume prohibited substances like alcohol and salty foods.

CONCLUSION

In this study different barriers of health literacy were explored. Lack of knowledge, economic problems, lack of social support, poor communication with health care providers, cultural influences, lack of regular health education, lack of access to health care services and poor infrastructure were main barriers of health literacy in patients with NCD. Therefore, we recommended all concerned bodies to work on social and behavioral change communication intervention focusing on awareness creation, supply of drugs and create supportive environment to get accessible and affordable health care service to decrease the impact of non-communicable disease at personal, community and national level.

Design and Validation of a Health Literacy Assessment Tool for COVID-19 Among Iranian Workers

BACKGROUND

The workforce is an organization's most important asset, and ensuring their health and safety is crucial for achieving the organization's mission and goals.

OBJECTIVE

The objective of this study was to design and validate a health literacy tool for COVID-19 among Iranian workers.

METHODS

This cross-sectional study involved a total of 201 participants. A personal information questionnaire was administered, and The Health Literacy Assessment (HLA) Tool was used to collect data specifically related to COVID-19. The HLA for COVID-19 was designed and developed, and the validity of the tool was evaluated through face, content, convergent, and construct validity analyses. To examine convergent validity, the Perceived Stress Scale was used. The reliability of the questionnaire was assessed using internal consistency measures, such as Cronbach's alpha coefficient.

KEY RESULTS

The mean content validity index was 0.93, indicating high content validity. Confirmatory factor analysis results supported the five-dimensional structure of the tool. Significant correlations were found between the HLA for COVID-19 and perceived stress levels. The Cronbach's alpha coefficient for all items was 0.84, indicating high internal consistency.

CONCLUSION

The HLA for COVID-19 is a concise, reliable tool for measuring health literacy related to COVID-19 among Iranian workers. Assessing COVID-19 health literacy in this population can be useful in evaluating the effectiveness of government officials, the media, and the medical and scientific community in providing necessary information. [HLRP: Health Literacy Research and Practice. 2024;8(2):e62-e68.].

Equity of health resource allocation in Chongqing, China, in 2021: a cross-sectional study

BACKGROUND

Chongqing, the most populous city in Southwest China. This study aims to examine the equity of health resource allocation in Chongqing using the latest statistics, analyse possible shortcomings and propose strategies to address these issues.

METHODS

This cross-sectional study used healthcare resource, population, area and gross domestic product data from the Seventh National Census Bulletin of Chongqing, the National County Statistical Yearbook, the Chongqing Municipal Bureau of Statistics and the Chongqing Health Statistical Yearbook 2022. We also studied the equity of health resource allocation in Chongqing by using the Gini coefficient, Lorenz curve and Theil index, and used the Analytical Hierarchy Process and Technique for Order of Preference by Similarity to Ideal Solution (AHP-TOPSIS) method to comprehensively evaluate the health resources in the four major regions of Chongqing.

RESULTS

The Gini coefficient of health resources in Chongqing in 2021 was the highest when allocated according to geographical area, between 0.4285 and 0.6081, both of which exceeded 0.4, and the Gini coefficient of medical equipment was the highest and exceeded 0.6. The inter-regional Theil index of each resource was greater than the intraregional Theil index, and the contribution of inter-regional differences ranged from 64.83% to 80.21%. The results of the AHP-TOPSIS method showed that the relative proximity between health resources and ideal solutions in four regions of Chongqing ranged from 0.0753 to 0.9277.

CONCLUSION

The allocation of health resources in Chongqing exhibits pronounced inequities, particularly in the distribution of medical equipment according to geographical area. Moreover, there exists a substantial gap in the equity of health resource allocation among the four regions of Chongqing. As such, this study emphasises the need for Chongqing, China, to prioritise the equitable allocation of health resources and increase consideration of geographic factors. Implementing measures to promote equitable allocation of health resources, particularly in geographic terms, is critical.

Health Literacy in Ethiopia: Evidence Synthesis and Implications

Background

Health literacy plays a pivotal role in healthcare utilization and health-related lifestyle choices. This makes health literacy a pressing concern, particularly in low-income countries like Ethiopia, where there are intricate health challenges. Despite its significance, there is a dearth of studies on the issue in Ethiopia. This study aimed to provide a comprehensive synthesis of the available evidence on health literacy in Ethiopia, and to discuss the implications for healthcare practice, health promotion, and research endeavors.

Methods

A systematic scoping review was conducted to achieve the purpose of this study. A comprehensive search of databases such as PubMed, CINAHL, AJOL, and PLOS Global Public Health was conducted for eligible evidence. Searches were conducted from May 12 to September 9, 2022. The PRISMA flow diagram guideline was utilized to ensure transparent reporting of the reviews process. The data extraction tool used was based on the JBI methodology guidance for reviews.

Results

The search in total yielded 543 records. However, only 16 studies met the eligibility criteria after a thorough screening process. All eligible studies were conducted in health facilities and schools with limited scopes. The main findings of the eligible studies focused on health literacy levels, health information sources, and health literacy determinants among the studies participants. Many of the studies reported low health literacy levels and multiple predicting factors ranging from personal to socioeconomic conditions among the respondents.

Conclusion

This review has provided critical insights into the state of health literacy in Ethiopia. There is a need for comprehensive research and the development of context-appropriate health literacy measurements tailored to the Ethiopian context, as well as evidence-based health literacy interventions. Prioritizing health literacy as a key research and intervention area is essential for improving the health of individuals and populations and achieving health-related Sustainable Development Goals in Ethiopia.

Moving forward through consensus: a national Delphi approach to determine the top research priorities in prostate cancer in Uganda

OBJECTIVE

To identify key areas for research in prostate cancer (PC) in the Ugandan context by establishing the major health system, socioeconomic and clinical barriers to seeking, reaching and receiving high-quality cancer care.

DESIGN

Modified Delphi Technique.

SETTING

Government and private-not-for-profit hospitals.

METHODS

We applied a two-stage modified Delphi technique to identify the consensus view across cancer experts. In round 1, experts received a questionnaire containing 21 statements drawn from a systematic review identifying the reason for the delay in accessing cancer care. Each statement was scored out of 20. Statements scoring ≥15 from over 70% of participants were prioritised for inclusion while statements for which <30% of participants gave a score of ≥15 were excluded. Sixteen statements were included in round 2 as they did not receive consensus for inclusion or exclusion.

RESULTS

We found that the top six research priority areas arise from challenges including: (1) lack of diagnostic services-ultrasound, laboratory tests and biopsy facilities; (2) high costs of services, for example, surgery, radiotherapy, hormone therapy are unaffordable to most patients, (3) lack of essential medicines, (4) limited radiotherapy capacity, (5) lack of awareness of cancer as a disease and low recognition of symptoms, (6) low healthcare literacy. The lack of critical surgical supplies, high diagnostic and treatment costs were ranked highest in order of importance in round 1. Round 2 also revealed lack of diagnostic services, unavailability of critical medicines, lack of radiotherapy options, high costs of treatments and lack of critical surgical supplies as the top priorities.

CONCLUSION

These research priority areas ought to be addressed in future research to improve prompt PC diagnosis and care in Uganda. There is need to improve the supply of high-quality affordable anticancer medicines for PC patients so as to improve the survivorship from the cancer.

How informed is informed consent?-Evaluating the quality of informed consent among surgical patients in a tertiary care hospital in Nepal

BACKGROUND

Informed consent-taking is a part of clinical practice that has ethical and legal aspects attached to it. This protects the autonomy of the patients by providing complete information regarding the rationale, modality, potential risks, benefits, and alternatives of the planned procedure to the patients. This enables the patients to make the right decision for themselves and their care. This study aims to find out if the informed consent-taking process has ensured the active participation of the patients or the next of kin in the decision-making.

MATERIALS AND METHODS

This is a prospective cross-sectional study conducted in a military healthcare institution among patients undergoing major surgical procedures from July 2022 to October 2022. Ethical clearance was obtained before the commencement of this study. A structured questionnaire was prepared, and the collected data was refined in Excel and imported into SPSS for analysis.

RESULTS

A total of 350 individuals of mean age 47.95 ± 16.057 years were part of this study. The majority of the respondents were married, literate, and family by beneficiary category. All of the respondents received and signed the consent form. About 77% of the respondents read it completely, and 95.4% of them reported that it was understandable. The majority of the patients did not know who was going to perform the surgery, the alternatives to the planned treatment, the benefits of the surgery, or the outcome of non-treatment. On the patient satisfaction scale, 16.28% of the participants agreed that they were satisfied with the informed consent-taking process.

CONCLUSION

Deficiencies in the informed consent-taking process were the lack of dissemination of adequate information on the nature, duration, pros and cons, post-operative state, and alternative of the planned procedure. A well-structured format of the consent form that is specific to a particular procedure should be adopted, and various alternatives to it must be disseminated to the patient or the next of kin to improve the quality of the informed consent-taking process.

Practice environment determinants of job satisfaction among midwives at healthcare facilities in Accra Metropolis: A multicentre study

INTRODUCTION

Sustainable Development Goal 3 (SDG 3) has been one of the key goals for all partners of health globally. The health workforce especially midwives are among the principal skilled experts for achieving the goal. This is evidenced in the role they play in caring for pregnant women from the antenatal stages to the postpartum periods. However, very little has been reported about midwives' job satisfaction in Ghana. The study assessed the practice environment determinants of job satisfaction among registered midwives in Ghana.

MATERIALS AND METHODS

A cross-sectional design was adopted to recruit midwives from public and quasi-government hospitals in Accra Metropolis. Validated scales-'Measure of Job Satisfaction' and 'Practice Environment Scale of Nursing Work Index' were used for data collection. Data was analysed through descriptive statistics, Pearson correlation and linear regression.

RESULTS

Midwives had a positive perception of their work environment. They were generally satisfied with their job but were dissatisfied with their salaries. Key determinants of midwives' job satisfaction included years of work as a midwife, managers' leadership and support, and adequacy of human and material resources.

CONCLUSION

Improving midwives' job satisfaction through enabling the work environment will go a long way to improve healthcare provision in the healthcare delivery points in helping achieve SDG 3.

Assessment of satisfaction with delivery care among mothers in selected health care facilities in Ekiti state

The study assessed the maternal satisfaction with delivery care in selected health care facilities in Ekiti state. The study employed a descriptive cross-sectional study design and a simple random sampling technique was utilized to select respondents based on calculated sample size and a total of 267 respondents participated in the study. A semi-structured pretested questionnaire was used for the data collection. Data was analyzed and summarized using descriptive statistics and inferential statistics (Chi-square) with significance set at p < 0.05. The mean respondents' age was 28.2 ± 1.4 years with majority falling within the age group of 21-30 years. Majority of the respondents revealed to be satisfied with the following: proximity of the health facilities 194 (72.7%); cost of service 174 (65.2%); drug availability 184 (69.7%); cleanliness of the hospital ambience 219 (82.0%); and professional conduct of the care givers 186 (70.2%). However, the respondents expressed dissatisfaction in terms of the following: referral link 107 (40.1%); waiting time 122 (45.7%); communication gap 56 (21.0%); and maintenance of privacy 51 (19.1%). Overall, majority (94.8%) of the respondents were satisfied with the delivery services rendered at the facilities while 14 (5.2%) expressed dissatisfaction. Furthermore, a significant association exists between respondents' level of education and maternal satisfaction on delivery care (p < 0.05). Although the general maternal gratification/satisfaction on intrapartum and postpartum care in this study was overwhelmingly high, the few domains of discontentment identified need to be addressed by all the stakeholders in the health sector to enhance the usage of health care services amongst women, thus promoting the attainment of Sustainable Development Goal (SDG) 3.

The Trends and Content of Research Related to the Sustainable Development Goals: A Systemic Review

This study employed a comprehensive systematic review of the literature (SRL) process with the Content Analysis Toolkits for Academic Research (CATAR) for conducting a bibliometric analysis of the 2814 general SDG-related papers and 92 review papers selected from the Web of Science database from 2013 to 2022. The overview analysis found that the US and UK took the lead in publication and citation. The WHO and several universities were identified as the most prominent institutes around the globe. The field distribution of the most cited papers revealed the existence of a “strong sustainability” paradigm and the importance of science and technology. A landscape of 1123 papers was included in eight clusters according to the bibliographic coupling algorithms in the Multi-stage Document Clustering (MSDC) process. These clusters were then categorized into three groups, “synergies and trade-offs”, “networking”, and “systems analysis”, demonstrated in the theme maps. As for the 92 SDG-related review papers, most were shaped based on literature analysis without specified countries. Moreover, SDG 3 was identified as that exclusively studied in most papers. The information presented is expected to help research scholars, public sectors, and practitioners monitor, gather, check, analyze, and use the growing volume of SDG-related academic articles.

Gender and Antimicrobial Resistance: What Can We Learn From Applying a Gendered Lens to Data Analysis Using a Participatory Arts Case Study?

Antimicrobial resistance (AMR), the natural process by which bacteria become resistant to the medicines used to kill them, is becoming one of the greatest threats to health globally. AMR is accelerating at alarming rates due to behaviors across human, animal, and environmental health sectors as well as governance and policy shortfalls across each sector. Antimicrobial resistant infections occur through the same channels as other infectious diseases and are most common in countries/areas where there is limited access to improved sanitation facilities, reliable healthcare and health education. At the community level, much remains to be understood about the drivers of antimicrobial resistance and how to generate community-led, acceptable solutions. Gender can influence every part of an individual's health experiences; access to knowledge, healthcare facilities, financial resources and paid employment are all heavily gendered and influence behaviors relating to the procurement of antimicrobial and antibiotic agents. This analysis uses data gathered during a participatory video study designed to work with two communities in Nepal to understand drivers of antibiotic mis and over use from the perspective of the communities themselves. Findings reveal that gender impacts upon many aspects of AMR-driving behaviors within this community and stimulate essential discussion as to the importance of gender in future AMR research. This paper places a spotlight on gender in the wider AMR conversation, an area that is currently neglected, and improve our collective knowledge on the drivers of AMR from a gendered perspective.

Use of the English Health Literacy Questionnaire (HLQ) with Health Science University Students in Nepal: A Validity Testing Study

Research evidence shows that health literacy development is a key factor influencing non-communicable diseases care and patient outcomes. Healthcare professionals with strong health literacy skills are essential for providing quality care. We aimed to report the validation testing of the Health Literacy Questionnaire (HLQ) among health professional students in Nepal. A cross-sectional study was conducted with 419 health sciences students using the HLQ in Nepal. Validation testing and reporting were conducted using five sources outlined by ‘the 2014 Standards for Educational and Psychological Testing’. The average difficulty was lowest (17.4%) for Scale 4. Social support for health, and highest (51.9%) for Scale 6. Ability to actively engage with healthcare providers. One factor Confirmatory Factor Analysis (CFA) model showed a good fit for Scale 2, Scale 7 and Scale 9 and a reasonable fit for Scale 3 and Scale 4. The restricted nine-factor CFA model showed a satisfactory level of fit. The use of HLQ is seen to be meaningful in Nepal and warrants translation into native Nepali and other dominant local languages with careful consideration of cultural appropriateness using cognitive interviews.

Generic Medicine and Generic Prescribing in Nepal: An Implication for Policymakers

Generic medicines are being promoted in many countries for their added benefits over branded drugs, such as reduced price, therapeutic equivalence, and convenience to the patients. However, generic prescribing is still not up to the optimum level in Nepal to assure access to cost-effective, quality medicines to the public and to reduce the overall economic burden and practice-related errors of medications. This review aimed to discuss the current scenario of generic medicine, generic prescribing, hurdles on the one hand, and potentials ways in promoting generic medicine usage and generic prescribing in Nepal on the other. Extensive literature on generic medicine usage and generic prescribing practice in Nepal was reviewed. This review found some of the major challenges to be addressed for the proper implementation of generic medicine prescribing, and utilization. These challenges include lack of facilities and competency to assure therapeutic equivalence of different brand-name medicines, lack of understanding about generic medicines among health care providers (HCPs) and the public, and lack of stringent regulation towards promoting generic medicines. Rational pharmaceutical promotion and awareness about generic medication to the medical students are also inevitable towards promoting the practice of generic medicines. The practice of generic medicine and generic prescribing is not possible without the assurance of therapeutically equivalent generic alternatives. The study recommended the prompt effort of the regulatory authority to enforce the generic prescribing and generic substitution policy through strengthening policies, procedures and laboratory testing to assure citizens’ right to access to cost-effective, and affordable quality medicine, as the Nepal’s National Health and Drug Policy mandated.

Nursing students' understanding of health literacy and health practices: a cross-sectional study at a university in Namibia

Background

A poor understanding of health literacy and inadequate health practices among nurses can be detrimental to a population’s health. The starting point of solving this problem is through the provision of methodical health literacy and health practice education in the nursing curriculum. This study explored nursing students’ understanding of the concept of ‘health literacy’ and their health practices at a university in Namibia.

Methods

A descriptive cross-sectional study was carried out among 205 nursing students. A simple stratified sampling method was used and data were collected using a self-reporting Understanding of Health Literacy (UHL) questionnaire. Pearson correlation, independent t-test and One-way ANOVA were used to analyse the data.

Results

The overall mean Understanding of Health Literacy score was 13.04 ± 1.52. The majority (n = 157; 76.5%) of the students were found to have adequate health literacy scores, 21.5% had moderate health literacy scores, and only 2% had inadequate health literacy scores. The overall mean health practice score was 32.4 ± 5.50. Most (n = 106; 51.7%) of the students were found to have poor health practices, 44.4% had average health practices, and just 3.9% had good health practices. There was no significant relationship between the health literacy levels and health practices of the students (p = 0.63).

Conclusions

Nursing students have a good understanding of the concept of health literacy, but more effort can be made to translate this understanding into health literacy skills. There is a need to investigate the contributing factors to poor health practices, as well as develop strategies that can support good health practices among nursing students. These health literacy skills could then be transferred into the students' professional careers as nurses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00776-z.

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

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

Exploring the design and introduction of the Ophelia (Optimising Health Literacy and Access) process in the Philippines: A qualitative case study

ISSUE ADDRESSED

The Ophelia (Optimising Health Literacy and Access) process is a systematic approach for improving access to health information and services through health literacy interventions. However, there is limited understanding of how this process can be adapted in low- and- middle-income countries.

METHODS

A qualitative case study was used to describe how an Ophelia project was designed and introduced in a community setting in the Philippines and to explore the experiences of stakeholders involved in this process. Two qualitative methods were used: document analysis (n = 12) and semi-structured interviews (n = 12).

RESULTS

Data showed that the project stakeholders had embedded the eight Ophelia principles in the design of the project, introduced the Ophelia process in one target community, and conducted a health literacy needs assessment. Project stakeholders faced challenges engaging with local authorities and community members in this location, but overcame these issues through building relationships and understanding their needs. Local authorities and stakeholders provided access to resources and knowledge of this target community.

CONCLUSIONS

The Ophelia process can be adapted for a community setting in the Philippines. Understanding local communities is crucial for introducing and engaging participation in this process. SO WHAT?: The Ophelia process may have implications for increasing access to health information and services for vulnerable populations in the Philippines and the Asia Pacific.

The effect of distance on maternal institutional delivery choice: Evidence from Malawi

In many low- and middle-income countries, geographical accessibility continues to be a barrier to health care utilization. In this paper, we aim to better understand the full relationship between distance to providers and utilization of maternal delivery services. We address three methodological challenges: non-linear effects between distance and utilization; unobserved heterogeneity through non-random distance "assignment"; and heterogeneous effects of distance. Linking Malawi Demographic Health Survey household data to Service Provision Assessment facility data, we consider distance as a continuous treatment variable, estimating a Dose-Response Function based on generalized propensity scores, allowing exploration of non-linearities in the effect of an increment in distance at different distance exposures. Using an instrumental variables approach, we examine the potential for unobserved differences between women residing at different distances to health facilities. Our results suggest distance significantly reduces the probability of having a facility delivery, with evidence of non-linearities in the effect. The negative relationship is shown to be particularly strong for women with poor health knowledge and lower socio-economic status, with important implications for equity. We also find evidence of potential unobserved confounding, suggesting that methods that ignore such confounding may underestimate the effect of distance on the utilization of health services.

Factors affecting utilization of mental health services from Primary Health Care (PHC) facilities of western hilly district of Nepal

AIM

To explore the factors affecting mental health service utilization from Primary Health Care facilities of Arghakhanchi district, a western hilly district of Nepal.

BACKGROUND

Mental health service utilization has many facilitating and hindering factors present at different socio-ecological levels. Stigma and lack of awareness in the community have been identified as the major barriers for mental health service demand and access worldwide.

METHODS

A cross-sectional qualitative study was conducted in Arghakhanchi district of Nepal in July-August 2019 that collected information through face-to-face In-depth and Key Informant Interviews of three categories of participants selected judgmentally. Thirty-two purposively selected participants from the three categories were interviewed using validated interview guidelines. Thematic analysis was performed using RQDA package for EZR software. Validation of translated transcripts, member checking and inter-coder percent agreement were performed to maintain rigor in the study.

RESULTS

Mental health stigma and inadequate awareness were identified as major factors that caused barriers for mental health service utilization at community level. They also influenced different factors at other socio-ecological levels to act as barriers. Awareness in community along with accessibility and availability of comprehensive mental health services were recommended by the participants for increasing service utilization from Primary Health Care facilities.

CONCLUSION

Individual, family and community awareness could help reduce and/or eliminate mental health stigma. Accessibility of health facilities and availability of comprehensive mental health services in Primary Health Care facilities could help increase service utilization from those facilities.

The role of mass media communication in public health: The impact of Islamic Republic of Iran broadcasting health channel on health literacy and health behaviors

Background: By informing and educating, the Media play a main role in increasing the health literacy of the community. Broadcasting health channels (BHCs) are established to improve health literacy and public health worldwide. This study was aimed to evaluate the role of Islamic Republic of Iran the broadcasting health channel (IRIB HC) on public health.

Methods: A cross-sectional, comparative study was performed on 500 participants throughout 6 urban areas in Tehran, the capital of Iran in 2019. About 250 of the samples were included in viewing the health channel group. A standard questionnaire was used to measure the levels of public health in the 2 groups. Data were analyzed and compared using SPSS software version 25.

Results: According to the results, health literacy was higher in the group that used the health channel rather than the other group. Also, with regard to physical and psychological health levels, a significant difference was observed between audiences and nonaudiences (p= 0.013, p= 0.001, respectively).

Conclusion: The IRIB HC has positive effects on increasing the level of health literacy, Physical and psychological health, and consequently improving public health. Therefore, these channels have a great role in the implementation of health polices to improve health status.

Exploring traditional medicine utilisation during antenatal care among women in Bulilima District of Plumtree in Zimbabwe

Traditional medicine utilisation during antenatal care has been on the increase in several countries. Therefore, addressing and reinforcing the Sustainable Development Goal of maternal mortality reduction, there is a need to take traditional medicine utilisation during pregnancy into consideration. This paper explores traditional medicine utilisation during antenatal care among women in Bulilima District of Plumtree in Zimbabwe. A cross-sectional survey was conducted on 177 randomly selected women using a semi-structured questionnaire. Fisher's Exact Test, Odds Ratios, and Multiple Logistic Regression were utilised to determine any associations between different demographic characteristics and traditional medicine utilisation patterns using STATA SE Version 13. The prevalence of Traditional Medicine utilisation among pregnant women was estimated to be 28%. Most traditional remedies were used in the third trimester to quicken delivery. The majority of women used holy water and unknown Traditional Medicine during pregnancy. There was a strong association between age and Traditional Medicine utilisation as older women are 13 times more likely to use Traditional Medicine than younger ones. Women use traditional medicine for different purposes during pregnancy, and older women's likelihood to use Traditional Medicine is higher than their counterparts. The traditional system plays an essential role in antenatal care; therefore, there is a need to conduct further studies on the efficacy and safety of utilising Traditional Medicines.

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

BACKGROUND

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

METHODS

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

KEY RESULTS

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

DISCUSSION

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

Perception that Mothers and / or Guardians of Overweight or Obese Preschool Children Have of a Text Messaging Program to Support Behaviour Change in their Children

In most childhood obesity preventive programs, parents are targeted as they are key in achieving lifestyle behavior change in their children. Because their participation is generally low, new technologies, such as text messaging, are being tested to assess if their participation increases. The objective of this study was to determine the perception that mothers of overweight/ obese preschool children have of a textmessaging program developed to support their children’s lifestyle behavior change. Text messages were sent to 60 mothers twice a week for 12 weeks; 58 of them said they received all of them. During the process mothers were contacted twice regarding their opinion on all aspects related to the messages. At follow-up, we determined perception by in depth interviews administered to participants. Results show that text messaging implemented in a personalized manner was considered successful in regards to providing useful information to support their children’s behavior change.

C. B, Khanal S. Translation, cross-cultural adaptation and validation of Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0) into the Nepalese version in a community settings

Background

Understanding patient satisfaction with pharmacy services can help to enhance the quality and monitoring of pharmacy services. Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) is a valid and reliable instrument for measuring patient satisfaction with services from the pharmacist. The availability of the PSPSQ 2.0 in Nepalese version would facilitate patient satisfaction and enhance pharmacy services in Nepal. This study aims to translate the PSPSQ 2.0 into the Nepalese version, culturally adapt it and verify its reliability and validity in the Nepalese population.

Methods

The methodological and cross-sectional study design was used to translate, culturally adapt it, and validate PSPSQ 2.0 in Nepalese. The Nepalese version of PSPSQ 2.0 went through the full linguistic validation process and was evaluated in 300 patients visiting different community pharmacies in Kathmandu district, Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation, and Cronbach's alpha was used to evaluate the reliability.

Results

Three-hundred patients were recruited in this study. Participants ranged in age from 21 to 83 years; mean age was 53.93 years (SD: 15.21). 62% were females, and 34% educational level was above 12 and university level. Only 7% of the participants were illiterate. Kaiser-Meyer-Olkinwas found to be 0.696, and Bartlett's test of sphericity was significant with a chi-square test value of 3695.415. A principal axis factor analysis conducted on the 20 items with orthogonal rotation (varimax). PSPSQ 2.0 Nepalese version (20 items) had a good internal consistency (Cronbach’s alpha = 0.758). Item-total correlations were reviewed for the items in each of the three domains of PSPSQ 2.0.

Conclusion

The PSPSQ 2.0 Nepalese version demonstrated acceptable validity and reliability, which can be used in the Nepalese population for evaluating the satisfaction of patients with pharmacist services in both community pharmacy and research.

Growth of health literacy research activity in three Middle Eastern countries

BACKGROUND

Health literacy is defined as the capacity to obtain, interpret and understand basic health information. In each country, the count of published literature is a good indicator for scientific activity. This study aimed to assess the growth rate of scientific production in the field of health literacy in Middle Eastern countries during 2005-2014.

METHODS

We used the PubMed database and retrieved 839 papers in the field of health literacy from three productive countries in the Middle East: Iran, Saudi Arabia and Turkey. We applied the bibliometric indicator of Price's Law to assess the increase of scientific literature. The correlation between bibliometric data and some health indicators such as gross domestic product and population was calculated.

RESULTS

Worldwide research productivity in health literacy field was 56 653 documents while that from Middle Eastern countries were 839 papers. Iran, Turkey and Saudi Arabia were three productive countries in Middle East. Iran and Saudi Arabia have undergone exponential growth, but Turkey has undergone linear growth over the studied period.

CONCLUSIONS

In conclusion, although the present data show promising increase and good start in research productivity from countries in Middle East, they have a trivial sharing in publishing scientific papers in the field of health literacy through 2005-2014.

Socio-demographic and behavioral correlates of health literacy: a gender perspective in Ghana

Relatively little research has been conducted on the place of health literacy (HL) as an essential mechanism to achieve the Sustainable Development Goal for gender equality (SDG 5) or to enhance its role in SDG 3, good health and well-being, particularly in sub-Saharan Africa (SSA). The present analyses examined the role of socio-economic, health and behavioral factors associated with HL among men and women in the Ashanti Region of Ghana using a cross-sectional design and data collected from 779 rural and urban residents from June 2015 to October 2015. HL was higher among men. In multivariate logistic regression analyses, income and education were positively associated with HL for both men and women. Ethnicity showed a positive relationship with HL among men, while religious affiliation was associated with HL of overall population. Smoking was negatively associated with HL among men. Among women, self-reported health was positively associated with HL but having health insurance was inversely related. These gender differences may be due to dominant male gender roles and differing expectations and opportunities for socio-economic advancement for men and women. An inter-disciplinary approach is suggested for understanding and improving HL in both genders and especially in women, given their current low HL.

Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal

Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care-first-contact access, care coordination, comprehensiveness and continuity-offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular 'at-goal' metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. 'At-goal' status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions.

Health literacy of future healthcare professionals: a cross-sectional study among health sciences students in Nepal

Background

There is an assumption that health literacy is higher among health professionals, allowing them to improve the health literacy of their patients. This study explored health literacy profiles of health science students in Nepal, the future health professionals and educators of health literacy.

Methods

The multidimensional Health Literacy Questionnaire and demographic questions were administered online to medical and other health science students at the B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

Results

More than half (55.8%) of the participants were male, 68.3% were ≤19 y of age, 62.2% had parents with a university degree, 73.5% were studying undergraduate courses and 61.6% were pursuing medicine. Students reported having moderate support and skills to manage their health. Health was regarded as important to them. They reported a moderate ability to engage with health professionals and the healthcare system. Medical students reported higher scores for all scales except social support for health, which was similar across the groups.

Conclusions

Universities should target interventions to improve students' access to health information and to develop students' ability to engage actively with healthcare providers. This will likely produce health professionals with improved health literacy levels who are sensitive to the health literacy needs of their patients from different population groups.

Health Literacy and Knowledge of Chronic Diseases in Nepal

Background:

Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal.

Objective:

This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases.

Methods:

A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire.

Key Results:

The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (β = 0.32; p < .05), diabetes mellitus (β = 0.41; p < .05), and chronic obstructive pulmonary disease (β = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake.

Conclusions:

A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [HLRP: Health Literacy Research and Practice. 2018;2(4):e221–e230.]

Plain Language Summary:

Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary.

Predictors of Health Care Service Quality among Women Insured Under Ghana's National Health Insurance Scheme

Background:

Insured women in Ghana are more likely to use maternity care services than their uninsured counterparts. To improve service quality among insured women in Ghana, better understanding of the factors that predict quality standards of primary health care services is essential.

Objective:

To examine predictors of health care service quality among insured women under the National Health Insurance Scheme (NHIS) in Ghana.

Methods:

Data from the 2014 Ghana Demographic Health Survey was analysed. Cluster analysis was applied to construct a dependent variable; service care quality. Socio-demographic/background characteristics were used as independent variables. Descriptive and inferential analyses were performed followed by multiple regression to predict service quality among the insured population of women aged 15–49 years. SPSS version 21 was used during the clustering while STATA version 14 was used to perform the inferential and regression analyses.

Findings:

A total of 5,457 women with valid health insurance were included in the analysis. Overall, geographical region of respondents was significant to expressions of insured service quality (χ² = 495.4, p ≤ 0.001). Literacy levels were significant at χ² = 69.232 and p < 0.001 for service quality. On place of residence, the estimation showed urban residency to be more positively correlated with indicating quality ratings of health services compared to rural residency (χ² = 70.29, p < 0.001). Highest educational level had the highest predictive influence (coefficient = 0.15) on women’s views about the quality of health care services.

Conclusions:

A health insurance system that shifts towards introducing valued-based care models for patients, insurers, and health care providers could be supportive in improving the quality of healthcare delivered to Ghanaians.

Predictors of Health Care Service Quality among Women Insured Under Ghana's National Health Insurance Scheme

BACKGROUND

Insured women in Ghana are more likely to use maternity care services than their uninsured counterparts. To improve service quality among insured women in Ghana, better understanding of the factors that predict quality standards of primary health care services is essential.

OBJECTIVE

To examine predictors of health care service quality among insured women under the National Health Insurance Scheme (NHIS) in Ghana.

METHODS

Data from the 2014 Ghana Demographic Health Survey was analysed. Cluster analysis was applied to construct a dependent variable; service care quality. Socio-demographic/background characteristics were used as independent variables. Descriptive and inferential analyses were performed followed by multiple regression to predict service quality among the insured population of women aged 15-49 years. SPSS version 21 was used during the clustering while STATA version 14 was used to perform the inferential and regression analyses.

FINDINGS

Overall, geographical region of respondents was significant to expressions of insured service quality (χ2=495.4, p ≤ 0.001). Literacy levels were significant at χ2=69.232 and p ≤ 0.001 for service quality. On place of residence, the estimation show urban residency was more positively correlated with indicating quality ratings of health services compared to rural residency (χ2=70.29, p ≤ 0.001). Highest educational level had the highest predictive influence with a coefficient of 0.15.

CONCLUSIONS

A more supportive health insurance system approach that shifts towards introducing valued-based care models for patients, insurers and health care providers could be supportive in improving quality standards among insured population groups in Ghana.

Progress in Implementing National Policies and Strategies for Health Literacy-What Have We Learned so Far?

Health literacy has been a prominent issue on the agenda of the World Health Organization (WHO) for almost two decades. WHO recently established a strong global mandate for public policy action on health literacy by positioning it as one of three key pillars for achieving sustainable development and health equity in the Shanghai Declaration on Health Promotion. Several countries have national health literacy policies, with many others expected to develop them in the immediate future. It is, therefore, timely to examine current policy approaches to health literacy. The purpose of this study was to analyze a selection of existing policy documents for their strengths, limitations and themes, and offer observations about their potential to improve health literacy and health outcomes. In doing so our intention is to offer lessons and advice from early adopters that will have usefulness for future policy development and implementation. We selected six policies for review; Australia, Austria, China, New Zealand, Scotland, and the United States. We used a set of criteria to guide a systematic analysis of policy documents for their context, intended target audiences, objectives, proposed actions and interventions, evidence of financial investment and intentions to monitor outcomes. We observed a number of common features that provide helpful signposting for future policy development in other countries. All represent a response to perceived deficiencies in the quality of patient communication and patient engagement. Most present health literacy as a universal challenge, with some also identifying groups who are of higher priority. They all recognize the importance of professional education in improving the quality of communication, and most recognize that the health literacy responsiveness of the health system needs to be improved. However, there was significant variability in linking resources to specific strategies and actions, as well as in the systems for monitoring progress and accountability for progress. This variability reflects important contextual differences between countries and health systems. However, this lack of specificity will likely have an impact on the priority given to improving health literacy and on the long-term sustainability of defined actions to improve health literacy in populations.

Health literacy and health: rethinking the strategies for universal health coverage in Ghana

OBJECTIVES

Health literacy (HL) is generally thought to be associated with positive health behaviour, appropriate health service utilisation and acceptance of interventions to maximise health outcomes. It is, therefore, increasingly suggested that evidence-based research should investigate how HL may operate in the context of universal health coverage (UHC). However, the role of HL in the relationships between elements of UHC such as access to health care and health insurance has not been widely explored. This applies in particular in Sub-Saharan Africa, although service coverage and health outcomes vary hugely between and within many countries. This article addresses this lacuna in Ghana, today one of the Africa's most promising health systems.

STUDY DESIGN

It is a cross-sectional study.

METHODS

The study used structured interviews to gather data from 779 rural and urban adults using a multistage cluster sampling approach.

RESULTS

In a three-step multiple hierarchical linear regression model, HL (B = -.09, standard error [SE] = .04) and health insurance subscription (B = -.15, SE = .04) were found to be inversely associated with poor health-related quality of life (HRQoL). Access to health care did not predict HRQoL (B = -.02, SE = .02). However, the interaction between access to health care and HL produced a negative effect on poor HRQoL (B = -.08, SE = .03). The interaction between HL and health insurance subscription also showed a similar effect on HRQoL (B = -.10, SE = .03). Further analysis depicted that access to health care (β = -.09, P = .05) and health insurance subscription (β = -.24, P = .00) related positively to HRQoL only when HL was high.

CONCLUSION

The article argues that where HL is low, even favourable policies for UHC are likely to miss set targets. While not losing sight of relevant sociocultural elements, enhancing HL should be a central strategy for policies aimed at bridging health inequalities and improving UHC.

Hereditary gynaecologic cancers in Nepal: a proposed model of care to serve high risk populations in developing countries

Background

Endometrial, ovarian and breast cancers are paradigms for global health disparity. Women living in the developing world continue to present in later stages of disease and have fewer options for treatment than those in developed countries. Risk reducing surgery is of proven benefit for women at high risk of gynaecological cancer. There is no specific model for identification and management of such women in the developing world.

Methods

We have integrated data from our published audit of a major gynaecological oncology centre at Royal Hospital for Women in Australia, with data from our survey and a focus group discussion of Nepalese gynaecological health care professionals regarding genetic testing, and findings from the literature. These data have been used to identify current barriers to multidisciplinary gynaecological oncology care in developing nations, and to develop a model to integrate hereditary cancer services into cancer care in Nepal, as a paradigm for other developing nations.

Results

The ability to identify women with hereditary gynaecological cancer in developing nations is influenced by their late presentation (if active management is declined or not appropriate), limited access to specialised services and cultural and financial barriers. In order to include genetic assessment in multidisciplinary gynaecological cancer care, education needs to be provided to all levels of health care providers to enable reporting of family history, and appropriate ordering of investigations. Training of genetic counsellors is needed to assist in the interpretation of results and extending care to unaffected at-risk relatives. Novel approaches will be required to overcome geographic and financial barriers, including mainstreaming of genetic testing, telephone counselling, use of mouth swabs and utilisation of international laboratories.

Conclusion

Women in Nepal have yet to receive benefits from the advances in early cancer diagnosis and management. There is a potential of extending the benefits of hereditary cancer diagnosis in Nepal due to the rapid fall in the cost of genetic testing and the ability to collect DNA from a buccal swab through appropriate training of the gynaecological carers.

Sharing Histories-a transformative learning/teaching method to empower community health workers to support health behavior change of mothers

BACKGROUND

One of the keys to improving health globally is promoting mothers' adoption of healthy home practices for improved nutrition and illness prevention in the first 1000 days of life from conception. Customarily, mothers are taught health messages which, even if simplified, are hard to remember. The challenge is how to promote learning and behavior change of mothers more effectively in low-resource settings where access to health information is poor, educational levels are low, and traditional beliefs are strong.

METHODS

In addressing that challenge, a new learning/teaching method called "Sharing Histories" is in development to improve the performance of female community health workers (CHWs) in promoting mothers' behaviors for maternal, neonatal and child health (MNCH).

RESULTS

This method builds self-confidence and empowerment of CHWs in learning sessions that are built on guided sharing of their own memories of childbearing and child care. CHWs can later share histories with the mother, building her trust and empowerment to change. For professional primary health care staff who are not educators, Sharing Histories is simple to learn and use so that the method can be easily incorporated into government health systems and ongoing CHW programs.

CONCLUSIONS

I present here the Sharing Histories method, describe how it differs from other social and behavior change methods, and discuss selected literature from psychology, communications, and neuroscience that helps to explain how and why this method works as a transformative tool to engage, teach, transform, and empower CHWs to be more effective change agents with other mothers in their communities, thereby contributing to the attainment of the Sustainable Development Goals.