Health Literacy amongst Health Professional University Students: A Study Using the Health Literacy Questionnaire

A study on the effect of school and family environments and self-efficacy on health literacy of college students

Background

Health literacy is an important means to improve health outcomes and reduce health disparities. It plays an important role in promoting multiple health-related behaviors of individuals. Numerous studies have demonstrated a number of sociodemographic and school characteristics, and family related factors were related to health literacy among college students. However, these characteristics and factors were relatively unchangeable. Research on the relationship between factors, that can be intervened, and health literacy remains scarce. This study aims to explore the association between personal and changeable environmental factors, and the level of health literacy in college students.

Methods

A cross-sectional study, which used a stratified random sampling method, was conducted at a university in Wuhan (N = 447). The survey questionnaire included sociodemographic characteristics, the School Environment Questionnaire, the Family Environment Questionnaire, the General Self-Efficacy Scale Questionnaire, and the Health Literacy Questionnaire. We used Spearman correlation tests, and Student's tests or analyses of variance to describe the relationship among continuous variables. In addition, we employed linear regression analysis to test the mediating effect based on the bias-corrected nonparametric percentile Bootstrap method.

Results

Factors related to socioeconomic status, such as living costs (p = 0.011), residential area (p = 0.003), annual household income (p = 0.001), and parents' education level (fathers: p = 0.001; mothers: p = 0.01) and occupation type (fathers: p < 0.001; mothers: p = 0.044), had close correlations with health literacy. School and family environments and self-efficacy had a positive impact on college students' health literacy (β = 0.235, p < 0.001; β = 0.323, p < 0.001; β = 0.489, p < 0.001). Self-efficacy had a mediating effect on the relationship between school and family environments, as well as health literacy. The total, direct, and indirect effects of the school environment on health literacy were 0.235, 0.157, and 0.078, respectively. The total, direct, and indirect effects of the family environment on health literacy were 0.323, 0.189, and 0.134, respectively.

Conclusion

This study confirms that improving school and family environments could directly or indirectly increase college students' health literacy through promoting their self-efficacy. Socioeconomic status has a significant impact on their health literacy. Moreover, other factors that affect students' health literacy and relationships among self-efficacy, surrounding environments, and health literacy may need to be explored in the future.

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

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

Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire

ISSUE ADDRESSED

With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme.

METHODS

Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data.

RESULTS

Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system).

CONCLUSIONS

Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.

Health literacy profiles of final year pre-service teachers in two initial education programs compared with the general population: A cross-sectional study using the Health Literacy Questionnaire

ISSUE ADDRESSED

Health literacy (HL) can be developed throughout the lifespan starting from the early years highlighting that educational institutions, curriculum and teachers are powerful settings, places and people that can foster HL in youth. Current research shows that Australian teachers need more support to teach health education that promotes students' HL, with limited research focusing on pre-service teachers (PST). This study aims to identify the HL strengths and challenges of PST at one Australian university across two initial teacher education programs (HPE and primary) and compare their health literacy profiles with that of the Australian general population.

METHODS

The Health Literacy Questionnaire (HLQ) was administered in March and April, 2022 to measure HL in Australian PST. The research setting was a university in Sydney, Australia, with two of the University's undergraduate initial teacher education (ITE) programs (Health and Physical Education [HPE] and Primary). Of the 24 PST in the HPE cohort, 23 consented. Of the 70 PST in the Primary cohort, 34 consented. The results were compared with Australian Bureau of Statistics data.

RESULTS

The participants' median age was 22.3(4.3) years (SD), age ranged from 20 to 54 years, with 36% of participants under the age of 22 years. When comparing the PST data with the general population there were two significant differences: (1) PST scored significantly higher than the general population for Domain 4 (Social support for health, 3.41 vs. 3.19; p < 0.001; d = 0.57); and (2) the PST scored significantly lower for Domain 9 (Understand health information enough to know what to do, 4.02 vs. 4.27; p < 0.01; d = -0.43). In addition, we found that primary PST had significantly lower scores for domains 5-9 (demonstrative of interactive and critical HL), compared with the general Australian population.

CONCLUSIONS

Findings show that PST strengths are that they perceive that there they are able to access social support for health, however the PST find it more difficult to analyse and apply health information, compared with the general Australian population. SO WHAT?: Further understanding of health literacy profiles of Australian PST should influence the design of ITE programs and its health education curricular to ensure that PST are able to further develop their HL understandings and capabilities.

General, Vaccination, Navigational and Digital Health Literacy of Students Enrolled in Different Medical and Health Educational Programs

Evaluating prospective graduates' health literacy profiles before they enter the job market is crucial. Our research aimed to explore the health literacy levels of medical and health students by assessing their ability to obtain health-related information, understand healthcare systems, use e-health, and be informed about vaccination as well as to explore the factors associated with health literacy. Short versions of the HLS19-Q12 were used for a cross-sectional survey that was carried out among 1042 students enrolled in various medical and health educational programs at three medical universities in Kazakhstan between September and November of 2023. Additionally, instruments such as Digital Health Literacy (HLS19-DIGI), Navigational Health Literacy (HLS19-NAV), and Vaccination Health Literacy (HLS19-VAC) were employed. The score of General Health Literacy was 88.26 ± 17.5. One in eight students encountered difficulties in Vaccination Health Literacy. Despite overall high health literacy, Navigational Health Literacy posed challenges for all students. The Public Health students exhibited the highest General Health Literacy (91.53 ± 13.22), followed by students in Nursing, General Medicine, other educational programs (Dentistry and Biomedicine) and Pharmacy. Financial constraints for medication and medical examinations significantly influenced health literacy across all types of individuals. Since comprehensive health literacy instruction or interventions are still uncommon in the curricula, it seems reasonable to develop and incorporate appropriate courses for medical and health educational programs.

"The barriers are plentiful." Speech-language pathologists' perspectives of enablers and barriers to hearing assessment for children in metropolitan, regional, and rural Australia: A mixed methods study

PURPOSE

Access to hearing assessment is important for children, as poor auditory information can lead to poor speech and oral language development. This study aims to identify enablers and barriers to accessing hearing assessments for Australian children from the perspective of speech-language pathologists (SLPs), comparing access in metropolitan, regional, and rural areas.

METHOD

This is a sequential, explanatory mixed-methods study. Forty-nine participants completed the quantitative survey and 14 participated in semi-structured interviews. The study was undertaken online and included participants from metropolitan, regional, and rural parts of Australian states and territories.

RESULT

Similar accessibility issues were experienced across geographic locations and access to hearing assessment was related to the complexity of individual contexts. Speech-language pathologists felt that awareness and knowledge of hearing loss was low in parents and health professionals. Participants discussed barriers such as long wait times, complex criteria, and inefficient services that lead to compromised outcomes for clients.

CONCLUSION

Barriers to hearing assessment are extensive and multifaceted. Future research might examine the accessibility of the health system in light of the barriers discussed in this research, and whether policies and procedures could be adapted to allow more easily accessible services.

Cross-sectional survey of health literacy among health science students in Singapore

Background

Health literacy proficiency is essential for health care professionals to provide quality patient care. There is limited research exploring health literacy proficiency among undergraduate health science students.

Objectives

To determine health literacy among health science students in Singapore using the electronic Health Literacy Questionnaire (HLQ).

Design

A cross-sectional survey using purposive sampling was conducted among undergraduate health science students.

Methodology

This study hypothesises that health literacy is influenced by gender, and it increases with the level of health science education, attributed to the increased exposure to the health care system and health care education as undergraduates progress through the years of study. Eligible students from the 4-year entry-level programmes of diagnostic radiography, dietetics, occupational therapy, physiotherapy, radiation therapy and speech and language therapy, aged from 21 to 50, were invited. Exclusion criteria were students who were no longer studying due to dropping out or having immediately graduated from these programmes and students in the accelerated programmes whose studies would be completed in less than 4 years.

Results

In total, 111 respondents (72 females and 37 males) completed surveys (response rate, 7.7%) returned from physiotherapy (n = 69), occupational therapy (n = 25), diagnostic radiography (n = 12) and dietetics (n = 5), with nil from radiation therapy and speech and language therapy. All participants were English literate. Female participants demonstrated higher HLQ with a mean total score of 30.67 (standard deviation (SD) = 0.61) versus male participants 29.83 (SD = 0.53). Year 2, 3 and 4 students generally scored higher than Year 1 across all nine HLQ scales. Overall, dietetics students had the highest total score on the HLQ, while the diagnostic radiography students had the lowest scores for all the nine HLQ scales.

Conclusion

This study established the health literacy level of health science students in Singapore. Gender and years of study influenced health literacy levels, supporting the hypothesis.

Psychometric properties of the Health Literacy Knowledge and Experience Survey-2 for Turkish nursing students

Nursing students should be able to assess the health literacy levels of patients and enable patients to understand important health information. No scale has been developed to measure the health literacy knowledge and experience of Turkish nursing students. The Health Literacy Knowledge and Experience Survey-2 (HLKES-2) is a measurement tool with excellent psychometric properties that can be used to assess the health literacy knowledge and experience of nursing students. In this study, we aimed to determine the validity and reliability of the Turkish version of the Health Literacy Knowledge and Experience Survey-2 (HLKES-2-T) among Turkish nursing students. The study sample consisted of 510 undergraduate nursing students. The psychometric properties of the HLKES-2-T were analysed in terms of internal consistency, item-total score correlations, content validity, discriminant validity and known-group comparison. The HLKES-2-T total mean ± SD score was 11.69 ± 3.32. The Kuder-Richardson 20 coefficient of the knowledge subscale of the HLKES-2-T was 0.67, and its item-total score correlations ranged between 0.20 and 0.50. The Cronbach's alpha coefficient of the experience subscale of the HLKES-2-T was 0.73, and its item-total score correlations ranged between 0.75 and 0.78. The content validity index for the overall HLKES-2-T was 0.98. The HLKES-2-T is thus a reliable and valid tool that can be used to assess the health literacy knowledge and experience levels of Turkish nursing students.

Intention of health experts to counter health misinformation in social media: Effects of perceived threat to online users, correction efficacy, and self-affirmation

Our study analyzes the intention of Chinese health experts (health professionals and medical students) to correct health misinformation in social media. In an experimental 2 × 2 × 2 between-subjects factorial design (n = 415), we manipulated the experts' perception of the threat that health misinformation poses for online users, their self-efficacy with respect to correcting misinformation, and their self-affirmation. To select the potential influence factors, we draw on self-affirmation theory and the extended parallel process model. Results of our experiment revealed that correction intention increases if experts perceive the threat for online users as severe, believe that they are capable of countering the impact of misinformation, and have a high motivation to maintain a positive self-image of caring for others. We discuss the consequences of our findings for motivating experts to help reduce the adverse effects of health misinformation in social media.

The Promotion of Health Literacy

Abstract: Progress in predictive medicine has increased the challenges to navigating complex risk information for patients and healthcare professionals. This contribution investigates how people facing the risk of developing Alzheimer’s dementia perceive risk, what aspects are relevant to their health literacy, and how to promote individual health literacy in predictive medicine. We conducted a qualitative study analyzing narrative interviews, body maps, and sociodemographic data from persons who had undergone early predictive procedures in a memory clinic. We understand the promotion of health literacy as an ethical task in predictive medicine and argue for (1) emphasizing personal resources to promote subjective health literacy, (2) reframing communication and decision-making about disease risk, and (3) teaching skills for value-sensitive, individualized risk communication.

Health literacy status of pregnant women and women with young children in Tasmania

ISSUE ADDRESSED

The literature provides evidence that maternal health is strongly linked with noncommunicable diseases (NCDs) and their associated risk factors. Enabling women with the asset of health literacy may help to reduce the intergenerational impact of NCDs. However, little is known about the health literacy of pregnant women and women with young children in Tasmania and globally. This study aimed to identify the health literacy status of pregnant women and women with young children (0-8 years) living in Tasmania and describe their health literacy status according to their demographic characteristics.

METHODS

An online cross-sectional survey was undertaken. The survey included demographic questions and a health literacy questionnaire (HLQ). The description of demographic differences across the HLQ scales focused on effect sizes (ES) for standardised differences in mean health literacy scores. The differences found to be statistically significant at P < 0.05 were also included.

RESULTS

194 participants completed the survey with a mean age of 35.3 years. 73.2% were married, 16.5% were pregnant, 93% had one or more children and 81.5% were university educated. For the first five HLQ scales (score range 1-4), the lowest overall score was seen for the scale "Actively managing my health" (mean = 2.96; SD = 0.54). For the last four scales (score range 1-5), the lowest overall score was seen for the scale "Navigating the health care system" (mean = 3.75, SD = 0.67). Nonpregnant women, women with children, women with chronic health conditions and nonmarried women experienced more health literacy challenges.

CONCLUSION

Women in our study showed various strengths and challenges with mean scores varying across the nine HLQ scales. Understanding the health literacy needs of women will enable health services to co-design solutions and interventions capable of responding to the evolving health needs of pregnant women and women with young children. This approach will ensure that codesigned solutions can engage the end-user in healthy lifestyle practices and the solutions are sustainable. SO WHAT?: We must shift away from a "one size fits all" approach to tailor services to respond to the differing health literacy needs of pregnant women and women with young children to support healthy lifestyle practices and reduce the NCD burden.

Electronic health literacy and its association with lifestyle behavior among undergraduate students: A cross-sectional survey

Background

This study aims to assess healthy lifestyle behaviors among undergraduate students and determine the association between electronic health literacy with lifestyle behavior among undergraduate Jordanian university students.

Methods

A descriptive cross-sectional design was used. The study recruited 404 participants utilizing undergraduate students from public and private universities. The e-Health literacy scale was used to assess the level of health information literacy among university students.

Results

Data were collected from 404 participants who reported very good health status, the majority of the participants were female 57.2% with an average age of 19.3 years. The results showed that participants had good health behavior in terms of exercise, taking breakfast, smoking status, and sleeping status. The results have shown an inadequate level of e-Health literacy 16.61 (SD = 4.10) out of 40. The vast majority of students, in terms of their attitudes toward the Internet, thought that Internet health information was very useful/useful (95.8%). Also, they thought that online health information was very important /important (97.3%). The results showed that students who were attending public universities had higher e-Health literacy scores rather than those who were attending private universities, t (402) = 1.81, p = .014. The mean e-Health literacy score for nonmedical students was higher than those for medical students (p = .022).

Conclusion

The study's findings provide important insights into the health behaviors and electronic health literacy of undergraduate students in Jordanian universities, and offer valuable guidance for future health education programs and policies aimed at promoting healthy lifestyles in this population.

Factors Influencing Drug Use Information Received at Primary Healthcare Centre Pharmacies in Ghana

Background

Health literacy addresses environmental, political, and social factors that determine health. Drug dispensers play a major role in educating patients on drug use to increase effective and efficient drug utilisation, thereby promoting positive healthcare outcomes. From the patients' perspective, this study examined the communication quality between patients and drug dispensers at primary healthcare centres in the Cape Coast Metropolis of Ghana.

Method

We conveniently surveyed 269 patients seeking health care at primary healthcare facilities using a researcher-constructed 13-item instrument. In SPSS version 21 software, we analysed the data using percentages, chi-square analysis, and logistic regression.

Results

Almost half of the participants (n = 132) reported low health literacy, with 81% (n = 218) reporting that drug side effects were not discussed with them at the pharmacies. The findings further indicated that health literacy and educational level predicted general communication quality between participants and drug dispensers; participants with secondary education were about 3 times more likely to report not being told of the side effects of prescribed drugs as compared with those who had completed only basic education.

Conclusions

There is still a high level of low health literacy among patients seeking healthcare at primary healthcare centres and a very high percentage of patients did not receive any education on side effects of dispensed drugs. Drug use directives from dispensers at primary healthcare facilities can make a difference between any 2 patients.

Knowledge of Human Monkeypox and Its Relation to Conspiracy Beliefs among Students in Jordanian Health Schools: Filling the Knowledge Gap on Emerging Zoonotic Viruses

Background and Objective: The recent multi-country outbreak of human monkeypox (HMPX) in non-endemic regions poses an emerging public health concern. University students in health schools/faculties represent a core knowledgeable group that can be helpful to study from a public health point of view. As future healthcare workers, assessment of their knowledge and attitude towards emerging zoonotic viral infections can be helpful to assess their taught material and courses with potential improvement if gaps in knowledge were identified. Therefore, we aimed to evaluate the level of HMPX knowledge, conspiracy beliefs regarding emerging virus infections, as well as their associated determinants among university students studying Medicine, Nursing, Dentistry, Pharmacy, Medical Laboratory Sciences, and Rehabilitation in Jordanian health schools/faculties. In addition, we sought to evaluate the correlation between HMPX knowledge and the extent of holding conspiracy beliefs regarding emerging viral infection. Materials and Methods: A convenient sample of university students was obtained through an electronic survey distributed in late May 2022 using the chain-referral approach. Assessment of HMPX knowledge and general attitude towards emerging virus infections was based on survey items adopted from previously published literature. Results: The study sample comprised 615 students with a mean age of 20 years and a majority of females (432, 70.2%) and medical students (n = 351, 57.1%). Out of eleven monkeypox knowledge items, three were identified correctly by >70% of the respondents. Only 26.2% of the respondents (n = 161) knew that vaccination to prevent monkeypox is available. Age was significantly associated with better HMPX knowledge for a majority of items. Older age, females, and affiliation to non-medical schools/faculties were associated with harboring higher levels of conspiracy beliefs regarding emerging virus infections. Our data also indicate that lower levels of HMPX knowledge were associated with higher levels of conspiracy beliefs. Conclusion: The current study pointed to generally unsatisfactory levels of knowledge regarding the emerging HMPX among university students in Jordanian health schools/faculties. Conspiracy beliefs regarding emerging virus infections were widely prevalent, and its potential detrimental impact on health behavior should be evaluated in future studies.

Measurement Properties of the Health Literacy Questionnaire in the Understanding Multiple Sclerosis Massive Open Online Course Cohort: A Rasch Analysis

BACKGROUND

Online health education and other electronic health improvement strategies are developing rapidly, highlighting the growing need for valid scales to assess health literacy (HL). One comprehensive HL scale is the Health Literacy Questionnaire (HLQ), but little is known about its measurement properties in online health education cohorts.

OBJECTIVE

The purpose of this study was to determine if the multidimensional HLQ is an appropriate tool to measure HL in a cohort of Understanding Multiple Sclerosis (MS) online course enrollees.

METHODS

Participants who enrolled in the first two open enrollments of the Understanding MS online course completed the HLQ (N = 1,182) in an online survey prior to beginning course materials. We used Rasch analysis to assess the measurement properties of the HLQ.

KEY RESULTS

The nine Domains of the HLQ each had ordered category function and a good fit with the Rasch model. Each domain was one-dimensional and exhibited good internal consistency and reliability. None of the 44 individual items of the HLQ demonstrated item bias or local dependency. However, while the overall fit was good, few measurement gaps were identified in this cohort for participants in each of the nine Domains, meaning that the HLQ may have low measurement precision in some participants.

CONCLUSION

Our analysis of the HLQ indicated acceptable measurement properties in a cohort of Understanding MS online course enrollees. Although reliable information on nine separate constructs of HL was obtainable in the current study indicating that the HLQ can be used in similar cohorts, its limitations must be also considered. [HLRP: Health Literacy Research and Practice. 2022;6(3):e200-e212.] Plain Language Summary: In this study, we have shown that the HLQ is suitable for measuring HL in an online public health educational platforms for chronic diseases including multiple sclerosis. This finding adds to the evidence that the HLQ can be widely used in measuring HL in different settings, populations, and health educational platforms.

The relationship between e-health literacy and health-promoting behaviors of Turkish hospital nurses

The increase in information technologies has made it easy to access much health information online. In this context, e-health literacy emerges as a skill for acquiring health information. Obtaining health information through information technology for health promotion requires e-health literacy. The aim of this study was to examine the e-health literacy and the health-promoting behaviors of Turkish hospital nurses directly involved in patient care. This descriptive and cross-sectional study was carried out with 451 nurses working in two large training and research hospitals in Izmir between June and August 2019. Data were collected using the Turkish version of the Healthy Lifestyle Behavior Scale II and the Turkish version of the e-Health Literacy Scale. Descriptive statistics and multiple linear regression analysis were used for data analysis. Nurses were found to have moderate levels of healthy lifestyle behaviors (130.56 ± 21.90) and e-health literacy (29.87 ± 5.39). There was significant relationship between the e-health literacy levels of the nurses and their overall health-promoting behaviors (R = .349; F = 12,381; p = 0.013), health responsibility (R = .326; F = 10,567; p = 0.014), spiritual development (R = .242; F = 5.276; p = 0.001) and interpersonal relations (R = .343; F = 9.896; p = 0.001) scores. The results of this study showed that the development of strategies to improve the e-health literacy of nurses may contribute to the maintenance of health-promoting behaviors of both nurses and their patients.

eHealth usage among Chinese college students: qualitative findings

BACKGROUND

The information technology has developed rapidly with the evolution of internet environment transformed from requiring computer skills for information searching to self-managing health data and applying information. Therefore, a more diverse range of eHealth skills is required and these skills are referred as eHealth literacy. However, most eHealth literacy studies focused mainly on information searching skills. Little is known about eHealth usage behaviors of college students in this day and age.

OBJECTIVES

This study aimed to investigate how Chinese college students engage with eHealth tools and to determine the elements of their eHealth literacy.

METHODS

A purposive sample of 18 Chinese college students was recruited for in-depth interviews. Interviewees included three males and three females of each city (Beijing, Wuhan and Putian) from sports, medical, and non-health-related majors. Conventional content analysis was applied for data analysis.

RESULTS

The eHealth usage of different-major-students were compared and profiled by three themes of Expectance, Usage pattern and Perception. In Expectances, non-health major students applied eHealth only for urgent health need, sport major students used it to monitor health while medical major students, as frequent users for searching health database. In Usage pattern, purposes of eHealth for personal, practical and theoretical were identified for non-health major, sport major and medical major groups, respectively. In Perceptions, sport students felt more curious about eHealth than the other groups who perceived either fear (non-health students) or skeptical (medical students). By compiling those themes, the whole picture of eHealth usage was emerged. Based on that, the current study identified the related skills using the trilogy of Web 1.0 to 3.0, and derived a conceptual framework for eHealth literacy in the present day.

CONCLUSIONS

The current study obtained a comprehensive understanding of eHealth usage and a framework of eHealth literacy required for Chinese college students. And it gives a clearer look at web 3.0 related eHealth behaviors.

Health Literacy Profiles of Early Intervention Providers: Use of the Health Literacy Questionnaire

BACKGROUND

Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices.

OBJECTIVE

This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables.

METHODS

A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level.

KEY RESULTS

Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 "Appraisal of health information" (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 "Navigating the healthcare system" (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience.

CONCLUSIONS

EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128-e136.] Plain Language Summary: EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.

Assessment of information literacy skills and knowledge-based competencies in using electronic resources among medical students

Purpose

This paper aims to focus on the information literacy skills and how the resources are being used by medical students of Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. The main aim is to determine the medical students use, purpose, search strategies and sources through which aware and literacy skills acquired. Further, this paper aims to bring out the problems faced.

Design/methodology/approach

A survey method was conducted through a structured questionnaire distributed among 120 medical students from first year to fourth year. Stratified random sampling was used for selection of students.

Findings

Findings of the study revealed that medical students largely used medical databases such as Bentham Sciences, ProQuest, PubMed and MedlinePlus. Further, the paper reveals that majority used health information for updating their knowledge and to acquire general information. The students’ information literacy level found minimal, which may be the reason majority of the students found difficulty in locating the desired materials followed by irrelevant information, inadequate e-resources and lack of awareness reported some extent.

Originality/value

The recommendations made based on the study are expected to be beneficial to the authorities and library administration of the surveyed institution to take appropriate measures for effective utilization of resources.

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.

Future Problem-Solving Practiced During COVID-19: Implications for Health Management Students' E-Health Literacy Identity

The current study describes the implementation of an online Future Problem Solving (FPS) program in the field of Health education and set out to explore its contribution to students' eHealth Literacy identity, by using two levels of teacher guidance: minimal vs. frequent. FPS was employed in two groups of Health students. In the research group, frequent weekly guidance was provided to the students centered on the enhancement of eHealth Literacy skills, whereas in the control group minimal guidance was offered by the lecturer. Data for the analysis were gathered from 113 Israeli undergraduate students of a Management of Health Service Organizations program, of whom 62 comprised the research group. Data were gathered twice, pre- and post-program implementation from both groups. Findings showed significant differences between the tests only for the research group, with increased levels of eHealth Literacy skills detected between the tests. The perception of the FPS program as meaningful contributed to students' perceived eHealth Literacy skills only in the research group whereas non-significant results were shown for the control group. This study mainly shows that the enhancement of skills in online educational environments requires frequent and personalized guidance. Faculty must recognize the role of the instructor as a facilitator of learning and design successful scaffolding strategies to nurture students' lifelong learning skills during distance learning.

Health Literacy Among University Students: A Systematic Review of Cross-Sectional Studies

OBJECTIVE

The aim of this systematic review was to provide an overview of cross-sectional studies that examined health literacy among university students and to identify possible determinants related to health literacy.

METHOD

The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three databases (PubMed, Scopus, and Web of Science) were systematically searched for cross-sectional studies that examined health literacy among university students. Results of included studies were narratively summarized.

RESULTS

The systematic review includes twenty-one research studies. The majority of studies report health literacy scores among university students that are lower compared to reference samples. The health literacy of students is influenced by different variables (age, gender, number of semesters, course of studies/curriculum, parental education, and socioeconomic background).

DISCUSSION

Health literacy activities should target all students. Universities should make use of their resources and offer health literacy courses for students in which content is used from disciplines available at the university (e.g., medicine, health, or psychology). To increase effectiveness, health literacy courses should be adapted according to the different needs and characteristics of the student subgroups.

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.

Generalized Anxiety among Swiss Health Professions and Non-Health Professions Students: An Open Cohort Study over 14 Months in the COVID-19 Pandemic

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4–20.7) in HP students and 24.4% (95% CI = 22.3–26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3–29.5) and 36.9% (95% CI = 32.9–40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.

Determining mental health literacy of undergraduate nursing students to inform learning and teaching strategies

There is limited research on mental health literacy among undergraduate nursing students in Australia. Overseas studies indicate significant gaps in students' knowledge and practice. The aims of this study were to (1) assess mental health literacy knowledge in undergraduate nursing students and compare these across year levels, and to (2) identify students' learning needs about mental health literacy in practice. A convenience sample of 114 Bachelor of Nursing students studying at one Australian University completed the online survey. Results showed that third-year students reported higher levels of mental health literacy compared to first- and second-year students. Almost 40% of students felt they did not have sufficient understanding of mental health literacy for practice. Most respondents (66.7%) wanted more information on different types of mental illnesses, treatments, how to reduce mental health stigma, and how to care for and communicate with people with mental illness. Students identified that mental health first aid training should be compulsory for all nursing students. Mental health literacy is a crucial area to be addressed in undergraduate nursing education. Explicit content and skill development are required to improve students' awareness of health literacy and inform their practice.

Validity arguments for patient-reported outcomes: justifying the intended interpretation and use of data

BACKGROUND

Contrary to common usage in the health sciences, the term "valid" refers not to the properties of a measurement instrument but to the extent to which data-derived inferences are appropriate, meaningful, and useful for intended decision making. The aim of this study was to determine how validity testing theory (the Standards for Educational and Psychological Testing) and methodology (Kane's argument-based approach to validation) from education and psychology can be applied to validation practices for patient-reported outcomes that are measured by instruments that assess theoretical constructs in health.

METHODS

The Health Literacy Questionnaire (HLQ) was used as an example of a theory-based self-report assessment for the purposes of this study. Kane's five inferences (scoring, generalisation, extrapolation, theory-based interpretation, and implications) for theoretical constructs were applied to the general interpretive argument for the HLQ. Existing validity evidence for the HLQ was identified and collated (as per the Standards recommendation) through a literature review and mapped to the five inferences. Evaluation of the evidence was not within the scope of this study.

RESULTS

The general HLQ interpretive argument was built to demonstrate Kane's five inferences (and associated warrants and assumptions) for theoretical constructs, and which connect raw data to the intended interpretation and use of the data. The literature review identified 11 HLQ articles from which 57 sources of validity evidence were extracted and mapped to the general interpretive argument.

CONCLUSIONS

Kane's five inferences and associated warrants and assumptions were demonstrated in relation to the HLQ. However, the process developed in this study is likely to be suitable for validation planning for other measurement instruments. Systematic and transparent validation planning and the generation (or, as in this study, collation) of relevant validity evidence supports developers and users of PRO instruments to determine the extent to which inferences about data are appropriate, meaningful and useful (i.e., valid) for intended decisions about the health and care of individuals, groups and populations.

The health literacy of university students in North Cyprus

Health literacy is individuals' motivation and ability to obtain, understand, evaluate and use health information. Health literacy is very important during university education when students have the ability to acquire and accumulate knowledge of the best way. The aim of this study was to determine the health literacy of university students. The sample of this descriptive cross-sectional study was composed of 365 students who were first-time visitors at the health center of a private university in Northern Cyprus between May and July 2017. An introductory information form and the Adult Health Literacy Scale (AHLS) were used as data collection tools. The mean AHLS score of the students was found as 13.91 ± 2.90. Health literacy was found to be lower for male students and students with more years of study. The students with low daily alcohol use had higher AHLS scores. The results of the study suggest that curricula should be revised to raise the health literacy of university students to the highest level. It is important to organize conferences, seminars and scientific activities to improving the health literacy of male students and students with more years of study. Due to the limitations of studies of health literacy in North Cyprus, future studies should be conducted with larger samples and different measurement tools.

Effectiveness of health literacy education for nursing students: A randomized controlled trial

AIM

The aim of this study was to determine the effect of health literacy education given to nursing students on health literacy level.

BACKGROUND

Health literacy has become an important issue in the field of health. Health literacy is an issue of interest to health professionals as well as individuals.

METHODS

The study was conducted as a randomized controlled trial. A total of 206 nursing students, 103 in the intervention and 103 in the control group, were included in the study. The intervention group received four weekly training sessions of health literacy education. The research was registered at ClinicalTrials.gov with the registration number NCT04868487.

RESULTS

On the baseline assessment, there were no statistically significant differences between the intervention and control group in terms of health literacy level (p > 0.05). In the 1st- week and 12th-week measurements, the health literacy level of the intervention group was significantly higher than control group (p < 0.05).

CONCLUSION

Health literacy education was effective in increasing the health literacy level of the students. Therefore, the concept of health literacy should be added to the nursing education curriculum.

Functional Health Literacy in Patients with Cardiovascular Diseases: Cross-Sectional Study in Ethiopia

OBJECTIVE

This study assessed functional health literacy and associated factors among adult patients with cardiovascular diseases (CVDs) in Ethiopia.

METHODS

A cross-sectional study was conducted on 410 respondents from May 1 to July 1, 2020, using a functional health literacy questionnaire consisting of 14 items that covers three conceptually distinct functional health literacy domains: having sufficient information to manage my health, ability to find good health information and understand health information well enough to know what to do. Data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 23. Data were collected by exit face-to-face interview using an interviewer administered and pre-tested questionnaire. Statistical significance of associated variables had been declared based on the adjusted odds ratio (AOR) with its 95% CI and p-value <0.05.

RESULTS

Adequate functional health literacy was determined in 55.4% of CVD patients understanding health information whereas inadequate functional health literacy was determined in 53.9% participants for finding health information and in 50.5% of them having sufficient information to manage my health. Educational status was found to have a statistically significant association across the three domains.

CONCLUSION

The functional health literacy level of CVD patients varied by domain. Educational status of the participant is significantly associated with the three domains of functional health literacy whereas household monthly income and number of information sources are significantly associated with having sufficient information and the ability to find good health information. The findings indicate the need to streamline medical communication that improves the functional health literacy of CVD patients.

What Do Young Adults Think about the Safety of Over-the-Counter Analgesics? Findings from a Cross-Sectional Survey

Analgesics are commonly used over-the-counter (OTC) medicines readily available for purchase, sometimes without advice of a health professional. However, analgesics can cause harm even when taken according to dosing recommendations. Young adults may be more vulnerable to harm if they perceive low risk with OTC analgesic use, or struggle to interpret dosing instructions. This study aimed to explore factors affecting how young adults use OTC analgesics and associated perceptions of safety. An online survey was distributed to school-leavers and university students (17 to 25 years), in South-East Queensland, Australia, in the period November-December 2019. Most of the 302 respondents (school-leavers n = 147, university students n = 155) did not use analgesics frequently. School-leavers deferred to parents for analgesic information, while university students preferred the internet. The majority of respondents appeared safety conscious and did not take outside indicated use or instructions. However, a small proportion reported taking analgesics for an inappropriate indication. The difference in preferred source of analgesic information may reflect experience with analgesic use, increasing autonomy or decreased parental influence. Whilst it is encouraging that the majority of young adults appeared safety conscious, greater insight is needed into factors influencing decision making on OTC use, e.g., medicines knowledge, and changes with increasing age.

Stress, adversity quotient, and health behaviors of undergraduate students in a Thai university during COVID-19 outbreak

Background

University students are an essential human resource for national development. Thus, it is important to study the stress, adversity quotient, and health behaviors of these students during the COVID-19 pandemic.

Objective

This study aimed to identify stress, adversity quotient, and health behaviors and examine the relationship between these factors in undergraduate students during the COVID-19 outbreak.

Methods

The current study was a quantitative study with a cross-sectional design conducted from 27 November to 10 December 2020. A total of 416 undergraduate students in a Thai university were selected using a convenience sampling technique. A questionnaire was used to collect the data on stress, adversity quotient, and health behaviors of undergraduate students during the COVID-19 outbreak. Data were analyzed using mean, standard deviation, and Pearson's Product Moment Correlation Coefficient.

Results

This study indicated that stress was at a high level (3.54 ± .53; Mean ± SD), adversity quotient was at a high level (3.77 ± .63; Mean ± SD), and health behaviors were at a moderate level (3.06 ± .53; Mean ± SD). The current study also found that stress and adversity quotient were irrelevant. Stress and health behaviors were negatively correlated with a level of significance of .01 (r = -.31), and adversity quotient and health behaviors were positively correlated with a level of significance of .01 (r = .051).

Conclusion

It is suggested that healthcare providers, families, and professors should consider stress and adversity quotient in developing interventions to promote healthy behaviors in terms of physical and psychological factors in university students.

Training physiotherapists to be responsive to their clients' health literacy needs

Objective: To evaluate health literacy learning modules designed specifically for physiotherapists in private practice.Methods: Mixed-method design was used, evaluating pre-post physiotherapist health literacy knowledge and competencies using questionnaires and semi-structured interviews. One rural and one metropolitan private physiotherapy practice were recruited.Participants: Clients, physiotherapists, and other clinic staff. The OPHELIA (Optimizing Health Literacy and Access) process was applied to identify the health literacy needs of clients; co-design interventions; and implement and evaluate the interventions. The health literacy learning modules were co-designed with the physiotherapists and included one 3-h face-to-face workshop, followed by two 1-h videoconference workshops. Health literacy knowledge (rated 1-5 for 10 items, max score 50) and skills (rated 1-5 for 5 items, max score 25) were assessed before and after the workshops. Data were analyzed by paired t-test. Interviews were recorded, transcribed, and thematically analyzed.Results: Health literacy knowledge of 19 health professionals improved after the workshop by 63% (pre 26.0 (7.5), post 41.0 (2.7), p < .001). Health literacy skills improved by 65% (pre 4.2 (3.3), post 21.8 (2.3), p < .001). We identified three themes from interview data: 1) 'the multi-faceted nature of health literacy requires multiple strategies'; 2) 'changing practice to promote understanding'; and 3) 'reflection on roles of multidisciplinary private practice.'Practice Implications: Improvements in health literacy knowledge and skills are possible through post-graduate professional development.Conclusion: Workshops changed physiotherapists' understanding of their role in promoting health literacy.

The effect of undergraduate nursing students' e-Health literacy on healthy lifestyle behaviour

e-Health literacy has become more important in promoting healthy lifestyles in recent years. The purpose of this study was to determine the effect of undergraduate nursing students' e-Health literacy on healthy lifestyle behaviours. This cross-sectional study was conducted during the 2016-2017 academic year at a Nursing Department in the Faculty of Health Sciences in Istanbul. The study population consisted of 232 undergraduate nursing students. The study sample was 205 students who volunteered to participate in the research. The data were collected using the Structured Questionnaire Form, the e-Health Literacy Scale in Adolescent and the Adolescent Lifestyle Profile Scale. The mean score of the e-Health Literacy Scale in Adolescent was 29.50 ± 5.02. The mean total score of the Adolescent Lifestyle Profile was 112.11 ± 14.66. There was a positive correlation between students' Internet attitudes and general health-promoting lifestyle (r = 0.273; p < 0.01), indicating the higher the students' e-Health literacy, the higher their levels of healthy lifestyle behaviours. The result showed that e-Health literacy is an important parameter in promoting healthy lifestyle behaviours of nursing students.

Translation method is validity evidence for construct equivalence: analysis of secondary data routinely collected during translations of the Health Literacy Questionnaire (HLQ)

BACKGROUND

Cross-cultural research with patient-reported outcomes measures (PROMs) assumes that the PROM in the target language will measure the same construct in the same way as the PROM in the source language. Yet translation methods are rarely used to qualitatively maximise construct equivalence or to describe the intents of each item to support common understanding within translation teams. This study aimed to systematically investigate the utility of the Translation Integrity Procedure (TIP), in particular the use of item intent descriptions, to maximise construct equivalence during the translation process, and to demonstrate how documented data from the TIP contributes evidence to a validity argument for construct equivalence between translated and source language PROMs.

METHODS

Analysis of secondary data was conducted on routinely collected data in TIP Management Grids of translations (n = 9) of the Health Literacy Questionnaire (HLQ) that took place between August 2014 and August 2015: Arabic, Czech, French (Canada), French (France), Hindi, Indonesian, Slovak, Somali and Spanish (Argentina). Two researchers initially independently deductively coded the data to nine common types of translation errors. Round two of coding included an identified 10th code. Coded data were compared for discrepancies, and checked when needed with a third researcher for final code allocation.

RESULTS

Across the nine translations, 259 changes were made to provisional forward translations and were coded into 10 types of errors. Most frequently coded errors were Complex word or phrase (n = 99), Semantic (n = 54) and Grammar (n = 27). Errors coded least frequently were Cultural errors (n = 7) and Printed errors (n = 5).

CONCLUSIONS

To advance PROM validation practice, this study investigated a documented translation method that includes the careful specification of descriptions of item intents. Assumptions that translated PROMs have construct equivalence between linguistic contexts can be incorrect due to errors in translation. Of particular concern was the use of high level complex words by translators, which, if undetected, could cause flawed interpretation of data from people with low literacy. Item intent descriptions can support translations to maximise construct equivalence, and documented translation data can contribute evidence to justify score interpretation and use of translated PROMS in new linguistic contexts.

Using the Health Literacy Questionnaire (HLQ) with Providers in the Early Intervention Setting: A Qualitative Validity Testing Study

More than one in four parents in the United States of America (USA) have low health literacy, which is associated with reduced health equity and negatively impacts child health outcomes. Early intervention (EI) programs are optimally placed to build the health literacy capacity of caregivers, which could improve health equity. The health literacy of interdisciplinary EI providers has not previously been measured. This study used the Health Literacy Questionnaire (HLQ) with EI providers (n = 10) to investigate evidence based on response (cognitive) processes. Narratives from cognitive interviews gave reasons for HLQ score choices, and concordance and discordance between HLQ item intent descriptions and narrative data were assessed using thematic analysis. Results found scales with highest concordance for Scales 3, 6, and 9 (each 96%, n = 24). Concordance was lowest on Scale 5 (88%, n = 22), although still strong with only 12% discordance. Three themes reflecting discordance were identified: (1) Differences between Australian and USA culture/health systems; (2) Healthcare provider perspective; and (3) Participants with no health problems to manage. Results show strong concordance between EI providers’ narrative responses and item intents. Study results contribute validity evidence for the use of HLQ data to inform interventions that build health literacy capacity of EI providers to then empower and build the health literacy of EI parents.

The Association between Health Literacy and Self-Rated Health Amongst Australian University Students

Health literacy is the capacity to understand, access, and effectively utilize health information and healthcare to make informed health decisions. This cross-sectional study uses the multi-dimensional Health Literacy Questionnaire (HLQ) to investigate associations between demographic characteristics, self-rated health and health literacy among students (n = 932) in two Australian universities. We used Pearson's chi-square to determine differences in self-rated health between demographic groups, Cohen's defect Sizeto measure differences in HLQ scale scores between demographic groups, and logistic regression to determine associations between HLQ scores and self-rated health. A clear association was found between self-rated health and health literacy: as health literacy increased, so did self-rated health. Findings also demonstrate lower health literacy for culturally and linguistically diverse students, and those studying Arts compared to Health degrees. Lower self-rated health was correlated with HLQ scales including being less active in managing one's own health, having less social support for one's health, possessing insufficient health information and lower confidence in navigating the healthcare system. This study provides a comprehensive picture of potentially vulnerable students and identifies strategies for supporting their health endeavors while studying at university.

Factors influencing eHealth literacy among Korean nursing students: A cross-sectional study

Successful online learning depends on the supported learner's attitude, motivation, and self-efficacy, along with their ability to use the flexibility and convenience of digital technology. As information and communications technology is introduced in healthcare, eHealth literacy (eHL) is becoming increasingly essential in nursing education. This study aimed to identify the eHL levels and the factors affecting eHL among nursing students. A survey was conducted among 205 nursing students from two colleges in Korea. The collected data were analyzed using descriptive statistics, and the factors associated with the eHL of nursing students were examined using multiple regression analysis. The eHL of nursing students, measured using the eHealth literacy scale, was found to be higher than in previous studies. Factors affecting eHL of nursing students were academic level, digital literacy toward information and communications technology for learning, and self-efficacy for online education. These factors accounted for 38.8% of the variability in eHL among nursing students. In order to improve the eHL of nursing students, nursing education should consider a multidimensional approach toward developing digital literacy and self-efficacy among them.

Health literacy in Indigenous people with chronic disease living in remote Australia

Background

Health literacy is strongly associated with health outcomes and is important for health policy and service delivery. Low health literacy was reported in 59% of Australian adults, however, there is no national data on the health literacy of Aboriginal and Torres Strait Islander (ATSI) peoples. The ATSI population in Australia experience a notable gap in health outcomes compared with non-Indigenous Australians which is due, in part to a higher prevalence of chronic diseases. The health outcome gap is more pronounced in rural and remote locations. This study aims to establish the health literacy profile of ATSI adults with chronic disease living in remote North-West Queensland Australia, and to investigate associations between the Health Literacy Questionnaire (HLQ) domains and self-reported chronic disease and demographic characteristics.

Methods

Using a cross-sectional design, 200 ATSI adults with a diagnosis of chronic disease/s (cardiovascular disease, diabetes, respiratory disease and/or chronic kidney disease) were recruited from two sites with the assistance of Aboriginal Health Workers. Data were collected using the HLQ, a multidimensional 44 item instrument to assess nine domains of health literacy. Demographic and health data were also collected. Analysis of variance using backwards modelling was used to determine predictors of health literacy.

Results

Participants were mostly male (53.5%) and aged between 19 and 89 years. The most prevalent chronic disease was cardiovascular disease (74%) followed by diabetes (67.5%). More than half (62%) had two or more chronic diseases. There was at least one independent predicator for each of the nine health literacy domains. Age, number of chronic diseases, gender, and level of education were all highly significant predictors of health literacy.

Conclusion

Improved health literacy will enable individuals to take an active role in their health. Understanding the health literacy of ATSI adults is a crucial first step. Our findings can assist Australian healthcare organisations to review their health literacy responsiveness and examine ways to improve patients’ needs and health capabilities to better support people to engage in effective self-management for chronic diseases.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4335-3) contains supplementary material, which is available to authorized users.

Health literacy of nursing students and its effective factors

BACKGROUND

The insufficiency of health literacy negatively affects the national economy as it leads to increased health service expenditure. It is very important for individuals to have accurate health-related information to reduce these negative effects.

AIM

The aim of the study is to examine the health literacy of nursing students and its effective factors.

METHODS

This descriptive study was carried out with students from the nursing department of a vocational school of health sciences between September and October 2018 in Turkey. A semi-structured questionnaire regarding the descriptive features of the participants and the European Health Literacy Scale were used for data collection.

RESULTS

The study included 283 nursing students; 29.3% had a problematic-limited health literacy level. The study found a statically significant difference between student year, high school graduation and family's income level and the total mean score of the HLS-EU scale.

CONCLUSION

The subject of health literacy should be integrated into the educational program of nursing students. The nurses are the most important workforce in health services, and awareness about this subject should be raised.

The HLKES-2: Revision and Evaluation of the Health Literacy Knowledge and Experiences Survey

BACKGROUND

Low health literacy impacts individual health and the health care system. The Health Literacy Knowledge and Experience Survey (HLKES) was created to evaluate preparedness of nurses to provide health literate care. However, the instrument was developed a decade ago and needs revision. The purpose of this study was to update and shorten the HLKES into a feasible, valid, and reliable instrument.

METHOD

The HLKES was refined into a 14-item instrument (10 knowledge questions and four experience questions). Expert review was obtained. Face validity was assessed, and pilot and field testing with students was conducted.

RESULTS

Scale content validity index was 0.95, and individual questions demonstrated appropriate item difficulty and discrimination. Cronbach's alpha coefficient was .565 for the 10 multiple choice questions and .843 for the four Likert-type questions, indicating good reliability.

CONCLUSION

A reliable and valid HLKES-2 was developed to evaluate health literacy knowledge and experiences in a contemporary setting. [J Nurs Educ. 2019;58(2):86-92.].

Health literacy in a population-based sample of Australian women: a cross-sectional profile of the Geelong Osteoporosis Study

Background

The term health literacy refers to the abilities and resources required to find, understand and use health information in managing health. This definition is reflected in the recent development of multidimensional health literacy tools that measure multiple facets of health literacy. The aim of this study was to determine the health literacy profile of a randomly selected, population-based sample of Australian women using a multidimensional tool, the Health Literacy Questionnaire (HLQ). A second aim was to investigate associations between independent HLQ scales, sociodemographic characteristics and lifestyle and anthropometric risk factors for chronic disease.

Methods

We surveyed women involved in the Geelong Osteoporosis Study (GOS), a longitudinal, population-based study. We included demographic data, lifestyle information and anthropometric measures as well as the HLQ. The HLQ has 44 items, scored on either 4- or 5-point scales, within nine conceptually distinct scales. Means for each scale were calculated, and HLQ scales were regressed on educational level and socioeconomic status. Risk factors for chronic disease were investigated using analysis of variance (ANOVA) and calculation of effect sizes.

Results

Higher mean scores were seen for the scales ‘Feeling understood and supported by healthcare professionals’ (mean 3.20, ± SD 0.52) and ‘Understanding health information well enough to know what to do’ (mean 4.28, ±SD 0.54), and lower mean scores were seen for ‘Appraisal of health information’ (mean 2.81, ±SD 0.48) and ‘Navigating the healthcare system’ (mean 4.09, ± SD 0.57). Associations were also seen between lower HLQ scores and poor health behaviours including smoking and being more sedentary, in addition to greater body mass index and waist circumference. Positive gradients were seen between several HLQ scales and education level, as well as SES. For some HLQ scales, these associations were non-linear.

Conclusions

The profile of this population-based cohort of women demonstrated associations between low health literacy and low SES, lower levels of education, increasing age, and anthropometric and lifestyle risk factors for chronic disease. These findings suggest implications of health literacy for health policy makers focusing on improving lifestyle prevention of chronic disease and promoting health equity at a population level.