Health Literacy Studies Conducted in Australia: A Scoping Review

Older rural women's pre-visit planning and involvement in South Australian general practices: A candidacy theory perspective

OBJECTIVE

To explain older rural women's participation in clinical decision-making with GPs and explore factors associated with their pre-visit planning and involvement in treatment processes.

METHODS

A sequential, theory-driven mixed-method study was conducted. Women aged 65 years or above who had visited a GP three months prior were recruited from five rural towns in South Australia through the local Rotary Club. Data collection utilised an 18-item scale and a semi-structured interview guide. Quantitative data were analysed using chi-square tests and multinomial logit models, whereas qualitative data were coded into themes. As applied in the discussion, the candidacy theory provided a framework for further adding meaning to the results.

RESULTS

Seventy-one older rural women completed surveys. Across the domains, including health knowledge, GP visit preparation, participation in discussion, and attitudes towards shared decision-making, most items indicated a moderate level of women's health knowledge and involvement in GP treatments. Multivariate analysis revealed having less than a basic education, not speaking English at home, and being in the youngest-old age group (65-74 years) were positively associated with low levels of pre-visit planning and involvement in GP treatments. Analysis of interviews with 21 women identified three themes: capacity for health planning and preparedness, communication styles and preferences, and accessibility and continuity of care.

CONCLUSION

The findings of this study underscore the urgent need for redesigning GP services. By considering the intersection between behavioural and clinical aspects of older rural women's pre-visit planning and involvement in GP treatment processes in rural South Australia, we can inspire positive change in healthcare delivery.

PRACTICE IMPLICATIONS

Practice Implications: our study provides actionable insights on how and where to intervene to enhance older rural women's capacity to engage in pre-visit planning for successful GP consultations. This knowledge can empower healthcare professionals and policymakers to implement effective strategies.

Health literacy after traumatic brain injury: characterisation and control comparison

Background Little is known about health literacy in traumatic brain injury (TBI) survivors. The aims of this study were to compare health literacy in individuals with TBI with that of a control group; to examine the association between health literacy in individuals with TBI and demographic, injury, and cognitive factors; and compare the relationship between health literacy and physical and mental health outcomes. Methods A cross-sectional observational study design was used. Adults (≥18years) were recruited from an outpatient research centre in Victoria, Australia. There were 209 participants with a complicated mild to severe TBI at least 1year previously (up to 30years 6months) and 206 control participants. Results Individuals with TBI did not have poorer health literacy than controls (IRR=1.31, P =0.102, CI95% [0.947, 1.812]). Further analysis could not be completed due to the highly skewed Health Literacy Assessment Using Talking Touchscreen Technology - Short Form (Health LiTT-SF) data. Conclusion Health literacy performance in individuals with TBI was not significantly different to controls. Premorbid education may provide a critical cognitive reserve upon which TBI survivors can draw to aid their health literacy. These findings are specific to the Health LiTT-SF measure only and require replication using more comprehensive health literacy measures in culturally diverse samples.

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

PURPOSE

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

DESIGN

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

SETTING

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

SUBJECTS

422 healthcare professionals.

MEASURES

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

ANALYSIS

Linear regression, SPSS version 25.

RESULTS

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

CONCLUSION

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

Understanding health literacy in men: a cross-sectional survey

BACKGROUND

Males have a shorter life expectancy than females. Men are less likely to seek the advice of a health professional or utilise preventive health services and programs. This study seeks to explore health literacy and the characteristics affecting this among Australian men.

METHODS

Four hundred and thirty-one adult males engaged with the New South Wales Rural Fire Service, completed an online cross-sectional survey, undertaken from September - November 2022. The survey tool captured demographic data, health status and lifestyle risk characteristics. Health literacy was measured using the 44-item Health Literacy Questionnaire (HLQ). Descriptive statistics, frequencies, percentages, means and standard deviations, were used to describe the sample. Interferential statistics, including the Mann-Whitney U Test and the Kruskal-Wallis Test, were used to explore differences between demographics and HLQ scales.

RESULTS

For the first 5 scales (4-point Likert scale), the lowest score was seen for 'Appraisal of health information' (Mean 2.81; SD 0.52) and the highest score was seen for 'Feeling understood and supported by healthcare providers ' (Mean 3.08; SD 0.64). For the other 4 scales (5-point Likert scale), the lowest score was seen for 'Navigating the healthcare system' (Mean 3.74; SD 0.69). The highest score was seen for 'Understand health information well enough to know what to do' (Mean 4.10; SD 0.53). Age, income level and living in an urban/rural location were significantly related to health literacy scales.

CONCLUSIONS

This study provides new insight into men's health literacy and the factors impacting it. This knowledge can inform future strategies to promote men's engagement with health services and preventive care.

Interventions to improve oncofertility knowledge and decision-making in patients with low health literacy: A systematic review

OBJECTIVE

To conduct a systematic review of interventions that improve knowledge, health and decision-related outcomes in cancer, fertility or the intersection of both among low health literacy (LHL) patients.

METHODS

Articles published from 2000 to March 2022 in English were identified through searching MEDLINE, PsycInfo, and Embase databases on 29/03/2022. Studies were independently screened against eligibility criteria and appraised for quality. A narrative synthesis of data was presented.

RESULTS

Of 235 citations, 11 studies (2585 participants) investigating three categories were included: decision-support tools (n = 8), mobile health applications (n = 2) and communication tools (n = 1). No eligible study was identified for fertility or oncofertility. All interventions integrated multimedia or interactivity to supplement plain-language text. Decision aids and mobile health applications improved knowledge, reduced decisional conflict and increased clarity around cancer-related choices. Overall, findings favoured the use of online interventions tailored for LHL patients.

CONCLUSION

There is a lack of data on LHL interventions in fertility and oncofertility. In cancer, LHL interventions improved knowledge and decision-making outcomes. The ideal intervention remains inconclusive.

PRACTICE IMPLICATIONS

Lack of engagement with LHL needs in oncofertility and fertility settings have implications for informed treatment decision-making. In cancer, further research is required to ascertain most effective intervention format.

Hypertension Diagnosis and Management in Africa Using Mobile Phones: A Scoping Review

Target 3.4 of the third Sustainable Development Goal (SDG) of the United Nations (UN) General Assembly proposes to reduce premature mortality from non-communicable diseases (NCDs) by one-third. Epidemiological data presented by the World Health Organization (WHO) in 2016 show that out of a total of 57 million deaths worldwide, approximately 41 million deaths occurred due to NCDs, with 78% of such deaths occurring in low-and-middle-income countries (LMICs). The majority of investigations on NCDs agree that the leading risk factor for mortality worldwide is hypertension. Over 75% of the world's mobile phone subscriptions reside in LMICs, hence making the mobile phone particularly relevant to mHealth deployment in Africa. This study is aimed at determining the scope of the literature available on hypertension diagnosis and management in Africa, with particular emphasis on determining the feasibility, acceptability and effectiveness of interventions based on the use of mobile phones. The bulk of the evidence considered overwhelmingly shows that SMS technology is yet the most used medium for executing interventions in Africa. Consequently, the need to define novel and superior ways of providing effective and low-cost monitoring, diagnosis, and management of hypertension-related NCDs delivered through artificial intelligence and machine learning techniques is clear.

Consumer perceptions of direct-to-consumer electronic prescription services in Queensland, Australia

Background

Direct-to-consumer (DTC) electronic prescription services (EPS) are a novel addition to the Australian healthcare landscape. This study aimed to explore consumers' perceptions on how this model of care supports the delivery of best-practice care.

Method

Focus groups participants were recruited through social media and included adults aged 18 years or older, Queensland (Australia) residents, and interested in DTC EPS. Focus groups were conducted via Zoom® and repeated until data saturation. Inductive thematic analysis was undertaken to elicit consumer perception themes from focus group discussions and field notes.

Results

Three focus groups were conducted between July and August 2022 and included 13 participants of which two (15%) had previously used DTC EPS. Four major perception themes were induced: (a) Consumer responsibility. There is an assumed level of consumer health literacy leading to an unacceptable burden of responsibility on the patient; (b) System processes appear to be underdeveloped to support best-practice care; (c) Access to convenient and timely healthcare will be improved for many patients, however, out of pocket expenses may promote inequity; and (d) Service model improvements can address safety and quality concerns including integration of the model within existing national digital health platforms.

Conclusion

Participants believed that DTC EPS was a valuable addition to the Australian health care landscape increasing convenient and timely access to medicines for consumers. Participants were concerned that a heavy reliance on health literacy and underdeveloped system processes may lead to unsafe prescribing.

Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners

Digital communication tools have demonstrated significant potential to improve health literacy which ultimately leads to better health outcomes. In this article, we examine the power of digital communication tools such as mobile health apps, telemedicine and online health information resources to promote health and digital literacy. We outline evidence that digital tools facilitate patient education, self-management and empowerment possibilities. In addition, digital technology is optimising the potential for improved clinical decision-making, treatment options and communication among providers. We also explore the challenges and limitations associated with digital health literacy, including issues related to access, reliability and privacy. We propose leveraging digital communication tools is key to optimising engagement to enhance health literacy across demographics leading to transformation of healthcare delivery and driving better outcomes for all.

How Does the Health Literacy of Adults Residing in Social Housing Compare with That of Those Living in Other Housing Tenures in Australia? A Secondary Analysis of the Australian National Health Survey 2017-2018 Dataset

BACKGROUND

Social housing tenants have poorer health outcomes than homeowners or those renting privately. Health literacy is associated with access to care and health outcomes. This study aimed to examine the health literacy of Australian adults residing in social housing compared with that of people living in other housing types.

METHODS

A secondary analysis of the Australian National Health Survey 2017-2018 dataset was undertaken. A total of 5275 respondents were included in the sample and completed the Health Literacy Questionnaire (HLQ). Respondents were categorised according to their housing tenure: 163 (3.1%) respondents were living in social housing, 873 (17%) were living in private rentals, 2085 (40%) were homeowners, and 2154 (41%) were homeowners/mortgages. Mean scores were calculated for each of the nine health literacy domains in the HLQ and compared across housing tenure using linear regression models.

RESULTS

Social housing tenants had lower mean domain scores than either homeowners, owner mortgagees, or private renters on six of the nine health literacy domains. This included 'having sufficient information to manage my health', 'social support for health', 'ability to engage with healthcare providers', 'navigating the healthcare system' 'ability to find good health information', and being able to 'understand health information enough to know what to do'. However, the differences in mean scores were small.

CONCLUSIONS

Increasing health literacy may be an important part of multicomponent interventions seeking to improve the health and wellbeing of social housing tenants.

Health Literacy of Parents and Carers in a Regional Community: A Cross-Sectional Study

BACKGROUND

Supporting a child's healthy development is determined, in part, by a parent's ability to seek, access, interpret and effectively utilize health information. This aspect of parenting draws on a set of skills referred to as health literacy.

OBJECTIVE

To assess the level of health literacy among parents/carers in a regional South Australian community.

METHODS

Parents/carers of primary school-aged children, residing in Whyalla, South Australia, were invited to complete the 13-item All Aspects of Health Literacy Survey.

RESULTS

155 parents/carers completed the survey (79% mothers). Most participants were English-speaking (97%), employed (62%) and had 2-3 children (62%), with 52% completing tertiary education. Median total health literacy scores were mostly in the moderate-high range (median 27, IQR 26,27), as were critical health literacy scores (median 7, IQR 6,8). Higher scores were reported for functional health literacy (median 8, IQR 7,9), communicative health literacy (median 9, IQR 8,9) and empowerment health literacy (median 4, IQR 3,5).

CONCLUSIONS

Our findings reveal modest levels of health literacy among a sample of parents/carers of primary school-aged children in a regional South Australian community. Further work is needed to understand the differential effect of parental health literacy on child health outcomes, and the types of strategies that may mitigate the impact of these barriers on a child's healthy development.

A cross-sectional health literacy profile of Australian regional adults using the Health Literacy Questionnaire©

OBJECTIVE

Health literacy is the resources and abilities required to make and enact health decisions. This study aimed to describe the health literacy of a diverse cross-section of adults in regional Victoria.

METHODS

Participants were recruited from two primary care clinics differing in socioeconomic scope and through non-clinical recruitment via the town's largest football club. Health Literacy Questionnaire© measured nine distinct scales, and comprehensive demographic data were also collected. Effect-sizes and regression were used for health literacy comparison between groups.

RESULTS

In this sample of 351 adults, health literacy strengths were observed in Scale 1: 'Feeling understood and supported by healthcare providers' (mean 3.29/4 ±0.5) and Scale 9: 'Understanding health information well enough to know what to do' (mean 4.10/5 ±0.6). Challenging areas were Scale 5: 'Appraising health information' (mean 2.88/4 ±0.5) and Scale 7: 'Navigating the healthcare system' (mean 3.84/5 ±0.6). After adjustment, living alone predicted lower scores across most scales.

CONCLUSIONS

This study showed greater health literacy barriers experienced by certain groups, particularly those who live alone and those who weren't clinically recruited.

IMPLICATIONS FOR PUBLIC HEALTH

These findings have implications for further research into addressing health literacy barriers in marginalised individuals and non-clinical settings. Results from this study may inform interventions which address identified barriers.

Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia

BACKGROUND

Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics.

METHOD

Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults-Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education.

RESULTS

The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention.

CONCLUSIONS

Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.

A Visualized and Scientometric Analysis of Health Literacy Research

Purpose

The health literacy concerned by numerous policy and advocacy organizations is springing up rapidly and has evolved substantially over the past few decades. During the period of COVID-19, people who are in the absence of effective treatment and limited availability of vaccination need a higher health literacy to protective themselves. In order to provide a summary of the health literacy research, a visualized and Scientometric analysis is applied in this study.

Methods

Based on a scientific review of 3,670 data on health literacy from Web of Science, this research uses Citespace software to systematically and objectively describe health literacy to determine the knowledge evolution structure between articles and investigate research trends.

Results

The results show that the annual outputs of publications have grown rapidly since 2003. The USA and Australia make larger contributions compared with other countries in terms of quantity of publications and worldwide collaboration relationship between them. The “Soc Sci Med,” “J Health Commun.” “Patient Educ Couns” and “J Gen Intern Med” pay more attention to health literacy research. The leading authors with influence and authority are Wolf MS, Osborne RH, and Paasche-Orlow MK. Health literacy research in this field focuses on care, knowledge, and education, and so on. An emerging trend of health literacy with Covid-19, online tools, nursing, and obesity will spread across the globe.

Conclusion

Compared with simply reviewing existing articles, the major contribution in this study is a comprehensive review of yearly scientific output, journals, countries, institutions, contributors, highly cited papers, and keywords for health literacy research. The review also provides valuable and seminal guidelines for interested researchers on health literacy research.

Healthcare Providers' Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study

Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs and seeks to identify strategies for preventing them. Physicians, nurses, paramedics, and health administrators with experience in managing rural patients with PPHs were recruited from southern Tasmania, Australia. Semi-structured telephone interviews were conducted, and reflexive thematic analysis was used to analyse the data. Participants linked health literacy, limited access to primary care, and perceptions of primary care services with PPH risk. The belief that patients did not have a good understanding of where, when, and how to manage their health was perceived to be linked to patient-specific health literacy challenges. Access to primary healthcare was impacted by appointment availability, transport, and financial constraints. In contrast, it was felt that the prompt, comprehensive, and free healthcare delivered in hospitals appealed to patients and influenced their decision to bypass rural primary healthcare services. Strategies to reduce PPHs in rural Australian communities may include promoting health literacy, optimising the delivery of existing services, and improving social support structures.

The Influence of Robot-Assisted Learning System on Health Literacy and Learning Perception

Healthy aging is a new challenge for the world. Therefore, health literacy education is a key issue in the current health care field. This research has developed a robot-assisted learning system to explore the possibility of significantly improving health literacy and learning perception through interaction with robots. In particular, this study adopted an experimental design, in which the experiment lasted for 90 min. A total of 60 participants over the age of 50 were randomly assigned to different learning modes. The RobotLS group learned by interacting with robots, while the VideoLS group watched health education videos on a tablet computer. The content dealt with hypertension related issues. This study used the European Health Literacy Survey Questionnaire (HLS-EU-Q16), Health Knowledge Questionnaire, Reduced Instructional Materials Motivation Survey (RIMMS), and Flow Scale as evaluation tools. The result shows no significant difference in the pre-test scores between the two groups. Compared with the video-assisted learning system, the robot-assisted learning system can significantly improve health knowledge, health literacy, learning motivation, and flow perception. According to the findings of this study, a robot-assisted learning system can be introduced in the future into homes and care institutions to enhance the health literacy of the elderly.

Communicative health literacy in patients with non-communicable diseases in Ethiopia: a cross-sectional study

BACKGROUND

Health literacy plays a prominent role in empowering individuals for prevention as well as management of non-communicable diseases (NCDs). However, there is paucity of information on the health literacy of patients with non-communicable diseases in Ethiopia. Therefore, this study aimed to assess communicative health literacy and associated factors in patients with NCDs on follow-up at Jimma Medical Center (JMC), Ethiopia.

METHODS

A cross-sectional study was conducted from 4 May 2020 to 4 July 2020 with 408 randomly selected adult patients, attending outpatient department of JMC in Ethiopia. The final sample size was obtained by using single population proportion formula. All patients with NCDs who were on follow-up at chronic illness clinic, JMC, were used as a source population. All eligible patients with NCDs who fulfilled the inclusion criteria were included in this study. A simple random sampling technique was used to recruit study participants. Data were collected through structured interviewer administered questionnaires on the six of nine health literacy domains using Health Literacy Questionnaire (HLQ) containing 30 items, socio-demographic and socio-economic characteristics, disease-related factors, and health information sources. Multivariable logistic regression was executed to determine the associations.

RESULT

Descriptive analysis shows more than half of the respondents in four of the six health literacy domains had high communicative health literacy level (CHLL). The proportion of people with high CHLL across each of the domains was as follows: health care provider support (56.1%), social support for health (53.7%), active engagement with a healthcare provider (56.1%), and navigating healthcare system (53.4%). We found educational status was significantly associated with five of six health literacy domains whereas number of sources was associated with four of six health literacy domains.

CONCLUSION

The overall findings of the current study indicate that health literacy levels vary according to socio-demographic and disease characteristics of patients. Thus, healthcare professionals should assess patients' health literacy level and tailor information and support to the health literacy skills and personal context of their patients.

Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review

Background

Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child’s symptoms is one of many factors that play a role in parents’ decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents’ knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions.

Objective

The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home.

Methods

The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references’ titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported.

Results

The systematic review will commence during 2021.

Conclusions

This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions.

International Registered Report Identifier (IRRID)

PRR1-10.2196/27504

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.

Assessing parents, youth athletes and coaches subjective health literacy: A cross-sectional study

OBJECTIVES

The aim was to describe levels of subjective Health Literacy (HL), and to examine possible differences in prevalence proportions between sexes, age groups and level of educations among youth athletes and their mentors (coaches, parents/caregivers) in Swedish Athletics.

DESIGN

Cross-sectional.

METHODS

Data on subjective HL were collected using the Swedish Communicative and Critical Health Literacy (S-CCHL) instrument for mentors and for youth the School-Aged Children (HLSAC) instrument. Questions assessing mentors' literacy on sports injury and return to play were also included.

RESULTS

The surveys were completed by 159 (91%) mentors and 143 youth athletes (87%). The level of S-CCHL was sufficient in 53% of the mentors. Of youth athletes, 28% reported a high level of HL and the item with least perceived high HL (21%) was critical thinking. Ninety-four percent of the mentors believed that it is quite possible to prevent injuries in athletics and 53% perceived having a very good knowledge about how to prevent injuries. Forty-six percent of the mentors perceived having a very good knowledge of return to sport criteria.

CONCLUSIONS

The level of health literacy was low with about half of the mentors and one out of three youth athletes having adequate HL levels. Only half of the mentors stated having a good knowledge of various injury prevention strategies. To reduce health consequences in youth sport and enable talent development more work is needed to understand the facilitators and barriers for the uptake of various health promotion and injury prevention strategies.

Estimating the Economic Burden of Low Health Literacy in the Blacktown Community in Sydney, Australia: A Population-Based Study

Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the individual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically diverse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017–2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015–2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and $15,432,239 in 2020. This is projected to increase to between $18,922,844 and $24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups—comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)—was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy.

Refugee and Migrant Health Literacy Interventions in High-Income Countries: A Systematic Review

Health literacy is a key determinant of health in refugee and migrant populations living in in high-income countries (HICs). We conducted a systematic review of randomized-controlled trials (RCTs) to characterize the scope, methodology, and outcomes of research on interventions aimed at improving health literacy among these vulnerable populations. We searched EMBASE, MEDLINE, PsycINFO, CINAHL, and Web of Science databases to identify RCTs of health literacy intervenions in our target population published between 1997 and 2018. The search yielded 23 RCTs (n = 5625 participants). Study demographics, health literacy topics, interventions, and outcome measures were heterogeneous but demonstrated overall positive results. Only two studies used a common health literacy measure. Few RCTs have been conducted to investigate interventions for improving the health literacy of refugees and migrants in HICs. The heterogeniety of health literacy outcome measures used impeded a robust comparison of intervention efficacy.

Interventions to improve health literacy among Aboriginal and Torres Strait Islander Peoples: a systematic review

BACKGROUND

Aboriginal and Torres Strait Islander peoples continue to experience poorer health outcomes than other population groups. While data specific to Indigenous Australians are scarce, a known social health literacy gradient exists linking low health literacy and poor health outcomes within many minority populations. Improving health literacy among Indigenous Australians is an important way to support self-determination and autonomy in both individuals and communities, by enhancing knowledge and improving health outcomes. This review aims to rigorously examine the effectiveness of health literacy interventions targeting Aboriginal and Torres Strait Islander peoples.

METHODS

A systematic review across six databases (The Cochrane Library, PubMed, Embase, SCOPUS, ProQuest Dissertation and Thesis and Web of Science) was performed for publications evaluating interventions to improve health literacy among Indigenous Australian adults using search terms identifying a range of related outcomes.

RESULTS

Of 824 articles retrieved, a total of five studies met the eligibility criteria and were included in this review. The included studies evaluated the implementation of workshops, structured exercise classes and the provision of discounted fruit and vegetables to improve nutrition, modify risk factors for chronic diseases, and improve oral health literacy. All interventions reported statistically significant improvement in at least one measured outcome. However, there was limited involvement of the Aboriginal and Torres Strait Islander community members in the research process and participant retention rates were sub-optimal.

CONCLUSION

There is limited evidence on interventions to improve health literacy in Indigenous Australian adults. Participation in interventions was often suboptimal and loss to follow-up was high. Future studies co-designed with Aboriginal and Torres Strait Islander community members are needed to improve health literacy in this population.

A systematic review of mental health literacy in Pakistan

Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.

A pilot study of adolescent health literacy research in Melbourne: Implementation and reflections

ISSUES ADDRESSED

While adolescent health literacy research has gained momentum, there is little evidence regarding its implementation and data collection in school settings. This study explored the feasibility of collecting health literacy data from Australian secondary schools and piloted three health literacy instruments.

METHODS

A cross-sectional study was designed to recruit four government secondary schools in Melbourne. Active, opt-in consent was obtained from parents and students in Years 7-9, and an online survey was conducted. Three health literacy instruments were used: the 8-item Health Literacy Assessment Tool (HLAT-8), the Newest Vital Sign (NVS), and the 47-item Health Literacy Survey (HLS-47).

RESULTS

A total of 120 students (age 12-15 years) were finally recruited from one school, whereas the other three schools declined due to busy educational commitment or no interest in research. Learnings and reflections on data collection included: a shared perspective of health literacy evaluation between school and researchers; the feasibility of online data collection; and the possibility of obtaining passive, opt-out consent. About one-quarter (23.7%-32.2%) of students were likely to have poor health literacy.

CONCLUSIONS

Although the recruitment was challenging, this pilot study indicates the feasibility of large-scale online health literacy survey in future school-based research. SO WHAT?: Measuring and monitoring adolescent health literacy is essential to achieve the aim of the Australian Curriculum of Health and Physical Education. More implementation research is needed with representative samples to validate health literacy instruments and examine the impact of health literacy on health promotion outcomes in Australian adolescents.

Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy

Due to their rapid expansion and complexity, it is increasingly difficult for patients to orient themselves in health care systems. Therefore, patients require a high degree of health literacy, or more precisely, navigation health literacy (HL-NAV). The actual extent of HL-NAV of patients and citizens is still largely unknown due to the lack of adequate measurement instruments. Thus, within the new international Health Literacy Population Survey 2019 (HLS19), one aim was to develop a suitable instrument for measuring HL-NAV in the HLS19 the HL-NAV-HLS19. The item development was conducted by an international working group within the HLS19 Consortium led by the first and last authors. Methodologically, it is based on a scoping literature review, development of a conceptual framework for HL-NAV, and first item formation, as well as an evaluation by experts, stakeholders, focus groups, pre-test interviews, and continuously feedback from the HLS19 Consortium. HL-NAV was defined as the ability to access, understand, appraise, and apply information on navigational issues, drawing on ten selected publications and the health literacy definition of the HLS-EU Consortium. Main tasks of HL-NAV at the system, organization, and interaction level were identified, to which first related items were assigned. Based on the feedback from experts, the focus group discussions, and the HLS19 Consortium, the instrument was slightly revised. Finally, twelve items proved to be feasible in the pre-test. The instrument will be used for the first time in the HLS19 survey and will provide first data on HL-NAV in general populations for the countries participating in HLS19. It is suited for cross-country comparisons and monitoring, as well as for intervention development. However, the instrument should be translated into and validated in further languages and countries for population samples.

Hypothesis: improving literacy about health workforce will improve rural health workforce recruitment, retention and capability

BACKGROUND

One of the key barriers to health in rural areas is health workforce. Poor understanding and communication about health workforce across all stakeholder groups (including the broad community) is very common and can negatively affect the health workforce, recruitment, experiences and outcomes.

HYPOTHESIS

In this paper, we propose the concept of literacy about health workforce. We propose this as a specific, actionable extension of the existing and well accepted health literacy concept. We hypothesise that improving literacy about health workforce will improve, in particular, rural health workforce recruitment, retention and capability.

IMPLICATIONS OF THE HYPOTHESIS

We propose that literacy about health workforce is important for all members of the health and broader system (e.g. local GP, mayor, workforce agency, health manager, Aboriginal health worker, carers, community health facilitators, patients, schools, local businesses, cultural and recreation groups) because we hypothesise their literacy about health workforce affects their capacity to make informed decisions and take action to manage their health workforce needs in direct synchrony with the community's health needs. We hypothesise that improving literacy about health workforce will improve the effectiveness and efficiency of attracting, recruiting, training, and retaining a high quality, capable, health workforce, and further, will support the development and acceptance of innovative solutions to health workforce crises such as new models of care. This hypothesis is action orientated, is testable and includes the consideration of methods to engage and improve literacy of those within and external to the health workforce.