Health Literacy among Older Adults during COVID-19 Pandemic: A Cross-Sectional Study in an Urban Community in Thailand

Factors associated with poor health literacy in older adults: A systematic review

OBJECTIVES

To identify factors associated with poor health literacy in older adults.

METHODS

A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy".

PROSPERO - CRD

42022350140.

RESULTS

Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others).

CONCLUSIONS

The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

Trust, Interaction with Neighbors, and Vaccination during the COVID-19 Pandemic: A Cross-Sectional Analysis of Chinese Data

The COVID-19 pandemic significantly impacted public health and quality of life, leading to government recommendations for vaccination. Using cross-sectional data from a nationwide population-based survey conducted in China (N = 6860), this study aimed to examine the associations between individual vaccine uptake and general trust in others, trust in government, and interaction with neighbors. We conducted a multilevel logistic regression analysis to examine the relevance of these factors at the individual and community levels. Among young adults, higher levels of general trust at both levels were positively associated with vaccination, with odds ratios (OR) of 1.35 (95% confidence interval [CI]: 1.07, 1.70) and 1.58 (95% CI: 1.14, 2.18), respectively. We also found a positive association between vaccination and community-level interaction with neighbors, with ORs of 1.55 (95% CI: 1.11, 2.17). In contrast, among older individuals, vaccination was positively associated only with individual-level interaction with neighbors, with an OR of 1.55 (95% CI: 1.15, 2.08). The results indicated that vaccine uptake was associated with an individual's views of society and the social environment of the community, with substantial variations between the young and the old. Our findings emphasize the significance of public health measures to strengthen neighborhood interactions among older adults.

Exploring E-Health Literacy and Technology-Use Anxiety among Older Adults in Korea

The COVID-19 pandemic has increased the importance of health literacy in disseminating information on health in a non-contact society. This study focused on examining the acceptance capacity by older adults of smart devices in Korea and investigating the potential differences between men and women in terms of e-health literacy and technology-use anxiety. The study included 1369 respondents who were adults over 50 years of age and used welfare centers, public health centers, senior citizen centers, and exercise centers in Seoul and Incheon. An online survey was conducted from 1 June 2021 to 24 June 2021. The study found that the older adults' low levels of digital literacy could limit their access to health information and negatively impact their health. The difference between men and women in terms of technology-use anxiety was statistically significant, with the latent mean for men being higher than that for women. The effect sizes of the potential mean differences were found to be at a medium level for e-health literacy and a significant level for technology-use anxiety. With Korea's aging population and the need for the continuous management of chronic diseases among older adults, it is essential to discuss internet-based health information for disease maintenance and treatment.

“Even though we are elders living alone”: has social support reshaped the care of older adults during the COVID-19 pandemic?

Purpose

This study aims to explore how social support has reshaped the care of older adults living alone in northeast Thailand during the COVID-19 pandemic.

Design/methodology/approach

This study used a qualitative method using a narrative gerontological perspective with a descriptive design. Purposive sampling was conducted from 20 in-depth narrative interviews between November 2021 and February 2022 in Maha Sarakham province, northeast Thailand. Data transcriptions were performed using a narrative analytical process.

Findings

The in-depth narrative interviews indicated that older adults living alone during the coronavirus pandemic valued a comfortable life, a sense of place, favourable living arrangements, self-reliance, life goals and meaningful life. The gerontological analysis showed that social support for older adults living alone included a social safety net, networking, supporting needs, physical care and mental health responses to the COVID-19 pandemic.

Originality/value

To the best of the authors’ knowledge, this is the first qualitative narrative gerontological study to explore how social support reshaped the care of older adults living alone during the COVID-19 pandemic in northeast Thailand.

Factors Influencing Access to Health Services among Chronically Ill Older Adults with Physical Disabilities in the Era of the COVID-19 Outbreak

Chronically ill older adults with physical disabilities frequently face difficulties in their daily lives and require essential health service access, especially in the COVID-19 context. This study aimed to examine the association between social support, perception of benefits due to disability and access to health services among chronically ill older adults with physical disabilities during this crisis in Thailand. A total of 276 chronically ill older adults with physical disabilities were included in this cross-sectional study. Self-reported questionnaires were assessed through multi-stage random sampling. Correlations between the independent variables and health service access were examined using multiple regression analysis. Of the respondents, 159 were female (59.6%). Most participants perceived benefits (58.8%) and access to health services (56.2%) at good levels, while social support was at a moderate level (47.9%). Stepwise multiple regression analysis showed that social support (β = 0.351), perception of benefits (β = 0.257) and age (β = 0.167) were positively correlated with health service access. The findings are relevant for health care providers and multi-professional teams, who should enhance older adults' social support and perception of benefits to improve their access to health services, particularly among chronically ill older adults with physical disabilities, in the era of COVID-19.

Health-Promoting Behaviors among Older Adults with Noncommunicable Diseases in Rural and Urban Areas during the New Normal Post-COVID-19 Era: A Structural Equation Modeling Analysis

This study aimed to develop and test a causal relationship among perceived self-efficacy (PSE), health literacy (HL), access to COVID-19 preventive material (ACPM), social networks (SN), and health-promoting behaviors (HPBs). Multistage stratified random sampling was used to recruit 250 older adults with noncommunicable diseases (NCDs) from Thai urban and rural communities. The data were collected with self-reported questionnaires. Data analyses used descriptive statistics and structural equation modeling. The results indicated that participants in urban communities had higher PSE, ACPM, HL, SN, and HPBs than rural participants. The fitness parameters of the modified model (χ2 = 71.936, df = 58, p-value = 0.103, χ2/df = 1.240; root mean square error of approximation (RMSEA) = 0.031; standardized root mean square residual (SRMR) = 0.042; goodness of fit index (GFI) = 0.964; normed-fit index (NFI) = 0.964; comparative fit index (CFI) = 0.993) indicated its suitability as the research model. HPBs were directly positively influenced by PSE (β = 0.40, p < 0.001), ACPM (β = 0.24, p < 0.001), HL (β = 0.19, p < 0.01), and SN (β = 0.01, p < 0.05). Therefore, taking all predicting variables together could explain 81.0% of the variance in HPBs. Multidisciplinary healthcare teams could use these findings to establish proper interventions or healthcare activities to increase HPBs among older adults, particularly in this era of the “new normal”.

Food Delivery Drivers' Health Literacy Regarding COVID-19 Prevention and Protective Behaviors During the COVID-19 Pandemic: Cross-sectional Survey in Southern Thailand

Background

In 2019, COVID-19 spread worldwide, causing a pandemic that has posed unprecedented challenges and pressure for health systems and economies. Food delivery services have become an important medium for consumer food purchases to limit human-to-human contact. Thus, delivery drivers are at high risk of exposure to COVID-19 infection at work. To the best of our knowledge, no studies have analyzed the dimensions of health literacy (HL) regarding COVID-19 prevention in this population.

Objective

This study aims to explore the HL status toward COVID-19 prevention and its associated factors among food delivery drivers in southern Thailand.

Methods

Following a cross-sectional survey from July to August 2021, Thai food delivery drivers in the upper-south and lower-south regions of southern Thailand were recruited to participate during the compulsory COVID-19 lockdown. An online structured questionnaire was administered verbally and recorded by the interviewer. Univariate and multivariate linear regressions were used to explore independently associated factors.

Results

Of 401 drivers, 291 (72.6%) were men. The median age was 31 years (range 19-64 years). The median number of months working as a driver was 12 months, and the median number of working hours was 9 hours per day. The median number of daily food orders was 20, while the median daily income was Thai baht (THB) 600 (US $15.90). Social media (Facebook and Line) was a common source of health information. The most common information required was about the COVID-19 vaccine, medications, and treatment. Most drivers (285/401, 71.1%) had excellent HL levels regarding COVID-19 prevention. Only the practical application of information was statistically correlated with behavior (r=0.38, P<.001). Drivers in the lower south of Thailand were more likely to have excellent HL than other drivers (β=7.03, P<.001). Those who frequently accessed information through YouTube (β=–2.17, P=.01) and relatives (β=–4.19, P<.001) were less likely to have excellent HL levels.

Conclusions

Understanding HL among food delivery drivers would be useful for planning effective interventions that target this population. Conventional health education through social media alone may not be effective at educating people about COVID-19 prevention. Information literacy skills could determine individuals’ HL and drivers’ behaviors.

Do Health Information Sources Influence Health Literacy among Older Adults: A Cross-Sectional Study in the Urban Areas of Western China

BACKGROUND

Previous studies have found that the dissemination pattern and delivery mechanism of information can provide crucial resources and empowerment for individuals to the promotion of health literacy. The present study investigates how health information sources are associated with health literacy among older adults in west China, and tries to explain the mechanisms underlying the link between health information sources and health literacy in the Chinese context.

METHODS

The cross-sectional study employed a representative sample of 812 urban citizens aged 60 and older in 2017 in Western China.

RESULTS

We found that health information sources including healthcare practitioners (B = 4.577, p < 0.001), neighbors (B = 2.545, p < 0.05), newspapers (B = 4.280, p < 0.001), and television (B = 4.638, p < 0.001) were positively associated with health literacy. Additionally, age (B = -1.781, p < 0.001) was negatively associated with health literacy, and the socio-economic status factors including minority (B = -10.005, p < 0.001), financial strain status of perceived very difficult (B = -10.537, p < 0.001), primary school (B = 11.461, p < 0.001), junior high school (B = 18.016, p < 0.001), polytechnic school or senior high school (B = 21.905, p < 0.001), college and above (B = 23.433, p < 0.001) were significantly linked to health literacy, and suffering from chronic diseases (B = 3.430, p < 0.01) was also positively related to health literacy.

CONCLUSIONS

Health information sources including healthcare practitioners, neighbors, newspapers, and television have a strong influence on health literacy, which implies that the four main types of sources are the important patterns of health information dissemination in the reinforcement of health literacy. In addition, the present findings also indicate age, minority and disease differences in health literacy and confirm the influence of enabling factors including educational attainment and financial strain on health literacy. Based on these findings and their implications, specific evidence is presented for the reinforcement of health literacy in interpersonal and mass communication, and in the educational and financial settings in the Chinese context. The present results also suggest that the age-specific, minority-specific and disease-specific measures should be taken to promote health literacy among older adults.

Improving health and social care services for slum-dwelling older adults: Perspectives of health professionals

Background

Besides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care.

Aims

This study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults.

Method

A qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant.

Results

A total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement.

Conclusion

Health professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.

Factors Predicting the Coronavirus Disease 2019 Preventive Behaviors of Older Adults: A Cross-Sectional Study in Bangkok, Thailand

The coronavirus disease 2019 (COVID-19) pandemic has affected the health behaviors of older adults. Thus, the factors predicting the COVID-19 preventive behaviors of older adults during the COVID-19 outbreak should be examined. Therefore, this study aimed to assess the COVID-19 preventive behaviors of older adults and explore the factors predicting these. A cross-sectional study was performed with 400 older adults who were selected using the cluster sampling technique. The associations of all variables in preventing COVID-19 infection with COVID-19 preventive behaviors were examined using stepwise multiple regression. The study results revealed that 70.8% of the study participants had high levels of COVID-19 preventive behaviors. Among these, self-efficacy in preventing COVID-19 infection (β = 0.224) showed the highest ability to predict COVID-19 preventive behaviors, followed by COVID-19 response efficacy (β = 0.171), knowledge about COVID-19 (β = 0.110), and gender (β = -0.102). Older adults adopted protective behaviors at the beginning of the COVID-19 pandemic. The predictors of these behaviors should be considered while designing and developing appropriate COVID-19 preventive behavior interventions, aimed at inducing behavioral modifications to reduce further infection with and spread of COVID-19.

Quality of Life of Older Adults with Physical and Mobility Disabilities during the COVID-19 Pandemic: A Cross-Sectional Study in Thailand

Suffering during events such as the COVID-19 pandemic threatens the quality of life (QoL) of older adults with physical and mobility disabilities. This study aims to determine the QoL of older Thai adults with such disabilities during the COVID-19 pandemic and its predictor. A cross-sectional study was conducted among 360 older adults with physical and mobility disabilities. Data were collected by structured interview questionnaires. Data analyses comprised Pearson’s correlation coefficient and multiple regression analysis. The mean age of the participants was 73.52 years; a total of 58.6% of them were female and 97.8% had completed only primary education. More than half of them had a moderate QoL (63.3%). Self-esteem, age, and perception of the benefits of disability were found to be associated with the participants’ QoL (p < 0.05) and capable of predicting it with 54.7% accuracy. As self-esteem and the perception of the benefits of disability were found to be indicators of the QoL of older adults with physical and mobility disabilities, the healthcare providers of such older adults should organize activities that could enhance their self-esteem and the perception of the benefits of disability to improve their QoL, particularly during the COVID-19 pandemic.

Factors Associated with a Health-promoting Lifestyle among Adults and Older Adults in the Era of COVID-19: An Integrative Review

AIM: To identify the factors associated with a health-promoting lifestyle (HPL) among adults or older adults during the COVID-19 pandemic. METHODS: On the basis of the PRISMA guidelines, primary articles published in English within the period from December 2019 to December 2021 were searched for on five databases: PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL Plus with Full Text. RESULTS: The current review identified nine relevant studies with a total of 4,509 adults and older adults. We found that sociodemographic were associated with HPL among both adults and older adults in the COVID-19 era. The findings also asserted that a nurse-led lifestyle intervention is an effective program for improving the self-efficacy and HPL of older adults with chronic illnesses. CONCLUSION: According to this review’s findings, individuals and healthcare professionals should consider the sociodemographic and social factors associated with HPL among adults and older adults, it is important to improve and standardize the guidelines for home-based services so that they can be used properly to help them deal with the COVID-19 pandemic and similar health crises.

Influence of Self-esteem and Preparation for Aging on the Happiness of Older Thai Adults: A Cross-sectional Study

Background: Happiness is necessary for older adults’ physical and psychological well-being. The objective of this study was to examine the associations of self-esteem and preparation for aging with happiness and to determine the predictive factors of the happiness of older Thai adults. Methods: The study had a cross-sectional predictive correlational design and included 225 older Thai adults aged 60–69 years selected using multi-stage random sampling. Data were collected through self-administered questionnaires, and the collected data were analyzed using frequency, percentage, Pearson’s product moment correlation coefficient, and multiple regression analysis. Results: The study results showed that 64.9% of the study participants were moderately happy. The factors that significantly influenced their happiness were self–esteem and preparation for aging (p < 0.05), meaning their self–esteem and preparation for aging were able to predict their happiness, accounting for approximately 67.0% of the variance of such happiness. Conclusion: Older adults’ healthcare providers should organize activities for enhancing older adults’ self-esteem and for helping them prepare well for old age.

Association between Health Literacy, Self-care Behavior, and Blood Sugar Level among Older Patients with Type 2 Diabetes in Rural Thai Communities

Background

Diabetes mellitus is a major problem worldwide. Moreover, older patients with significantly limited health literacy (HL) tend to have worse self-care behaviors and health outcomes. This study aimed to describe the associations of HL, self-care behavior, and blood sugar levels among older patients with type 2 diabetes in rural Thai communities.

Methods

This cross-sectional study included 415 patients with diabetes who were purposively selected from rural Thai communities. Data were collected using questionnaires and analyzed using descriptive statistics, Pearson correlation, Spearman rho, and stepwise multiple linear regression.

Results

The results revealed that most participants were women (66.50%). The respondents had moderate overall HL (2.68±0.64). On average, the respondents had fair overall self-care behavior (4.0±0.33). We discovered that HL was significantly positively correlated with self-care behavior (r=0.90) but not with blood sugar level. In addition, self-care behavior was significantly negatively correlated with blood sugar level (r=-0.50). Self-care behaviors and blood sugar levels were significant predictors of HL in patients with type 2 diabetes (total variance, 28.4%).

Conclusion

The results suggested increased HL in patients with diabetes would improve self-care behavior and, consequently, decrease their blood sugar level. Our findings indicate the need to involve nurses and multidisciplinary healthcare teams when developing health promotion programs to encourage blood sugar control.