Beyond the tip of the iceberg: Health literacy in older people.

BACKGROUND: The research is based on the concept of health literacy. This is the “sixth vital sign” to navigating the healthcare system and raising self-efficacy in the field of healthcare. AIM: The study aim was to present the health literacy of the elderly in the Savinja statistical region in Slovenia. METHODS: The study was based on a non-experimental quantitative research approach. The study included 199 elderly people aged 65 and more, without the presence of dementia. The data were collected using the Health Literacy and Montreal Cognitive Assessment questionnaire. We used a non-random, convenience sampling. RESULTS: We established that in the study population, 64.8 % of the population was below the level of acceptable general health literacy, whereas only 3.5 % of this population had an excellent level of health literacy. Statistically significant differences in the level of health literacy are shown in the field of healthcare treatment in older adults living with their families (F = 5,198; p ˂ 0,001). Respondents who engaged in activities in day care centres also had a higher level of health literacy (t = 3,738; p < 0,001). People with low health literacy, who use health services more frequently, should be given access to health education, based on individual presentation of contents, supported by andragogical knowledge. CONCLUSION: The health literacy of older adults is the basis for their greater care for their own health and a better quality of life.

Kidney Health for All: Bridging the Gap in Kidney Health Education and Literacy

The demographic transition has led to an increase in the older population, resulting in a rise in individuals with comorbidities and reduced self-sufficiency. Low health literacy levels are associated with poor health outcomes especially among vulnerable groups (like older individuals). Enhancing health literacy through targeted programs is crucial for improving self-care in chronic conditions. To date, in Italy, there are no validated tools to measure health literacy in older people. Thus, the aim of this study is to validate the European Health Literacy Survey Questionnaire 6 in a Tuscan (Italy) sample of senior individuals. Cross-sectional. The sample was drawn from the Surveillance System of Advancements in health of the Italian Local Healthcare Units from 2017 to 2019. Item analysis, Cronbach's alpha and confirmatory factor analysis were used to validate the scale. Additionally, associations between Health Literacy levels and sociodemographic characteristics were analyzed. A total of 11,000 subjects were interviewed, with 1,080 (10%) aged 65-69. Cronbach's alpha was 0.89. In the older subgroup, the percentage of missing responses ranged from 4.54% to 11.85%, with the fourth item having the highest percentage of missing values. The confirmatory factor analysis revealed that the three-factor model showed a better fit to the data compared to the unidimensional model. Similar findings were observed in the 18-65-year-old population. In both groups, individuals with economic difficulties or lower education were at higher risk of having inadequate levels of health literacy. Moreover, in the 18-64 age group, being female reduced the probability of having an inadequate health literacy level, while being inactive/retired or a foreigner increased it. The study provides preliminary evidence supporting the validity and reliability of the European Health Literacy Survey Questionnaire 6 for assessing health literacy in the Italian older population. Further research is necessary to confirm these findings, particularly in samples of individuals aged over 69 years.

Purpose. This study aims to determine the relationship between successful aging and health literacy in older adults. Design and Methods. This cross‐sectional, descriptive, and correlational study was conducted between April and September 2021. The sample of the study comprised 379 voluntary older adults aged 65 and above who visited a health center. A descriptive information form, the adult health literacy scale, and the successful aging scale were used for data collection. Results. The levels of health literacy were low, whereas the perceptions of successful aging were high. Besides, compared to female participants, the levels of health literacy and the perceptions of successful aging were higher in male participants. Age was negatively correlated with the level of health literacy. Furthermore, health literacy levels and successful aging perceptions of married participants were high. Finally, as the education levels increased, so did the health literacy level and successful aging perceptions. Practice Implications. Health policies to promote successful aging and health literacy in adults may be developed. Besides, intervention plans to improve the health literacy levels of different age groups may be prepared. Further studies that use culture‐specific scales may be conducted.

Health Literacy: The Missing Link in the Provision of Health Care for Children and Their Families

Amongst scholarly journals, authors are commonly encouraged to communicate with their peers in simple language and to avoid jargon, abbreviations and overly complex language. How much more important is communication with recipients of health care, where misunderstandings might result in, at the least, no improvement in health and, at worst, admission to hospital or life-threatening situations. Health literacy is ‘the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions’. Health literacy requires a complex group of skills that include ‘the ability to interpret documents, read and write prose (print literacy), use quantitative information (numeracy) and speak and listen effectively (oral literacy)’. Health literacy is essential as our health care moves away from a paternalistic model to one increasingly directed towards a partnership between patient and health-care provider. This partnership will be influenced by the level of health literacy of the patient, carer and health-care provider and the degree to which all partners are ‘on the same page’ or at least can find an effective way to communicate both health seeking and health providing behaviours. Low levels of health literacy (print or oral literacy or numeracy) are associated with higher risk of death, more frequent hospitalizations and higher use of health-care services. The most recent American assessment of health literacy highlighted a number of vulnerable groups: (1) older adults (>65% of people aged 65 and older have difficulties using print materials including charts and forms and performing calculations and interpreting numbers); (2) immigrants (lower health literacy associated with speaking a language other than English before commencing school); and (3) people with low income living below the poverty threshold. As in other patient populations, levels of health literacy are variable amongst people with chronic obstructive pulmonary disease (COPD). However, it is likely that the proportion of people with low health literacy is relatively high in the population of people with COPD as they are older population with a lower average socioeconomic status, both of which are key contributors. Low health literacy might lead to the misunderstanding of instructions, which can impact on adherence to medical interventions. This was dramatically illustrated by Davis et al., who reported that just over a third of patients with low literacy were able to show how many tablets should be taken when given a written label containing the instruction ‘Take two tablets by mouth twice daily’. Existing health literacy tests can be time consuming. Simply asking patients about their education attainment is not sufficient, as the highest grade of education completed is often higher than the actual level of literacy. Whilst there are some health literacy tests that are easy to administer (e.g. Rapid Estimate of Adult Literacy in Medicine (REALM)), patients often feel awkward or embarrassed in providing truthful responses. Whereas not as accurate as the REALM, several studies have confirmed that asking a single question ‘How confident are you filling out medical forms by yourself?’ may be useful for detecting patients with inadequate health literacy. In the absence of screening, experts encourage health-care professionals to assume that all patients have low health literacy – ‘the lowest common denominator’. When using this approach, however, it is almost inevitable that patients with higher literacy

BackgroundHealth literacy is the ability to find, understand, assess, and apply health information. Individuals suffering from multiple chronic conditions have complex healthcare needs that may challenge their health literacy skills. This study aimed to investigate the relationship between multimorbidity, the number of chronic conditions, and health literacy levels in a sample of adults aged 58+ in Switzerland.MethodsWe used data from 1,615 respondents to a paper-and-pencil questionnaire administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy was measured using the short version of the European Health Literacy Survey questionnaire. The final score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0–8), problematic (9–12), and sufficient (13–16). The number of chronic conditions was self-reported based on a pre-defined list. Associations were examined using multivariable ordinary least squares and ordered probit regression models, controlling for key socio-demographic characteristics.ResultsOverall, 63.5% of respondents reported having at least one chronic condition. Respondents who reported one, two, and three or more chronic conditions were more likely to have lower health literacy scores compared to respondents who did not report any chronic condition (p<0.05, p<0.01, and p<0.001, respectively). Suffering from two and three or more chronic conditions (vs. no chronic condition) was significantly associated with a higher likelihood of having inadequate or problematic health literacy levels (both p-values <0.01).ConclusionsOur findings suggest a need to improve health literacy in older adults suffering from chronic conditions. Improved health literacy could constitute a promising lever to empower individuals to better self-manage their health to ultimately reduce the double burden of chronic diseases and insufficient health literacy in this vulnerable population.

BackgroundIn the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers’ needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored.ObjectiveThe aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions.MethodsA sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer’s associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures.ResultsAs a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017.ConclusionsCarers’ eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers’ perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers’ eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research.

The aim of this study was to determine the association between parents' health literacy, adolescents' health literacy and physical activity status. This cross-sectional study sample consisted of 521 adolescent and parent dyads from a middle school in Türkiye. Data were collected using the "Descriptive Information Form," "Health Literacy Scale for School-aged Children (HLSAC-T)," "Adult Health Literacy Scale (AHLS)," and "Physical Activity Questionnaire (PAQ)." The mean age of the adolescents was 11.61±1.13, and 54.9% were girls. The mean age of the parents was 39.44±7.32 and 89.4% were mothers. The mean total score of HLSAC-T was 32.00±5.65, the mean total score of PAQ was 26.24±6.82, and the mean total score of AHLS was 18.00±3.85. A moderate positive correlation was found between HLSAC-T and PAQ scores (r = 0.352, p = 0.000). There was a weak positive correlation between HLSAC-T and AHLS scores (r = 0.280, p = 0.000), and a moderate positive correlation between AHLS and PAQ scores (r = 0.442, p = 0.000). There was a moderately significant relationship between health literacy and physical activity levels of adolescents. The study also examined the relationship between parental health literacy, adolescents' health literacy and physical activity levels. While there was a significant, weak relationship between parental health literacy and adolescents' health literacy levels, there was a moderately significant relationship between parental health literacy and adolescents' physical activity levels.

Purpose/Objectives: Poor health literacy is a problem for over 45% of American adults and is associated with a variety of adverse health outcomes. Low health literacy has been associated with poor prenatal care utilization and a higher likelihood of poorer glycemic control. Poor glycemic control can lead to poor birth outcomes for both the mother and infant. Health literacy levels of pregnant women with diabetes can influence these outcomes and need to be known early in the pregnancy. Interventions can influence tighter glycemic control and lessen the impact of diabetes for the mother and infant. Therefore, the purpose of this study was to explore the associations among health literacy levels and health outcomes in pregnant women with pregestational and gestational diabetes. Methods: With a sample of 32 pregnant women in an urban, safety-net clinic in the South we measured health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM), the Literacy Assessment for Diabetes (LAD), and the Rapid Estimate of Adult Literacy in Genetics (REAL-G) and determined glycemic control. In addition, we evaluated three questions from the Short Test of Functional Health Literacy in Adults (S-TOFHLA) as a potential health literacy screening instrument in this sample. Outcome measures included birth outcomes for the mother of hypertension, premature birth, delivery method, polyhydramnios, and vaginal laceration, and for the infant, gestational age at birth, birth weight, respiratory distress, congenital anomalies, and fetal demise. The sample was characterized with descriptive statistics. Parametric and nonparametric tests were conducted to compare levels of health literacy and birth outcomes between groups. Results: Over 81% of the participants in this study were African American with 56.3% of the women demonstrating high health literacy as determined by the REALM. Glycemic control, measured by glucose self-report, demonstrated that women with high health literacy recorded more glucose readings (p = .02) than women with low health literacy scores. Mothers with high health literacy experienced more spontaneous labor at term (p = .10), a higher cesarean section rate and more normal weight infants than the mothers with low health literacy. While not statistically significant, women with low health literacy experienced more adverse birth outcomes. Women with pregestational diabetes trended toward higher health literacy than did women with gestational diabetes on all three instruments. In fact, those with gestational diabetes initiated prenatal care later than those with pregestational diabetes. The 3 questions from the S-TOFHLA did not show high enough correlation to the REALM (r = -.25) and thus were not considered as an effective as a screening tool for health literacy in this study. Conclusions: In our small sample, higher health literacy was associated with more glucose readings by maternal self-report and more spontaneous labor at term. A better understanding of health literacy and its’ role in maintaining health, specifically in relation to the health of pregnant women with diabetes, is needed by health providers as this knowledge may improve birth outcomes. These results need to be interpreted cautiously because of the small sample size and further research is needed.

Asian American immigrants have a lower level of health literacy than non-Latino whites, but their level of health literacy and its impact on health outcomes may differ among subgroups. We investigated the level of health literacy across five subgroups of Asian American immigrants and explored the association between health literacy and self-rated health status and symptoms of depression. We utilized a cross-sectional survey research design and a population-based sampling strategy using the 2007 California Health Interview Survey (CHIS). We sampled 30,615 non-Latino whites and 3,053 Asian American immigrants (1,058 Chinese, 598 Koreans, 534 Filipinos, 416 South Asians, and 447 Vietnamese). We used two questions as proxy measures to assess the level of health literacy in non-Latino whites and in both aggregated and disaggregated Asian American immigrant groups. We then investigated the effect of health literacy on two main health outcomes: self-rated health status and depression symptoms. The level of health literacy varied across the five subgroups of Asian American immigrants. Chinese, Korean, and Vietnamese groups had the lowest levels of health literacy, while Filipinos showed the highest level. Health literacy was positively correlated with health status in Chinese and Korean immigrants, and negatively correlated with depression symptoms in Korean and South Asian immigrants. We found heterogeneity in health literacy among Asian American immigrants and found that health literacy had varying associations with health outcomes. The aggregated Asian American immigrant group results may mask the true health disparities that each Asian American immigrant group faces. Koreans were the only group found to have a significant association between the proxy for health literacy and both health outcomes. Further research is needed to better understand the causes of heterogeneity and to investigate health literacy as a critical determinant of immigrant health.

The health literacy of citizen is determined by a set of demographic and social factors. The deficiency of health literacy of population in the Russian Arctic Zone conditions delay in indicators characterizing population health from their all-Russian values and menaces ability to achieve the targets of the National Strategy of Development of Russian Arctic Zone and Ensuring National Security up to 2035.The purpose of the study is to assess level of health literacy of patients and healthy population residing in circumpolar territories of Russia (Arkhangelsk Oblast).The level of general health literacy in the subgroups of respondents varied in narrow range of 26.9-36.3 points. The most significant difference was established between scores of interactive health literacy (Δ = 4.1 points) and critical health literacy (Δ = 3.4 points), which were higher in group of healthy respondents. The predictors of level of general health literacy are clinical status (value of dependent variables in healthy respondents was on average higher on 0.75-1.73 points), self-assessment of one's positioning in society (every additional point increases average level of general health literacy by 0.47-0.79 points) and age (every additional year of life reduces level of general health literacy by 0.08 - 0.09 points). The results of the study indicate on dependency between clinical status and the level of health literacy, determine social characteristics of risk group with low health literacy as object of additional preventive measures directed at citizen residing in in circumpolar terrotories of The Russian Federation.

Introduction: Health literacy enables adolescents to access, understand, and evaluate health information, act on it in a relevant and competent way, make decisions, and take measures that promote health in different contexts of everyday life. The study aimed to assess adolescents' health and e-health literacy levels, evaluate the differences in adolescents' health literacy to sociodemographic characteristics and health determinants, and determine their relationship. Material and methods: The study was designed as an observational, analytical, comparative, and cross-sectional survey of secondary vocational schools and gymnasium pupils. The sample consisted of a total of N = 456 adolescents. The following research instruments were used: The Health Literacy Measure for Adolescents (HELMA), the e-Health Literacy Assessment Scale (e-HEALS) and a general questionnaire for obtaining sociodemographic data and data on health determinants created for this research. Results: The desired health literacy level was reached by 61.6% of adolescents, and 38.4% were at limited health literacy. A high level of e-health literacy was established in the majority of adolescents. Adolescents showed the highest level of health literacy in understanding health information and communicating about it, and the lowest level was in the domain of calculations. The difference in the level of health literacy was determined by age, school performance and mother's education, as well as by health determinants. The health literacy level and e-health literacy among adolescents are strongly positively correlated. Conclusion: Considering that more than one-third of adolescents have limited health literacy and the impact of health literacy on disease prevention, self-care and quality of life, it is necessary to work on raising the level of health literacy among adolescents through educational interventions.

Introduction In order to ensure self-care, the individual must be able to decide, for example, on the lifestyle to adopt. These capacities and the capacities to take their share of responsibility in public health issues are called health literacy. In the same way, your attitude towards the treatments imposed on you is also crucial to the successful treatment and / or prevention of pathologies. In this case we talk about adherence to therapy. Objectives To clarify the concepts Health Literacy and Therapy Adherence and identify measurement measures of each concept. In addition to measuring these variables, the study also aimed at investigating the existence of a relationship between health literacy levels and levels of adherence to therapy. Methodology Through the application of a measurement tool, consisting of three validated instruments, in a pharmacy in the municipality of Mealhada, to 377 individuals residing there. To evaluate the levels of Health Literacy, two tests were applied: HLS-EU-PT (European Health Literacy Survey Questionnaire - Portugal) and METER (Medical Term Recognition Test). The first, quite comprehensive and previously applied at European level, of self-perception, and the second more objective. The third measurement instrument used was the MAT (Treatment Adherence Measure) to assess adherence to therapy. Results 59.2% of individuals from Mealhada County have a problematic or inadequate index of health literacy. Compliance rates correspond to 67.9%. In the sample studied, as regards non-adherents, it is the individuals with limited literacy that present the highest non-adherence rate (HLS-EU-PT 71.1%; METER 61.2%). In each of the three domains assessed by the HLS-EU-PT, in the individuals with adequate levels of literacy, the percentage of adherents is always higher than non-adherents. Conclusion There is a correlation between health literacy levels and adherence levels. Low levels of health literacy had a negative impact on treatment adherence.

Despite being widely regarded as a major cause of health inequalities, little is known regarding levels of health literacy among older adults in Switzerland. To fill this gap, this study assesses health literacy and its associations with individuals’ social, regional, and health characteristics in a nationally representative sample of adults aged 58 years and older in Switzerland. We use data of 1’625 respondents from a paper-and-pencil self-completion questionnaire that was administered as part of wave 8 (2019/2020) of SHARE in Switzerland. Health literacy is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). We use multivariable regressions to explore how respondents' sociodemographic characteristics are independently associated with health literacy. Overall, 6,8% of the respondents had inadequate health literacy, 24,6% problematic health literacy, and 68,6% sufficient health literacy. There were significant associations between health literacy and individuals' gender, education, economic situation, and self-rated health. Women had higher levels of health literacy than men (p < 0,001). Moreover, a higher education level (p < 0,001), fewer financial difficulties (p< 0.01), and higher self-rated health (p < 0,001) were positively correlated with adequate/higher levels of health literacy. One-third of older citizens have difficulties managing health-related issues in Switzerland. These findings call for targeted interventions, such as using simplified health or eHealth information tools, improved patient-provider communication, and shared decision-making, promoting lifelong learnings activities and health literacy screening for older patients to increase low health literacy and mitigate its consequences, thereby alleviating remaining social health inequalities in the Swiss population.