Enhancing the health knowledge and health literacy of recently resettled refugees through classroom-based instructional methods.

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

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

To address current gaps in health literacy research and practice in low-resource settings, the 'Alfa-Health Program' was designed to improve health literacy in older adults who live in a community dwelling in a socioeconomically disadvantaged community in North-East Brazil. In this longitudinal qualitative study, participants were interviewed before and after participating in the group-based program that was delivered November 2017 to December 2017 in the Primary Care Health Unit. Semi-structured interviews were guided by a previously validated health literacy instrument, translated and adapted for use in Brazil. Data was analyzed using Framework analysis. Of the 21 participants, the majority were age 60 to 69 years with a median of 4-years of school education. Our analysis identified self-reported improvements in health knowledge, behaviors, and skills that matched program content and indicated that participants were supported to manage their health conditions more autonomously. Other themes reflect the distributed nature of health literacy and the potential for group-based health literacy programs to facilitate feelings of social support and cohesion through co-learning. However, age-related deficits in memory and external and structural factors remained important barriers to program participation. This study provides insight into developing health literacy in low-resource settings with older adults, where health literacy is compounded by social determinants and cognitive and sensory changes that contribute to health disparities. Although the targeted Alfa Health Program addresses calls to ensure that priority is proportionate to need by reaching and engaging population groups who are disproportionately affected by low health literacy, further work is needed to adapt the program for people who are unable to read or write. [HLRP: Health Literacy Research and Practice. 2024;8(3):e140-e150.].

Impact of Health Literacy on Eye Health Disparities

OVER THE NEXT 3 YEARS, STATE AND LOCAL OFFIcials will be responsible for reaching out to and enrolling more than 30 million individuals in publicly funded or subsidized health plans offered through state insurance exchanges. Because low health literacy tends to be more prevalent in certain minority groups and among those with low income and education, the majority of the newly eligible individuals are likely to have low health literacy. Failure to meet enrollment goals will not only undermine the credibility and success of the Patient Protection and Affordable Care Act (ACA) but, more importantly, will do little to expand health insurance coverage and improve access to care among those at greatest need. Health literacy is “the degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make appropriate health decisions.” A 2004 Institute of Medicine report estimated that 90 million Americans lack the skills needed to understand and act on health information and concluded that “ . . . efforts to improve quality, reduce costs, and reduce disparities cannot succeed without simultaneous improvements in health literacy.” Recent estimates suggest that more than half (53%) of currently uninsured adults—those who will become newly insured under the ACA—have “below basic” or “basic” literacy skills. Such individuals have difficulty with tasks such as finding the date of a physician’s visit on an appointment slip or explaining why someone should have a medical test using information from a clearly written pamphlet. Individuals with low health literacy are less likely to actively participate in health care decision making and more likely to struggle with health management tasks and to face significant challenges navigating the health system. Recent studies also document higher rates of mortality among patients with limited health literacy. This growing evidence base prompted the Institute of Medicine to select “improving the health literacy of the population” as one of 24 Healthy People 2020 objectives submitted to the Department of Health and Human Services to help guide the US health agenda. The ongoing evolution of the health care system is leading US households toward greater responsibility for their own well-being. With this responsibility, however, comes an increasing need to be able to find, trust, use, and act on relevant information to make informed choices. Yet there continues to be a substantial mismatch between the high literacy burden of health information materials designed to support such choices and the health and financial literacy skills of individuals who use them. For example, approximately 9 of 10 US adults (88%) cannot calculate an employee’s share of health insurance costs using a table based on income and family size. In the current economic and policy environment, low health and financial literacy remains a barrier to reducing gaps in health care, raising concerns about the health and well-being of those who are unprepared for the increasing responsibility of choice. Enrollment in a health insurance plan, particularly a government-funded or subsidized plan in which eligibility must be verified, is a complex task. Individuals must navigate the system to find accurate and usable information; understand eligibility guidelines, complete forms, and provide mandatory citizenship and financial documentation necessary for enrollment (and for periodic reestablishment of eligibility); understand concepts such as premiums, copayments, and benefits and be able to apply these concepts to their existing or anticipated health situation to select the most appropriate plan; understand which services are and are not covered; and complete additional paperwork to enroll in their selected plan. The steps must occur prior to an actual visit with their physician, during which patients may spend limited time obtaining the information that is essential for maintaining optimal health and managing acute and chronic health conditions. In addition to developing a consumer-friendly enrollment system, evidence from Massachusetts’ 2006 reforms suggest that financially supporting community-based organizations and health care practitioners to help consumers navigate the process and fill out applications is effective: of all successful subsidy applications, 60% were completed with personal assistance to the consumers by such organizations.

More than 90 million U.S. adults have low health literacy, which is the ability to obtain and understand health information in order to make appropriate health decisions. Nutrition literacy is a component of health literacy pertaining to nutrition information. Nearly 68 million adults have hypertension, a preventable risk factor for cardiovascular disease and stroke; and persons with limited knowledge and understanding of diet and health concepts such as hypertension, generally have low health literacy and poor medication adherence. Community‐dwelling seniors in Sacramento County completed a modified health and nutrition knowledge survey, and two validated health literacy assessments: 1) the short Test for Functional Health Literacy (s‐ToFHLA) and 2) the Newest Vital Signs (NVS) to measure health or nutrition literacy. The goal was to determine the relationship between health and nutrition ˈknowledgeˈ and ˈliteracyˈ among hypertensive older adults (≥ 65 years). The sample included 69 older adults with an average age of 72 (SD= 7.3), and 26% African American, 9% Hispanic, and 58% White participants. Study findings included a modest correlation between the total literacy score and total knowledge score (r=0.58, p = 0.04), and significantly lower literacy scores for participants on blood pressure medication compared to those who were not (n=27) (95% CI: −83.04, −18.49%, p ≤ 0.01). No significant differences in scores were found for those on a low‐sodium diet compared to those who were not (p= 0.17). Future studies are needed to understand the relationship of health literacy to health outcomes to facilitate the development of tailored, effective interventions for older adults with chronic conditions.*Funding for this study was provided by the UC Davis Betty Irene Moore School of Nursing

* Abbreviations: NAM — : National Academy of Medicine NHES — : National Health Education Standards Only 12% of American adults have proficient health literacy, defined as a set of skills needed to effectively function in the health care system.1 This is troubling given that health literacy is a stronger predictor of health than age, income, employment status, educational level, or race.2 A growing body of research also shows that low health literacy is associated with worse child health outcomes,3 higher health care costs, and elevated mortality rates.1 Although Americans are increasingly expected to be knowledgeable consumers of health care, it is clear that many individuals lack the core health literacy skills needed to understand their health insurance.4 This inadequate understanding of health care information creates challenges beyond the selection of a health insurance plan or payment calculations. Poor health literacy, including health numeracy, extends into one’s ability to seek care at an appropriate time, navigate through the health system, and share in important medical decisions. In this Perspective, we describe national efforts to combat low health literacy rates and argue that they fail to adequately prepare children and adolescents to be health-literate adults. We then propose several steps for educators, health care providers, and policymakers to improve health literacy among children and adolescents in the United States. The US Department of Health and Human Services, the National Academy of Medicine … Address correspondence to Tyler N.A. Winkelman, MD, MSc, University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, North Campus Research Center, 2800 Plymouth Rd, Building 14, Room G100-20, Ann Arbor, MI 48109-2800. E-mail: tywink{at}med.umich.edu

Higher levels of parental health and digital literacy are associated with better health knowledge and therefore better health outcomes for their children. There is currently no research evaluating the impact of parental digital and health literacy on children's participation in sport. This cross-sectional study aimed to investigate the effect of parental digital and health literacy on the sport participation of their children and included parents of children aged 6-18 years, categorized into a sport-participating group (n = 201) and a non-participating group (n = 116). Parents completed a questionnaire assessing demographic characteristics, internet and mobile phone usage for health-related purposes, and their children's level of sport participation. Additionally, they were administered the Digital Literacy Scale and the Health Literacy Scale. The total, technical, and social dimension scores of the Digital Literacy Scale were significantly higher in parents of children participating in sport (P < .05). Similarly, the total score on the Health Literacy Scale, as well as the subscale scores for accessing/obtaining, understanding, and processing/appraising health-related information were significantly higher in the sport-participating group (P < .05). Furthermore, a significant correlation was observed between the total scores of the Digital Literacy Scale and the Health Literacy Scale (P = .001, r = 0.412). These findings indicate that parents of children engaged in sport have significantly higher digital and health literacy levels. Enhancing parental digital and health literacy may play a crucial role in promoting children's participation in sport. Interventions aimed at improving parental digital and health literacy could positively impact children's sport-related health outcomes.

In the setting of increased interest in health literacy, the American Academy of Pediatrics (AAP) convened a national conference on health literacy and pediatrics in Washington, DC, on November 8, 2008: “A Health-Literate America: Where Do Children Fit In?” The purpose of the conference was to examine health literacy related issues, problems, and opportunities with reference to children and children's health. Most health literacy research and interventions have focused on adult patients and diagnoses, and this gathering—which brought together pediatricians, health literacy researchers, educators, health systems researchers and policy makers, and adult learners—was designed to address complex questions related to where children fit in a national health literacy agenda. Themes of the conference that run through this collection of commissioned articles, which were presented at the conference and are published in this supplement to Pediatrics , identify some of the ways in which children are distinct from adults regarding issues of health literacy while reminding us of how they are also part of the larger health literacy picture. The challenge of including children in a “health-literate America” is necessarily part of the overall challenge of addressing health literacy. The goals for children and their adult caregivers are the same as for adults: to use the health literacy perspective and its insights and evidence base to enhance the health care system, increase access and inclusion, reduce disparities, and improve health outcomes. This supplement to Pediatrics includes a systematic review by DeWalt and Hink1 of the literature on health literacy and child health outcomes, including analysis of methodology, discussion of the parent-child dyad, and opportunities for studying new interventions as they are developed. Wolf et al,2 in their article, observe the relationship between health literacy and health learning, offer a broadened definition of health literacy, and emphasize … Address correspondence to Benard P. Dreyer, MD, New York University School of Medicine, Department of Pediatrics, 550 First Ave, NBV 8S4-11, New York, NY 10016. E-mail: bpd1{at}nyu.edu

BackgroundAdult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting.MethodsFeasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants’ health literacy and pilot test health literacy measures.ResultsTwenty-two socially disadvantaged adults with low literacy participated in the program and received 80–90 hours of health literacy instruction. The program received institutional support from Australia’s largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants’ health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals.ConclusionsPositive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0373-1) contains supplementary material, which is available to authorized users.

The Health Literacy of Adults With Severe Mental Illness

According to the World Health Organization, ＂health literacy＂ represents knowledge of health possessed by an individual and the capability to implement the knowledge when adopting health promotion actions. However, many people, including medical professional, often have misunderstood the definition of health literacy; it does not equal to health education. It is about empowerment; in fact, it improves people's literacy ability in health-related information, so they can have the capability to become healthier. Taipei City Hospital is not only a city hospital that has the responsibility to take care of its citizen’s health, but also a health promotional hospital that helps the citizens to improve their health literacy. In this study, 10 different aspects were used to determine the current health literacy promotion status of Taipei City Hospital, and the unique way that Taipei City Hospital uses to train its employees to make the whole hospital including the systems and providers to become more health literate are also described in the research. When training the employees, health professionals are not the only internal target group that will be trained, but every professional including the administrative staff will all be trained in health literacy improving programs. One must, especially for the medical professionals, be health literate in order to be aware of and identify people with low health literacy. The three key components for the Taipei City Hospital when promoting health literacy are desire, knowledge, and ability; using communication skill to help people finding the desire to be healthier, pass them the knowledge, and show them the way to execute it. The Taipei City Hospital contributes its effort in the promotion of health literacy and strengthens citizens' self-healthcare and health promotion. With the effective health literacy training program, the employees of the Taipei City Hospital have better health communication ability to complete their jobs and responsibility with efficiency. As a result, the patients' health literacy ability can be improved, and it will lead to a win-win result for health literacy promotion.

ObjectiveHealth literacy is a significant public health concern, particularly given the increased complexity of chronic disease health management and health system navigation, and documented associations between low health literacy and poor health outcomes. This study therefore aimed to identify the proportion and characteristics of outpatients visiting a specialist cancer hospital who report low health literacy and/or low cancer health literacy.MethodThis study used a cross-sectional survey administered verbally with patients attending a specialist cancer hospital located in Melbourne, Australia over a two-week period. Process data on conducting health literacy screening within a clinical setting was collected.ResultsThose identified with inadequate general health literacy were different to those identified with low cancer-specific health literacy, although overall both proportions were low. Cross-sectional screening of patients was difficult, despite utilising verbal surveying methods designed to increase capacity for participation.ConclusionHealth literacy screening using the tools selected was not useful for identifying or describing patients with low health literacy in this setting, given the disparity in those categorised by each measure.Practice ImplicationsUntil the theoretical construct of health literacy is better defined, measurement of health literacy may not be clinically useful.

An Integral Component of Pediatric Nursing Practice

Background: There is a paucity of evidence associating health literacy metrics with adults' enhanced health knowledge, health status, health practices, or health behaviors. Purpose: Investigate whether health-literate undergraduates exhibit enhanced health knowledge, health status, health practices, or behaviors compared to non-health-literate cohorts. Methods A convenience sample of 362 urban undergraduates responded to (1) Short Test Functional Health Literacy in Adults, (2) Health Knowledge Inventory, and (3) the American College Health Association's (ACHA) National College Health Assessment. Results: Only 4 of 78 variables discriminated between subjects rated health literate and not health literate. Three of the 4 discriminating variables had a negative association between adequate health literacy and positive health outcomes. Discussion: There was no difference between undergraduates who qualified as health literate and not health literate in (1) a minimal standard of health knowledge; (2) positive health practices; (3) positive health behaviors; or (4) health status. Translation to Health Education Practice: Recommendations: (1) health literate should be replaced with the functional intervention of health educated in the nation's priorities for improving health outcomes; and (2) state governments should capitalize on preexisting public/higher education infrastructures to deliver health education to the nation's population to remediate health disparities, improve health outcomes, and address national health outcome objectives.