Exploring the relationship between health literacy and attitude to believe fake news about food: a survey among the Italian population

BackgroundDuring the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19–related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors.ObjectiveThe objective of this study was to develop and verify a COVID-19–related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants’ health literacy and eHealth literacy.MethodsA snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19–related health behaviors.ResultsOf 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19–related health behavior questionnaire presented a two-factor structure—COVID-19–specific precautionary behaviors and conventional health behaviors—with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19–related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19–specific precautionary behaviors (βhealth literacy=.149, βeHealth literacy=.368; P<.001) and conventional health behaviors (βhealth literacy=.219, βeHealth literacy=.277; P<.001).ConclusionsThe COVID-19–related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19–related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19–related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19–related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students.

Individual health literacy is an established predictor of individual health outcomes. Community-level health literacy may also impact individual health, yet limited research has simultaneously considered the influence of individual and community health literacy on individual health. The study goal was to determine if community health literacy had an independent relationship with individual self-reported health beyond individual health literacy. We used data from the 2008 and 2010 Hawai'i Health Survey, a representative statewide telephone survey. Multilevel models predicted individual self-reported health by both individual and community health literacy, controlling for relevant individual-level (education, race/ethnicity, gender, poverty, insurance status, age, and marital status) and community-level variables (community poverty and community education). The sample included 11,779 individuals within 37 communities. Individual health literacy was defined by validated self-reported measurement. Communities were defined by zip code combinations. Community health literacy was defined as the percentage of individuals within a community reporting low health literacy. Census data by ZIP Code Tabulation Areas provided community-level variables. In descriptive results, 18.2 % self-reported low health literacy, and 14.7 % reported self-reported poor health. Community-level low health literacy ranged from 5.37 % to 35.99 %. In final, multilevel models, both individual (OR: 2.00; 95 % CI: 1.63-2.44) and community low health literacy (OR: 1.02; 95 % CI: 1.00-1.03) were significantly positively associated with self-reported poor health status. Each percentage increase of average low health literacy within a community was associated with an approximately 2 % increase in poor self-reported health for individuals in that community. Also associated with poorer health were lower educational attainment, older age, poverty, and non-White race. Both individual and community health literacy are significant, distinct correlates of individual general health status. Primary care providers and facilities should consider and address health literacy at both community and individual levels.

Background Patients’ economic status and level of health literacy may influence their experiences with healthcare services. However, few studies have examined how these factors shape inequalities in patient-reported experiences measures (PREMs), particularly in cancer care. Thus, we investigated whether experiences of cancer care differed according to patients’ economic status and level of health literacy. Methods We used data from 3,220 adult patients diagnosed with cancer collected by the Swiss Cancer Patient Experiences (SCAPE) study in eight Swiss hospitals from September 2021 to February 2022. Logistic regressions were used to investigate the association between patients’ economic status and health literacy and 30 different outcomes, in separate models for each outcome. The outcomes covered eight different areas of cancer care experiences. Models were adjusted for patients’ age, gender, education level and self-rated health. Since hospitals were located in two different linguistic regions of Switzerland, we tested interaction effects between the regions and economic status and health literacy. Results In the sample, 30.6% of patients experienced economic hardship and 25.7% had a low health literacy. Patients with low economic status and low health literacy had worse experiences of cancer care for 21 outcomes and 24 outcomes, respectively, compared to patients reporting higher economic status and higher health literacy. No differences were found between linguistic regions in the effects of these two predictors. Discussion: Our study showed that economic and health literacy factors generated inequalities in patients’ experiences of cancer care: patients with lower economic status and health literacy were negatively affected in their cancer care experiences. Hence, disadvantaged patients may require specific attention in order to enhance their experiences with healthcare services, and promote a more equal treatment of patients in cancer care. Key messages • Few studies have investigated inequalities in patients’ experiences with cancer care, while factors such as economic status and health literacy may affect care experiences. • Patients who face economic hardship and with low health literacy showed a worse cancer care experience. These disadvantaged patients may require specific attention to improve their care experience.

Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.

Fake health-related news has spread rapidly through the internet, causing harm to individuals and society. Despite interventions, a fenbendazole scandal recently spread among patients with lung cancer in South Korea. It is crucial to intervene appropriately to prevent the spread of fake news. This study investigated the appropriate timing of interventions to minimize the side effects of fake news. A simulation was conducted using the susceptible-infected-recovered (SIR) model, which is a representative model of the virus spread mechanism. We applied this model to the fake news spread mechanism. The parameters were set similarly to those in the digital environment, where the fenbendazole scandal occurred. NetLogo, an agent-based model, was used as the analytical tool. Fake news lasted 278 days in the absence of interventions. As a result of adjusting and analyzing the timing of the intervention in response to the fenbendazole scandal, we found that faster intervention leads to a shorter duration of fake news (intervention at 54 days = fake news that lasted for 210 days; intervention at 16 days = fake news that lasted for 187 days; and intervention at 10 days = fake news that lasted for 157 days). However, no significant differences were observed when the intervention was performed within 10 days. Interventions implemented within 10 days were effective in reducing the duration of the spread of fake news. Our findings suggest that timely intervention is critical for preventing the spread of fake news in the digital environment. Additionally, a monitoring system that can detect fake news should be developed for a rapid response.

Background The use of social media as a platform to access news and information has the potential to lead to the spread of fake news in Indonesia. This study aims to (1) understand the trust characteristics in information of Indonesians during COVID-19; (2) identify Indonesians’ ability to detect COVID-19 fake news; and (3) analyze the relationship between people’s trust characteristics in information with regard to COVID-19 information and their ability to detect fake news. Method An online survey was conducted with 751 Indonesians who use social media to access information about COVID-19. Cultural theory is used to categorize people’s trust characteristics in information, while signal detection theory is employed to identify people’s ability to discriminate between fake and real news. Results The results showed that 61% of respondents were categorized as having hierarchy trust characteristics. Concerning the detectability of fake news, most respondents could discriminate between fake and real news. Lastly, there was a relationship between trust characteristics in information and bias tendencies in detecting fake news. Conclusions The respondents have hierarchy trust characteristics, indicating they trusted government information related to COVID-19 issues. The respondents also have high ability to discriminate between fake and real news, even though they tended to miss more errors than identify false alarms when detecting fake news. The findings showed that respondents who had hierarchy and egalitarian characteristics tended to perceive real news as fake news and had a better ability to distinguish fake news compared to other trust characteristics in information.

Introduction. The spread of fake news on the internet is an increasingly serious problem. When analysing belief in fake news, people are usually treated as homogeneous group, however, previous studies suggest that different groups may exist. This study aims to identify clusters of older people according to their level of belief in real and fake news. Methods. 504 people aged 50 to 90 years (M=64.37, SD=9.10) participated in the study. Belief in true and false news was assessed using 10 news headlines (six false, four true). Respondents’ vaccination intentions and trust in democratic institutions were assessed. A cluster analysis was performed to distinguish between groups of respondents. Results. Four clusters were identified and replicated: moderately believing in fake and real news; believing in real but not in fake news; tending not to believe in either real or fake news; and tending to believe in both real and fake news. Individuals who fell into the cluster of believers in both real and fake news had lower intentions to vaccinate against COVID-19 and lower trust in political institutions. Conclusions. The study provides evidence that people aren’t homogeneous in their belief in fake and real news, and four meaningful clusters can be distinguished.

Background:People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population.Objective:This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury.Methods:Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health).Key Results:There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health.Conclusions:To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces. [Health Literacy Research and Practice. 2017;1(2):e71–e85.]Plain Language Summary:Health literacy represents people's abilities to obtain, understand, and use health information to make informed decisions about their health and health care. People with disabilities face physical, attitudinal, economic, and structural barriers to care. Consideration of health literacy in rehabilitation practice can enhance the effectiveness of the patient-clinician relationship and help address the needs of this population.

BackgroundAdolescence represents a crucial phase of life where health behaviours, attitudes and social determinants can have lasting impacts on health quality across the life course. Unhealthy behaviour in young people is generally more common in low socioeconomic groups. Nevertheless, all adolescents should have a fair opportunity to attain their full health potential. Health literacy is positioned as a potential mediating factor to improve health, but research regarding health literacy in adolescents and socially disadvantaged populations is limited. As part of Phase one of the Ophelia (OPtimising HEalth LIterAcy) framework, The purpose of this study was to explore the perceptions of socially disadvantaged Irish adolescents in relation to health literacy and related behaviours, and utilise this data to develop relevant vignettes.MethodsA convergent mixed method design was used to co-create the vignettes. Questionnaires were completed by 962 adolescents (males n = 553, females n = 409, Mean age = 13.97 ± 0.96 years) from five participating disadvantaged schools in Leinster, Ireland. Focus groups were also conducted in each school (n = 31). Results were synthesised using cluster and thematic analysis, to develop nine vignettes that represented typical male and female subgroups across the schools with varying health literacy profiles. These vignettes were then validated through triangular consensus with students, teachers, and researchers.DiscussionThe co-creation process was a participatory methodology which promoted the engagement and autonomy of the young people involved in the project. The vignettes themselves provide an authentic and tangible description of the health issues and health literacy profiles of adolescents in this context. Application of these vignettes in workshops involving students and teachers, will enable meaningful engagement in the discussion of health literacy and health-related behaviours in Irish young people, and the potential co-designing of strategies to address health literacy in youth.ConclusionAs guided by the Ophelia framework, the use of authentic, interactive and participatory research methods, such as the co-creation of vignettes, is particularly important in groups that are underserved by traditional research methods. The approach used in this study could be adapted to other contexts to represent and understand stakeholders’ perceptions of health, with a view to explore, and ultimately improve, health literacy.

Food choices are determined by intrinsic and extrinsic product characteristics, biological and physiological features, psychological factors, and situational and socio-cultural factors. Self-determination theory offers the explanation of health behavior change identifying motivations located along a continuum of autonomy. Another approach to the motivations guiding health behaviors, including food choices, relies on distinguishing thematic categories. Health motivations seem to be an obvious determinant of health behaviors, but final decisions regarding health are also the effect of other types of motivations such as economic, cultural, or emotional. The role of marketing pressure in modern society is perceived to be an important source of motivation for purchasing food and other products. The Motivation–Opportunity–Ability (MOA) framework was initially proposed in order to explain the processing of brand information from advertisements and was later expanded to other areas, including health and nutritional behaviors. The aim of this study was the analysis of determinants of food choices. We have developed a common regression model including six categories of motivations addressed by the Eating Motivations Scale and three health literacy types corresponding with element of ability from the MOA framework, adjusted for socio-demographic factors, health status, and the use of the Internet and TV. The analysis was performed on data from a computer-assisted web-based interviewing (CAWI) survey among 2008 adult Internet users completed in May 2022. The uni- and multivariate linear regression models were developed with the Index of Unhealthy Food Choices (IUFC), calculated based on the responses to items asking about the frequency of the consumption of twelve food categories. Univariate modeling revealed that IUFC is significantly associated with health, food, and e-health literacies and with five out of six eating motivations. However, the multivariate regression model yielded significant associations only for eating motivations but not for the three literacy scores. Health motivation was negatively associated with IUFC (B, standard error (SE): 0.83, 0.07; 95% confidence interval (95% CI): 0.98–0.69), but positively with emotional (B, SE: 0.22, 0.04; 95% CI: 0.14–0.3), economic (B, SE: 0.41, 0.08; 95% CI: 0.25–0.56), and marketing (B, SE: 0.62, 0.08; 95% CI: 0.47–0.78) motivations. Our findings suggest that motivations guiding food choices may prevail over the element of ‘ability’ distinguished in the frameworks and models that explain people’s behaviors, including behaviors relating to health. Thus, it is essential to emphasize development of appropriate motivations and not only to provide knowledge and skills. Furthermore, one should also remember motivations other than health motivations when searching for the determinants of health behaviors.

Identifying fake news has become an important issue. Increasing usage of social media has led to an increase in the number of people who can be influenced, thus the spread of fake news can potentially impact important events. Fake news has become a major societal issue and a technical challenge for social media companies to identify and has led many to extreme measures, such as WhatsApp deleting two million of its users every month to prevent the spread of fake news. The current problem of fake news is rooted in the historical problem of disinformation, which is false information intentionally, and usually clandestinely, disseminated to manipulate public opinion or obfuscate the truth. Our work addresses the problem of identifying fake news by (i) detecting and analyzing fake news features (ii) identifying the textual and sociocultural characteristics fake news features.

Background:Health literacy enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. Although health literacy research in China has gained increasing attention in recent years, most existing studies focus on adults rather than adolescents. In addition, little theory-driven empirical research has been conducted to fully understand the relationship among health literacy, its influencing factors, and health outcomes scored on a skills-based health literacy instrument.Objective:This study applied Manganello's framework to investigate how health literacy was related to its antecedents and health status in secondary students in Beijing, China.Methods:A cross-sectional study was conducted with 650 students in Years 7 to 9 (age 11–17 years) from four secondary schools. Students completed a self-administered questionnaire based on Manganello's health literacy framework, which measured key upstream determinants, including health literacy and self-report health status. Health literacy was measured on an 8-item skills-based instrument that assesses a person's ability to find, understand, appraise, and communicate health information in everyday life (scores range from 0–37). Descriptive statistics and path analysis were conducted to investigate the mediating role of health literacy in predicting health status.Key Results:Overall, the average scores of students' health literacy was 26.37 (±5.89). Manganello's framework was supported by the data collected (χ2/df = 2.049, p = .001, comparative fix index = 0.966, root mean square error of approximation = 0.041). Personal self-efficacy (r = 0.11, p = .007), social support (r = 0.18, p < .001), and school environment (r = 0.27, p < .001) predicted health literacy, which in turn predicted students' health status (r = 0.12, p = .005).Conclusions:Adolescent health literacy is not only a person's capability to protect health, but also an interactive outcome with the broader environment. Promoting health literacy could be a useful strategy to improve health status for adolescents; however, a holistic approach is needed to increase students' self-efficacy, promote social support, and create positive school environments to achieve optimal health literacy and health outcomes. [HLRP: Health Literacy Research and Practice. 2021;5(1):e1–e14.]Plain Language Summary:We investigated how health literacy was related to its influencing factors and health status among secondary students in Years 7 to 9 in Beijing, China. Students with low self-efficacy, low social support, and low perceptions of positive school environment were more likely to have low health literacy, which in turn predicted poor health status.

BackgroundOsteoarthritis (OA) is disproportionately prevalent in people from lower socio economic groups (1). People from lower socio economic groups are also more likely to have lower health literacy. Health literacy...

Cross-sectional survey study. The aim was to determine if health literacy level is associated with patient-reported outcomes and self-reported health status among patients presenting to an academic outpatient spine center. Patient reports are critical to assessing symptom severity and treatment success in orthopedic spine patients. Patient-reported outcome measures (PROMs) are important instruments commonly used for this purpose. However, the influence of patient health literacy on PROMs has not yet been given much consideration in spine literature. Consecutive English-speaking patients over the age of 18 years and new to our clinic verbally completed the Newest Vital Sign health literacy assessment tool and a sociodemographic survey, including self-reported health status. In addition, seven Patient-Reported Outcomes Measurement Information System scores were extracted from patient records. Regression modeling was performed with PROMs considered as dependent variables, health literacy level as the primary predictor, and all other factors (age, sex, race, ethnicity, native English speaker, highest educational degree, grade-level reading, marital status, employment status, annual household income, and type of insurance) as covariates. Among the 318 included patients, 33% had limited health literacy. Adjusted regression analysis demonstrated that patients with limited health literacy had worse PROM scores across all seven domains (Physical Function: P =0.028; Depression: P =0.035; Global Health-Physical: P =0.001; Global Health-Mental: P =0.007; Pain Interference: P =0.036; Pain Intensity: P =0.002; Anxiety: P =0.047). In addition, patients with limited health literacy reported worse self-reported health status ( P <0.001). Spine patients with limited health literacy have worse baseline PROM scores confounders and report worse general health. Further investigations are necessary to elucidate if limited health literacy is a marker or the root cause of these disparities. Findings from this study urge the consideration of patient health literacy when interpreting PROMs as well as the implications for patient assessment and discussion of treatment options.

The relationship between a subject’s ideological persuasion with the belief and spread of fake news is the object of our study. Departing from a left- vs. right-wing framework, a questionnaire sought to position subjects on this political-ideological spectrum and demanded them to evaluate five pro-left and pro-right fake and real news, totaling 20 informational products. The results show the belief and dissemination of (fake) news are related to the political ideology of the participants, with right-wing subjects exhibiting a greater tendency to accept fake news, regardless of whether it is pro-left or pro-right fake news. These findings contradict the confirmation bias and may suggest that a greater influence of factors such as age, the level of digital news literacy and psychological aspects in the judgment of fake news are at play. Older and less educated respondents indicated they believed and would disseminate fake news at greater rates. Regardless of the ideology they favor, the Portuguese attributed higher credibility to the sample’s real news, a fact that can be meaningful regarding the fight against disinformation in Portugal and elsewhere.