Health Literacy of Japanese Elderly who Participated in A Long-term Care Prevention Exercise Program by Household Composition

Health literacy (HL) is an important concept for patient education and disease management with heart failure (HF). However, research on HL has predominantly focused on functional HL (ability to read and write). The World Health Organization advocates evaluating comprehensive HL, including the ability to access information (communicative HL) and critically evaluate that information (critical HL). We developed an instrument for measuring functional, communicative, and critical levels of HL in patients with HF. We evaluated the reliability and validity of those 3 HL scales in a sample of 191 outpatients with HF (mean [SD] age, 66.9 [13.9] years; 64.9% males). Sociodemographic and clinical characteristics, knowledge of HF, a well as motivation to obtain health information were assessed for each patient through a self-administered questionnaire and review of electronic medical records. We constructed scale items to reflect directly the comprehensive World Health Organization definition of HL. We identified 3 interpretable factors by exploratory factor analysis. Internal consistency was marginally acceptable for total HL (Cronbach α = 0.71), functional HL (α = 0.73), communicative HL (α = 0.68), and critical HL (α = 0.69); the interclass correlation coefficients of the functional, communicative, and critical HL subscales were 0.882, 0.898, and 0.882, respectively. Low functional, communicative, and critical HL was characteristic of older patients, those with lower socioeconomic status, patients living alone, those without a high school education, and patients lacking HF knowledge. Our new HL scale was demonstrated to be a reliable, valid instrument for measuring functional, communicative, and critical HL in patients with HF. Exploring a patient's HL level, including the ability to access, understand, and use health information as well as the ability to read and write, may provide better understanding of patients' potential barriers to self-care.

BackgroundInformation technology has expanded the gap in patient health literacy (HL), and HL has various implications on the trust in patient-doctor relationship. Previously, only functional HL, the ability to interpret...

BackgroundHealth literacy, or the ability to access, understand, appraise and apply health information, is central to individuals’ health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.MethodsA total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.ResultsInternal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.ConclusionsThis study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan.Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1835-x) contains supplementary material, which is available to authorized users.

BackgroundRefugees have poorer health compared to indigenous populations, which may be explained by lower health literacy, i.e. not being able to access, understand, appraise or apply health information. This study aims to determine levels of functional and comprehensive health literacy, and factors associated with inadequate health literacy, in refugees coming to Sweden.MethodA cross-sectional study was performed among 455 adult refugees speaking Arabic, Dari, Somali or English. Participants in 16 strategically selected language schools for immigrants responded to a questionnaire. Health literacy was measured using the Swedish Functional Health Literacy Scale and the HLS-EU-Q16 questionnaire. Uni- and multivariate statistical methods were used to investigate group differences.ResultsThe majority of the participating refugees had inadequate or limited functional health literacy and comprehensive health literacy. About 60% of them had inadequate functional health literacy and 27% had inadequate comprehensive health literacy. Low education and/or being born in Somalia were factors associated with an increased risk of having inadequate functional health literacy. Having inadequate functional health literacy was associated with an increased risk of having inadequate comprehensive health literacy.ConclusionsThe majority of refugees in the language schools had limited or poor health literacy. Health literacy should be taken into consideration in contexts and in activities addressing migrants. More research is needed to better understand health literacy among refugees and to develop strategies and methods to increase health literacy and make life easier for those with low health literacy.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1030) contains supplementary material, which is available to authorized users.

Health Literacy and Health-Related Quality of Life in Older Adults with Mild Cognitive Impairment

Declining cognitive function (CF) and physical function (PF) relate to poorer health-related quality of life (HRQoL) in older adults. As health literacy (HL) facilitates health information utilization, it may mediate links between functionality and HRQoL appraisals. This study examined HL as an intermediary between joint CF and PF contributions and HRQoL in Hong Kong older adults. 490 older adults aged 50-80 years completed assessments from March to July 2021. Health Literacy Survey Questionnaire Short Form 12 questions (HLS-SF12), Montreal Cognitive Assessment (MoCA), Senior Fitness Test (SFT) and 12-Item Short-Form Health Survey version 2 (SF-12v2) were used to assess HL, CF, PF and HRQoL, respectively. Path analysis tested a model with HL mediating CF/PF predictors and HRQoL outcome. Results for direct effects indicated that CF significantly associated with PF (β = 0.115, SE = 0.012, p < 0.001), PF significantly connected to HL (β = 0.101, SE = 0.022, p < 0.001), and HL significantly related to HRQoL (β = 0.457, SE = 0.049, p < 0.001). Meanwhile, PF significantly linked to HRQoL directly (β = 0.156, SE = 0.025, p < 0.001) as well as indirectly (β = 0.046, 95% CI [0.028, 0.067]). Significant mediating effect of HL was found on the relationship of PF and HRQoL. Findings confirm CF and PF joint impacts on HL and HRQoL in older adults, elucidating HL's mediating role in translating functionality levels into HRQoL. Fostering enduring health knowledge access may thus buffer effects of age-related declines on well-being. Results can inform interventions leveraging this pathway to promote resilient trajectories.

Background and objective: It is unclear how health literacy is associated with health-related quality of life. The aim of this study was to examine the mediating role of treatment regimen adherence between health literacy and health-related quality of life (HRQoL) in older adults with type 2 diabetes mellitus (T2DM). Material and methods: In this cross-sectional study, a multi-stage cluster sampling method was used to recruit 300 diabetic patients aged 60 years and over with diabetes. The abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Swedish Health-related Quality of Life (SWED-QUAL) instrument were used to measure health literacy and HRQoL, respectively. In addition, the Morisky Medication Adherence Scale (MMAS), the diet and exercise adherence questionnaire, were used to assess treatment regimen adherence. The four steps of Baron and Kenny’s procedure were implemented to test the mediation hypotheses. Results: The mean age of the respondents was 64.92 years. In addition, the mean of the respondents’ health literacy score was 52.82. The prevalence rates of the inadequate, marginal, and adequate health literacy of the respondents were 70%, 14.7%, and 15.3%, respectively. Two items of treatment regimen adherence (medication adherence and diet and exercise adherence) had a partial mediating role between health literacy and quality of life in elderly diabetes patients. The result of Baron and Kenny’s procedure and Sobel’s test showed a significant mediation role in medication adherence (p = 0.00, Sobel’s Z = 2.77) and diet and exercise adherence (p = 0.00, Sobel’s Z = 6.26) between health literacy and HRQoL. Conclusion: Medication adherence, diet adherence, and exercise adherence are mediating factors in relationship between health literacy and HRQoL that increase the health literacy and quality of life in older adults with T2DM.

Background: Patients today are required to understand more and more complex health information, and to navigate increasingly complex health systems. As a result, they need to develop skills such as finding, processing, understanding, and applying information about health issues, which has been conceptualized as health literacy (HL). Assessing HL is critical to providing meaningful health information to patients. Objectives: This study aimed to examine the cultural adaptation and the psychometric properties of the Iranian version of the functional, communicative and critical health literacy (FCCHL) scales measuring three aspects of HL among type 2 diabetic patients. Patients and Methods: We conducted a methodological survey of 187 patients with type 2 diabetes using a cross-sectional design. The study was carried out in two phases: the first phase was designed to obtain a cross-cultural equivalent of the FCCHL scales, based on Beaton’s guidelines. In the second phase, a cross-sectional study was conducted to evaluate the psychometric properties of the questionnaire. Results: Exploratory factor analysis (EFA) identified three main factors with 27.07%, 22.46%, and 16.23% of extracted variance, respectively. Confirmatory factor analysis (CFA) completely supported the three-factor model of the HL scales. Internal consistency was approved for the total scale (α = 0.82) and for the functional, communicative, and critical subscales (α = 0.91, 0.80, and 0.76, respectively). Convergent validity analysis indicated a significant positive correlation (r = 0.45; P < 0.01) between the scores on the functional HL scales and the Iranian version of the Short Test of Health Literacy in Adults (S-TOFHLA), which was to be expected. Conclusions: We concluded that the FCCHL scales are valid and reliable, and can be used to measure health literacy among Iranian diabetic patients. However, further research is needed to establish stronger psychometric properties for the use of this questionnaire in Iran.

This study aimed to examine the relationship between health literacy and health-related quality of life in older adults. A cross-sectional survey design was used. We used a self-administered questionnaire to assess sociodemographic factors of older adults, the Chinese Citizen Health Literacy Questionnaire (HLQC) and the 36-item Chinese version of the Short Form 36 (SF-36) to measure health literacy and quality of life, respectively, among older adults. Between September 2011 and June 2012, information was collected from 1,396 older adults in 44 nursing homes in four cities through face-to-face interviews. The mean health literacy level of older adults in nursing homes was relatively low (71.74 ± 28.35). Health-related quality of life scores were moderate (104.77 ± 16.92). There were statistically significant differences in the effects of health literacy, education level, former occupation (professional), marital status (widowed) and race on health-related quality of life. Improving health literacy is considered an important intervention to promote health-related quality of life in older adults in nursing homes.

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

Purpose: Health literacy (HL) has been recognized as an important concept in patient education and disease management for heart failure (HF). However, previous studies on HL has focused predominantly on the functional HL (the ability to read and write), the relationship between comprehensive HL including the ability to access to information (communicative HL) and the ability to evaluate critically (critical HL) and self-care behavior has not been evaluated. This study aimed to determine the relationship between the functional, communicative, and critical HL and self-care behavior on HF patients. Methods: Cross-sectional analysis of data were completed the HL (the comprehensive HL scale), HF-related self-care behaviors (The European Heart Failure Self-Care Behavior Scale) and HF-related knowledge. Socio-demographic (age, gender, education level) and clinical characteristics (etiology, risk factors, comorbidity and severity of HF) were also assessed. We used the analyses of covariance and multivariate linear regression to estimate the associations between three levels of HL and self-care behavior. Results: 189 out of 201 patients with HF were assessed (mean age 66.8±13.9 years; 64.6% males; 46.6% NYHA function classII). Patients with low HL had poor HF-related knowledge and self-care behavior than those with high HL (Knowledge: 9.2 versus. 11.8, P<0.00, Self-care: 35.5 versus. 32.4, P=0.03). Out of the three components of HL, patients with low critical HL had poor self-care behavior than those with high critical HL (35.82 versus 32.70, P=0.03). Functional and communicative HL were not associated with self-care behavior (functional HL: low 33.45 versus high 33.96, P=0.71, communicative HL: low 35.66 versus high 32.91, P=0.80). Multivariate linear regression analysis revealed that critical HL (β= −0.25, P=0.02), HF-related knowledge (β= − 0.21, P=0.03), age (β= −0.01, P < 0.03), and occupation (β= −0.27, P<0.04) were independently associated with self-care behavior. Conclusions: Critical HL was independent associated with self-care behavior in patients with HF. We should develop the effective intervention to improve patient's skills for analyzing critically information and using it to making decisions.

Background Health literacy, defined as all skills and capabilities that enable a person to access, understand, appraise and apply health information, is a key factor regarding disease management, health outcomes, and health-decision-making. Internationally, migrants have been identified as a high-risk group for limited health literacy. However, it remains unclear if female and male migrants process health information differently. This systematic review aims to analyze gender differences in the health literacy of first and second generation migrants. Methods We performed a systematic review according to PRISMA guidelines. We searched OVID (MEDLINE), PsychInfo and CINAHL for original articles providing extractable data on the health literacy of male and/or female migrants. Two reviewers independently reviewed abstracts and full text articles for according to predefined inclusion criteria, including the use of a validated health literacy measurement tool, applying it to first and/or second generation adult migrants. We adapted a data extraction sheet from the Cochrane Collaboration for extracting relevant data. The included studies were evaluated against a standardized set of quality criteria. Results Our search yielded 3411 records. We included 48 studies, of which 37 were conducted in the USA and Canada, with 22 focusing Hispanic and Asian immigrants’ functional health literacy; the nine European studies examined a variety of work migrants and refugees using a comprehensive approach (e.g. measured by the HLS-EU-Q47). Thus, a strong heterogeneity in defining and measuring health literacy and in the populations examined can be stated. 15 studies exclusively examined the health literacy of women; none dealt with men only. Conclusions The heterogeneity in defining and measuring health literacy in migrants as well as the diversity of the populations studied make it difficult to compare international research in this area. There is a lack of research focusing male migrants. Key messages International research on health literacy with gender-specific data on migrants reveals a strong heterogeneity in defining and measuring health literacy. International research on health literacy with gender-specific data on migrants reveals a lack of studies regarding male migrants’ health literacy.

This cross-sectional study aimed to explore the relationships among sociodemographics, health literacy, self-efficacy, social support, health-promoting behavior, and health-related quality of life (HRQOL) in older adults. A total of 240 older adults aged >65 years were recruited from three community senior welfare centers in South Korea. Standardized self-administered questionnaires measuring sociodemographic characteristics, health literacy, social support, self-efficacy, health-promoting behavior, and health-related quality of life were distributed to older adults. Multiple regression analyses with stepwise selection was used to determine the factors affecting health-related quality of life. Factors affecting a higher physical component score of HRQOL were a higher comprehension level of and numeracy in health literacy, physical health-promoting behavior, perceived emotional-informational support, and a lesser number of comorbidities. Factors affecting a higher mental component score of HRQOL were a higher comprehension level of and numeracy in health literacy, self-efficacy, physical health-promoting behavior, perceived emotional-informational support, and a lesser number of comorbidities. To improve HRQOL among older adults, nursing interventions are required to measure health literacy, empower physical health-promoting behavior and self-efficacy, and enhance emotional-informational support from family or other resources.

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

BackgroundConsidering the rapid digital transformation, older adults are increasingly relying on online health information–seeking (OHIS) to support healthy aging. However, disparities in their digital competence levels (the ability to effectively use digital tools) and health literacy (the ability to access, understand, appraise, and apply health information) may influence engagement in OHIS.ObjectiveThis paper examines the prevalence of OHIS among older adults in Switzerland and identifies their motivations, barriers, and predictors of use. The objective is to determine key factors that promote or hinder OHIS use among older internet users.MethodsA cross-sectional survey was conducted with 1261 internet users aged 60 years and older living in Switzerland (mean age 70.1, SD 7.3 years; 539/1261, 42.7% female). Descriptive analyses and hierarchical binary logistic regression models were used.ResultsOverall, 77.6% (969/1248) of participants engaged in OHIS in their everyday lives. Subjective health status, internet use frequency, trust in online health information (OHI), and digital competence level significantly influenced OHIS use. Participants reporting good to very good health were less likely to engage in OHIS compared to those in poorer health (odds ratio [OR] 0.496, 95% CI 0.307-0.801; P=.004). Higher likelihood of OHIS use was associated with (almost) daily versus less frequent internet use (OR 1.550, 95% CI 1.011-2.376; P=.04), general trust versus distrust in OHI (OR 5.784, 95% CI 4.044-8.272; P<.001), and advanced versus low digital competence (OR 3.108, 95% CI 1.385-6.975; P=.006); health literacy was not a significant predictor of OHIS use (OR 0.912, 95% CI 0.393-2.117; P=.83, excellent vs deficient [reference]). Among OHIS users (n=969), the most common frequently indicated motivation for use (672/969, 69.3%) was to gain a better understanding of health conditions. Among nonusers (n=279), the most frequently indicated barriers were difficulties in assessing the credibility of information (159/279, 57%), distrust in the effectiveness of information provided (129/279, 46.2%), and concerns about dubious providers or spam (93/279, 33.3%).ConclusionsDigital competence, frequent internet use, and trust in OHI are critical for OHIS engagement among older adults. Programs to strengthen digital competencies in later life and initiatives to enhance the credibility of online health resources are essential to reduce digital disparities and support healthy aging. Notably, health literacy did not emerge as a significant factor in OHIS use, but digital competence did, suggesting that digital competence is most critical to OHIS use.