How Do Australians' Attitudes to Diagnostic Testing and Screening Risks Relate to Health Literacy, Broader Health Beliefs and Demographic Factors? A Survey Study.

Tobacco risk perceptions impact behavior. Our 2018 systematic review of tobacco risk perception measures found no measures of smokeless tobacco (ST) risk perceptions with demonstrated validity and complete consistency with tobacco researcher recommendations (e.g. specifying use frequency). This study develops such measures to assess seven specific risk perceptions of market-leading ST products: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to tobacco cessation. We fielded 64 items assessing risk perceptions associated with tobacco in an online survey experiment (N = 2754) that tested effects of exposing participants to a modified risk claim on a leading ST product. Through reliability and validity analyses, we reduced this to 35 items representing seven constructs. Exploratory factor analyses indicated single-factor solutions for all but two constructs: absolute health risk and health risk relative to cigarettes, which were each represented by two-factors (respiratory and oral risks). Participants perceived respiratory risks differently than oral risks: a modified risk claim reduced ST relative respiratory risk perceptions but increased ST perceived oral risks. Absolute and relative risk perceptions were each represented by two factors that behaved differently, underscoring the utility of assessing respiratory and oral risk perceptions separately. These measures of seven risk perception constructs demonstrated some validity and can be used to assess perceptions of ST risk in future research, such as postmarket surveillance of tobacco products authorized for marketing by FDA. This study develops and validates publicly available measures of seven smokeless tobacco risk perception constructs: absolute health and addiction risks, health and addiction risks relative to cigarettes, pregnancy health risks relative to cigarettes, health risks relative to nicotine replacement therapy, and health risks relative to tobacco cessation. This study suggests that for both absolute and relative risk perceptions, risks of respiratory and oral health effects should be assessed separately, because these risk perceptions may be impacted differently by modified risk claims, and are differentially related to smokeless tobacco beliefs, use intentions, and current use.

Adolescents’ risk perceptions in relation to risk behavior with long-term health consequences; antecedents and outcomes: A literature review

Despite the strong link between obesity and cancer development, individuals are less likely to identify obesity as a risk factor for cancer than family history. Family history of cancer has been documented to influence perceived risk of developing cancer, yet it is unclear if excess weight impacts cancer risk perceptions. The purpose of this study was to examine absolute and relative risk perceptions for cancer by weight status. Cross-sectional data were obtained from the National Cancer Institute's 2011 Health Information National Trends Survey (n = 2585). Demographics, anthropometric data, family history of cancer, health behaviors, and absolute and relative cancer risk perceptions were evaluated. The effect of weight and family history on absolute and relative cancer risk perceptions was analyzed through weighted descriptive and logistic regression analyses. 22.8 and 28.6% of subjects reported that they were very unlikely/unlikely to develop cancer in their lifetime (absolute risk) and when compared to others their age (relative risk), respectively. Findings indicated differences in risk perceptions between those with and without a family history of cancer (p < 0.0001). No significant differences were found between BMI categories for absolute cancer risk perceptions despite stratification by family history. Obese subjects were more likely to have an increased relative risk perception of cancer compared to healthy weight subjects (p = 0.0066); this association remained significant when stratified by family history (p = 0.0161). Educating individuals, especially those who are overweight/obese, about the impact of excess weight on cancer risk may improve risk accuracy and promote cancer risk reduction through weight management.

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

Second-trimester screening for Down syndrome identifies pregnant women with a fetus at increased risk usually defined as a risk above 1 in 200, 1 in 250, or 1 in 300. Such screening tests identify a population at increased risk, but additional diagnostic tests such as amniocentesis are required to confirm whether a fetus does or does not have Down syndrome. The communication format used by clinicians to explain the results of a confirmed diagnosis may influence the patient's perception of risk. Supplementing the quantitative (numerical) results of Down syndrome screening tests with qualitative labels such as “abnormal” and “positive” is associated with increased patient anxiety and greater perceived risk, and it may influence subsequent healthcare decisions. Interestingly, in a number of studies, physicians have been shown to have problems with understanding statistics (e.g., P values, risk ratios). It is not surprising that some clinicians have difficulty both estimating and explaining the likelihood that a fetus has Down syndrome after a positive screening test. The aim of this study was to assess how obstetric clinicians communicate results of the second-trimester serum screening tests to their patients. The investigators conducted a survey to determine (1) how positive and negative test results are communicated, (2) whether quantitative or qualitative information is used in reporting screening test results, and (3) whether understanding of numeracy (health literacy) influences the communication strategy used to present quantitative or qualitative information. Practicing members of the American College of Obstetricians and Gynecologists were invited to participate in the survey. The response rate was 55.6% (n = 203). The respondents answered questions about their communication strategy used to present Down syndrome screening results, which were evaluated on the Objective Numeracy Scale and the Subjective Numeracy Scale. The Subjective Numeracy Scale scores predicted the use of quantitative information. In contrast to the Subjective Numeracy Scale scores, the Objective Numeracy Scale scores did not predict use of the actual numbers. There were gender differences: the Subjective Numeracy Scale scores and the Subjective Numeracy Scale–Ability Subscale scores were greater among men than women when controlling for age. Response to open-ended questions showed that communication strategies used by clinicians to explain test results vary. Approximately 1 in 3 provided numerical information, the most commonly reported format. These findings indicate that patients of physicians with low subjective numeracy may receive only quantitative risk information, which may inflate their perceived risk. The communication strategy used by clinicians to explain test results may have implications for health decisions by patients and their quality of care.

Background: A rise in the number of people with diabetes is possible if immediate action is not taken to reverse the trend. Diabetes mellitus is a chronic medical condition that has serious health consequences for people. The goal of this study was to investigate the relationships between medication adherence, health literacy, and demographic characteristics. Materials and Methods: This correlational study methodology was used at the University of Benin Teaching Hospital in Benin City in 2020. The study included 180 diabetes participants. The tools used included belief about medications questionnaires (BMQ), medication adherence rating scales (MARS), and the Short Functional Health Literacy in Adults Test (STOHFLA), and used linear regression, descriptive statistics, and Spearman’s rho correlation. Results: The researcher discovered that 66.7% of the people lacked adequate health literacy, and MARS analysis revealed that medication adherence was low. Age and income level both had relationships with medication adherence, but marital status, and education did not. The researcher also found a link between medication adherence, health literacy, and medication belief using P-values of 0.004 and 0.002. The regression model indicates that age, medication belief, health literacy, and economic and income level are predicting factors for medication adherence. Conclusion: Nurses and hospital administrators need to focus more on the health literacy, age, income level, and health beliefs of their patients because there is evidence that these aspects are statistically associated with medication adherence.

This study aimed to determine how the frequency of impaired perception of cardiovascular disease (CVD) risk is correlated with health literacy in individuals with high CVD risk in two regions with different socioeconomic levels. A descriptive study was conducted. The Systematic Coronary Risk Estimation, recommended by the European and Turkish Cardiology Societies, provides recommendations based on individuals' actual CVD risk levels. According to the Systematic Coronary Risk Estimation, participants suffering from diseases were identified as high and very high risk. The perception of risk was determined by subjectively assessing the risk level of the individuals. The European Health Literacy Survey Questionnaire was used. The Mann-Whitney U test, Chi-squared test and Spearman's correlation analysis were used to analyse the data. We also conducted a logistic regression analysis to identify factors contributing to impaired perception of CVD risk. A total of 384 individuals, aged between 40 and 70years (with a mean age of 58.35±8.33years), were included in the study. These individuals had a high risk of CVD and were registered to family health centres from two different socioeconomic levels. Out of the 384 participants, 201 individuals belonged to the lower socioeconomic level region and 183 individuals belonged to the higher socioeconomic level region. A total of 61.7% of the participants with high CVD risk had an impaired perception of CVD risk. The health literacy level of 59.9% of individuals was either inadequate or problematic. The health literacy score of participants with impaired risk perception (29.59±9.07) was lower than those with correct risk perception (35.83±10.94; P <0.001). Factors that affected the perception of CVD risk included age, education level, working status, occupation, a family history of CVD, the CVD risk assessment by health professionals and the recommendation of health professionals to individuals for CVD screening. It is necessary for health care professionals to make risk assessments and perform interventions to improve health literacy to raise the awareness of individuals with high CVD risk on their actual risk.

In this exploratory study, perceptions of relative risk held by 120 early adolescents (11–14 years) were examined for 10 hazards—wild animals, fire, nuclear energy, pollution, storms, war, car accidents, people, no food, and drugs. Dissonance was found between perceptions of risk and computed risk associated with factual data. As a group, subjects perceived that war posed the greatest risk and people the least. Female adolescents perceived greater risk than male adolescents for car accidents (p < .08) and for drugs (p < .02). Subjects from the lower community socioeconomic setting (CSES) perceived greater risks than higher CSES subjects for wild animals (p < .01), nuclear energy (p < 01), and drugs (p < .07). Higher CSES subjects perceived more risk than lower CSES subjects for no food (p < .001) and for people (p < .001). Speculations about risk-taking behaviors and recommendations for future research are presented.

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.

Subjective risk perception is an important theoretical construct in the field of cancer prevention and control. Although the relationship between subjective risk perception and health behaviors has been widely studied in many health contexts, the causalities and associations between the risk perception of developing lung cancer and cigarette smoking have been inconsistently reported among studies. Such inconsistency may be from discrepancies between study designs (cross-sectional versus longitudinal designs) and the three hypotheses (i.e., the behavior motivation hypothesis, the risk reappraisals hypothesis, and the accuracy hypothesis) testing different underlying associations between risk perception and cigarette-smoking behaviors. To clarify this issue, as an initial step, we examined the association between absolute and relative risk perceptions of developing lung cancer and cigarette-smoking behaviors among a large, national representative sample of 1,680 U.S. adults by testing an accuracy hypothesis (i.e., people who smoke accurately perceived a higher risk of developing lung cancer). Data from the U.S. Health Information National Trends Survey (HINTS) were analyzed using logistic regression and multivariate linear regression to examine the associations between risk perception and cigarette-smoking behaviors among 1,680 U.S. adults. Findings from this cross-sectional survey suggest that absolute and relative risk perceptions were positively and significantly correlated with having smoked >100 cigarettes during lifetime and the frequency of cigarette smoking. Only absolute risk perception was significantly associated with the number of cigarettes smoked per day among current smokers. Because both absolute and relative risk perceptions are positively related to most cigarette-smoking behaviors, this study supports the accuracy hypothesis. Moreover, absolute risk perception might be a more sensitive measurement than relative risk perception for perceived lung cancer risk. Longitudinal research is needed in the future to investigate other types of risk perception-risk behavior hypotheses-the behavior motivation and the risk reappraisals hypotheses-among nationally representative samples to further examine the causations between risk perception of obtaining lung cancer and smoking behaviors.

Objectives: Purpose was to describe relationships between demographic characteristics and Health literacy in middle-age women 40-60 years old, living in Tanote sub-district, Nonsung district, Nakhonratchasima province, Thailand. In sample size 220. Data were collected using Health literacy interview. In this cross-sectional survey. Result: Most sample had low health literacy 50.4 %, Poor health literacy 19.1 %, Good health literacy 23.2 %, and Very good health literacy 16.0 %. In the cognitive of health most sample had good-level (73.1%), But half of the sample had access to health information, health communication and Management of health conditions in low-level (55.0%, 54.1% and 49.5%) respectively. And more than half of sample (66.4%) had low-level in be aware the media and decided to practice. Demographic factors has a significant associated to health literacy include: education level, occupation and income. The sample who had higher than the primary school were associated with an increase health literacy score 4.99 point, when compared with primary school group. (B = 4.99, 95%CI = 0.26-9.72, P-value = 0.04) Bureaucrat were associated with an increase in the health literacy scores 14.96 points compared to agriculture.(B = 14.96, 95%CI = 3.09-26.82, P-value = 0.01) But income related to decrease health literacy scores. Sample with income of 7000 baht or more has decrease 5.54 points of health literacy scores when compared with income below 7000 baht. And the variables none significant relationship were the marital status, merchant and Congenital disease. By who had couple associated with the increase health literacy score 3.73 point. Merchant correlated with the decrease health literacy score 4.72 point when compared with agriculture. Congenital disease correlated with an increase 1.12 point of health literacy scores. Compared with no disease. Conclusion: Middle-aged women more than half Low level of health literacy. Which It is necessary to be stimulated in health literacy. Especially in the access to health information and be aware the media. In order to the samples were analyzed from the media. To select good and accurate information to practice in order to achieve good health.

The Progress and Promise of Health Literacy Research

This study aimed to explore cross-country differences in the characteristics and determinations of self–other risk perceptions of the COVID-19 pandemic. We distinguished perceived risk to self from perceived risk to others and subdivided risk perceptions into three levels: personal, group, and societal. We focused on the differential impact of multiple communication channels (i.e., interpersonal communication, traditional media exposure, and new media exposure) on risk perceptions at the three levels. A sample of 790 college students completed self-report online questionnaires from May to June 2020, including 498 in China and 292 in the United States. The results showed an “ascending pattern,” revealing that participants perceived higher levels of risk to others than to themselves. In addition, U.S. college students perceived higher risks of COVID-19 than Chinese college students at all levels. As for the relations between communication and risk perceptions, the results revealed that interpersonal communication and traditional media exposure were more effective with Chinese participants, whereas new media exposure was more effective with U.S. participants. Specifically, interpersonal communication was positively associated with risk perceptions at three levels, and the magnitude of the effect was higher in the Chinese group than in the U.S. group. Traditional media exposure increased societal risk perception only for Chinese college students, and new media exposure increased societal risk perception only for U.S. college students. Our findings provide theoretical implications for the characteristics and forming mechanisms of risk perceptions and also provide practical implications for policymakers in the two countries to implement effective measures to foster individuals’ risk perceptions in relation to preventive behaviors.

Health literacy has been shown to play an important role in transitions of care in adult populations, with low health literacy associated with adverse health outcomes. The role of health literacy in the transition from pediatric to adult care has been less well studied. Among adolescents and young adults with spina bifida, high rates of unsuccessful transition have been shown, but how patient health literacy affects transition readiness remains unknown. To determine whether health literacy is associated with transition readiness in adolescents and young adults with spina bifida. This cross-sectional study involved collection of patient-reported questionnaires between June 2019 and March 2020 at a multidisciplinary spina bifida center at a single, free-standing children's hospital. Patient demographic and clinical characteristics were obtained from medical record review. Patients were aged 12 years or older with a diagnosis of spina bifida (myelomeningocele and nonmyelomeningocele) whose primary language was English or Spanish. Data analysis was performed from October 2020 to March 2021. Health literacy as assessed by the Brief Health Literacy Screening Tool. The primary outcome was total Transition Readiness Assessment Questionnaire (TRAQ) score, normalized into units of SD. Nested, multivariable linear regression models assessed the association between health literacy and TRAQ scores. The TRAQ and Brief Health Literacy Screening Tool were completed by 200 individuals (median [range] age, 17.0 [12.0-31.0] years; 104 female participants [52.0%]). Most of the patients were younger than 18 years (110 participants [55.0%]) and White (136 participants [68.0%]) and had myelomeningocele (125 participants [62.5%]). The mean (SD) TRAQ score was 3.3 (1.1). Sixty-six participants (33.0%) reported inadequate health literacy, 60 participants (30.0%) reported marginal health literacy, and 74 participants (37.0%) reported adequate health literacy. In univariable analysis, health literacy, age, type of spina bifida, level of education, self-administration vs completion of the questionnaires with assistance, ambulatory status, and urinary incontinence were associated with total TRAQ score. In all nested, sequentially adjusted, multivariable models, higher health literacy remained a significant, stepwise, independent variable associated with higher TRAQ score. In the fully adjusted model, having adequate compared with inadequate health literacy was associated with an increase in normalized TRAQ score of 0.49 SD (95% CI, 0.19-0.79). Patient-reported transition readiness is associated with health literacy, even after adjustment for education level and other demographic and clinical factors. Developing and implementing health literacy-sensitive care programs during the transition process may improve patient transition readiness.

ObjectivesAdequate health literacy is important for patients to manage chronic diseases and medications. We examined the association between health literacy and multiple medications in community-dwelling adults aged 50 years and...