Mapping Disaster Health Literacy for Chronic Patients: A Scoping Scientometric Analysis

Introduction: Health literacy is one of the effective factors in health promotion of chronic patients. However, little attention has been paid to it; no exact and clear definition of health literacy has ever been accessible in chronic diseases. This study was conducted with aim of defining and clarifying attributes, antecedents, and consequences of health literacy in multiple sclerosis (MS) patients.Methods: Rodgers’ evolutionary method of concept analysis was used to clarify the concept of health literacy in MS patients. A literature review was conducted with key terms "multiple sclerosis", "health literacy", "information literacy", "functional health", "health education", "health promotion" and "health behavior". Eight hundred and sixty papers for the period 1980– 2019 were found and finally 23 articles and texts were selected for the analysis. Data analysis was carried out using a thematic analysis.Results: Health literacy in MS patients is a multidimensional concept with forth attributes: health information evaluation, understand disease and its related issues, reading skills and capacity to use knowledge. Ability to read and comprehend, interacting with health personnel, and interacting with peers as an antecedents and improved self-care, health promotion, medication adherence, and decreased use of health care services to be the consequences of these attributes were found.Conclusion: The findings can add knowledge about the concept of health literacy in MS patients. Also, health care professionals can use a deeper understanding of the concept of health literacy in providing care plan for MS patients.

The concept of health literacy has been defined by the World Health Organization for 25 years. During this period, thousands of publications related to health literacy have been produced in the literature. The aim of this study is to examine publications from the last 10 years concerning the concept of health literacy and to identify topics associated with health literacy in these studies. This article provides a general overview of research conducted on the concept of health literacy using bibliometric methods. The Web of Science (WoS) database was utilized as the data source for gathering information. Over the last 10 years, it has been determined that there have been 17,864 studies conducted on health literacy. This study has examined the distribution of these studies by year, author names, the most frequently used 20 keywords, and the relationships between these keywords. The results of the bibliometric analysis indicate that a variety of topics related to health literacy have been explored. Among these, the most prevalent ones include mental health literacy, health improvement, and mental health. In order to comprehend the concept of health literacy, it is essential to accurately identify the associated sub-concepts. Clearly elucidating the multifaceted relationship between these identified sub-concepts and health literacy is of great importance. The presence of diverse publications in the literature related to sub-concepts associated with health literacy highlights the need to examine these publications, providing a basis for planning future studies.

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

Failure to adhere to fluid restrictions negatively affects the quality of life and increases the risk of complications among hemodialysis patients. In chronic diseases, including chronic kidney disease, health literacy plays a crucial role in mitigating disease complications. The level of health literacy in chronic diseases such as chronic kidney disease can play a significant role in reducing the complications of the disease. This study aimed to assess the relationship between fluid control and health literacy in hemodialysis patients, representing the first such research in Turkey. This descriptive, cross-sectional, and correlational study was conducted in all dialysis centers in Bolu province, Turkey, from September 2022 to August 2023. The study included 144 hemodialysis outpatients meeting the inclusion criteria. Patient fluid control and health literacy were assessed using the "Fluid Restriction Scale in Patients Receiving Hemodialysis Treatment" and the "Turkey Health Literacy Scale-32". Statistical analysis was performed using SPSS version 25.0. The mean total score on the Health Literacy Scale was 22.6 ± 10.2, indicating a relatively low level of health literacy among the hemodialysis patients. 54.2% of patients receiving hemodialysis treatment exhibited inadequate health literacy. The mean score on the Fluid Restriction Scale was 50.4 ± 8.63, suggesting moderate fluid control adherence among the study population. 56.3% of hemodialysis patients had moderate levels of fluid control. A statistically significant moderate positive correlation was found between fluid control and health literacy levels (r = 0.456, p < 0.001). Health literacy scores accounted for 20.2% of the variance in fluid restriction scores (R 2 = 0.20), indicating a moderate contribution of health literacy to fluid control adherence. This study revealed a positive correlation between health literacy and fluid control adherence. Therefore, it is recommended that hemodialysis nurses concurrently assess patients' health literacy and fluid control and develop tailored educational programs based on these assessments.

Analysis of Potential Profiles of Health Literacy in Chronic Heart Failure Patients.

BackgroundPulmonary embolism (PE) is a common cardiovascular disease and health literacy is necessary to deal with its consequences after the acute event. The aim of this study was to develop and validate a new questionnaire to measure PE-specific health literacy.MethodsA mixed-methods design with qualitative and quantitative elements was used in the development process. A literature review about health literacy concepts and instruments and interviews with patients with PE and clinicians were conducted. Quantitative analyses included factor analyses, item response theory with a graded partial credit model, and reliability analyses in different test and validation samples. Furthermore, convergent and known-groups validity and responsiveness were assessed.ResultsThe qualitative results supported a concept of PE-related health literacy with four main topics: dealing with PE-related health information, disease management, health-related selfcare, and social support. An initial item pool of 91 items was developed. Further interviews and an online survey with patients with PE (n = 1,013) were used to reduce the number of items and to confirm structural validity. Confirmatory factor analyses in the final evaluation study with patients with PE (n = 238) indicated a good model fit of the four-factor structure. The Health Literacy in Pulmonary Embolism (HeLP)-Questionnaire showed good reliability (Cronbach’s alpha: 0.82 to 0.90). All four subscales were responsive toward receiving a brochure with PE-related health information.ConclusionThe newly developed German HeLP Questionnaire comprises 23 items in four domains and showed good psychometric properties. Further evaluation of the questionnaire in different samples of patients with PE is needed.

Development and validation of a multidimensional health literacy questionnaire for multiple sclerosis patients

Introduction Burn injuries occur with a disproportionately higher frequency in vulnerable groups. Their health literacy (HL), defined as the way patients obtain, process, and understand health information, may be an important factor that influences access, care, and recovery after burns. This study aims to determine the current levels of health literacy and variables associated with poor health literacy for outpatients treated at two regional burn centres. Methods All eligible patients presenting to two tertiary outpatient burn centers were asked to participate. The Newest Vital Sign health literacy assessment tool and a sociodemographic survey were administered. The NVS scores were divided into poor (0-2), moderate (3-4), and adequate (5-6) health literacy. We first compared health literacy rates between sites using non-parametric Chi-squared test. We then developed a multivariable regression model using a stepwise construction with poor health literacy as our dependent variable. Included in the exploratory model were income, education level, working status, and age. Results Forty-nine patients with a mean age of 46.6 years (SD=17.4) were included; 57% (29/49) of patients identified as male. Most of the burn injuries (78%, 38/49) were less than 10% total body surface area. HL rates were poor, moderate, and adequate in 35% (17/49), 18% (9/29), and 47% (23/29), respectively. There were no differences in health literacy between the 2 sites. Age was the only independent predictor of poor health literacy in burn patients, with advanced age being associated with worse health literacy (95% CI: 1.001-1.119, p&amp;lt; 0.05). Income, education level and working status did not independently predict health literacy rates (Table 1). Conclusions More than half of patients treated at burn outpatient clinics have only poor or moderate health literacy. This study further suggests that older adults may be most at risk. This trend is consistent across two regional burn centres. This study highlights the importance of health literacy among patients with burn injury and stresses the importance of personalized and literacy-adjusted discussions surrounding care. Our next project will address the impact of health literacy on adherence to recommended therapies. Applicability of Research to Practice Poor health literacy is a barrier to obtaining burn care and is an important social determinant of health. We should identify factors associated with poor health literacy among patients with burn injury and improve the delivery of health information.

Background:Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease.Objective:The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure.Methods:This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence.Key Results:The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence.Conclusion:In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191–e199.]Plain Language Summary:This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.

Health literacy: a critical concept for public health

Health literacy, genetic literacy and outcomes in patients with genetic cardiac disease: A review of the literature

BackgroundHealth literacy research seems to lack a consensus on what aspects to include into literacy in the context of health and on how to operationalize these concepts for measurement purposes. In addition to health literacy, several other concepts, such as electronic health (eHealth) literacy and mental health literacy, have been developed across disciplines. This study examines how these different concepts are used when studying health-related competencies in Web contexts.ObjectiveThis study systematically reviews health literacy concepts and definitions and their operationalization in studies focused on Web-based health information environments.MethodsA systematic literature search was conducted in April 2016 in 6 electronic databases with a limitation to articles in English published between January 2011 and April 2016. Altogether, 1289 unique records were identified and screened according to the predefined inclusion criteria: (1) original, peer-reviewed research articles written in English; (2) the topic of the article concerned literacy in the context of health; (3) informants of the study were lay people, not health professionals or students of the field; and (4) the focus of the study was placed on an Web-based information environment. In total, 180 full texts were screened, of which 68 were included in the review. The studies were analyzed with an emphasis on the used health literacy concepts and measures.ResultsOn the basis of the included studies, several concepts are in use when studying health-related literacy in Web environments, eHealth literacy and health literacy being the most common ones. The reviewed studies represent a variety of disciplines, but mostly medical sciences. Typically, quantitative research methods are used. On the basis of the definitions for health literacy, 3 thematic categories were identified: general and skill-based, multidimensional, and domain-specific health literacy. Most studies adopted a domain-specific concept, followed by the ones that used a general and skill-based concept. Multidimensional concepts occurred least frequently. The general health literacy concepts were usually operationalized with reading comprehension measures, the domain-specific concepts with self-efficacy measures, and multidimensional concepts with several types of measures. However, inconsistencies in operationalization were identified.ConclusionsThe results show that in studies conducted in Web-based information environments, several different health literacy concepts are in use, and there is no clear consensus on the definitions for these concepts. Future studies should place emphasis on the conceptual development of health literacy in Web contexts to gain better results on operationalization for measurement. Researchers are encouraged to provide clear operational definitions for the concepts they use to ensure transparency in reporting.

The promotion and enhancement of health literacy in school-aged children is an important public health and education goal. To ensure healthy behaviours and attitudes in adulthood, children and adolescents have to learn about health and well-being early in life. Toward this goal, schools are considered the most important setting to address health literacy. Interventions delivered in schools can reach all children regardless of their social, cultural or development background. In the education sector, health literacy interventions can address not only the skills, attitudes and knowledge of students, but that of teachers, principals, health and education staff, as well as the whole school setting. Health literacy is linked to education, while it mainly addresses how people manage health information. In this context, health literacy enables children and adolescent to find, understand and critically appraise health information and use it to guide informed health decisions and promote health behaviour. While this understanding targets personal competencies of individuals, health literacy is also directed towards the environment. For example, the concept of organizational health literacy aims at increasing health literacy capacities of the environment and within settings, such as schools. This makes health literacy an important concept at the intersection of behaviour change (agency: personal health literacy) and social change (structure: organizational health literacy). While the behavioural approach is most promising to equip students with the necessary skills to act as their own agents of health information management and improve their health agency capacities, the social approach further includes consideration of social determinants of health to provide child- and adolescent-friendly environments and conditions. Therefore, effective health literacy interventions should aim at combining behavioural and social approaches, especially in such vulnerable groups as children and adolescents. The purpose of this workshop is to present and discuss four interventions on health literacy drawing on behavioural and social sciences. (i) The first presentation will introduce the Health Literacy Toolbox for Schools (Tool-HLCA). (ii) The second presentation will introduce a school curriculum for classroom based Mental Health Literacy (HLCA-IMPRES). (iii) The third presentation will provide the organizational health literacy school intervention: Health Literate Schools (HeLit-Schools). (iv) The fourth will present applied data on mental health literacy in teachers and an instrument to measure action competencies of teachers with respect to promoting their students’ mental health (MHAC). Each project will be given ten minutes to present their interventions and main findings, including time to discuss with the audiences and get feedback. The participants in turn will learn about recent empirical findings they can use in health literacy practice and policy. Key messages • Children and adolescent will benefit from early interventions to develop healthy behaviours and lifestyles in their life-course. • Health literacy is an important school topic and should be addressed within behavioural and social approaches.

Digital health literacy (DHL) has become important for individuals to take on the responsibility to manage their health for chronic disease. However, few studies have investigated what is DHL and its associated factors. Thus, we conducted a scoping review to to address the above knowledge gaps, and to identify the concept of DHL designed to counter these impacts for clinical application. A systematic review was conducted of studies published in MEDLINE, Embase, Cochrane Library, Web of Science from January 2011 to October 2019 using PRISMA-ScR guideline. Articles eligible for inclusion focused on the conceptualization of DHL or electronic health (eHealth) literacy (EHL) including new digital health technologies, and clinical application reported on factors of DHL and Included newly developed measurement instruments referred to as DHL, and EHL including new digital health technologies. In 26 studies, various terms and definitions of DHL were used, and most articles described a concept of eHealth literacy as e-Health focused the use of information communication technologies. We defined 3 thematic categories as DHL: 1) advanced health literacy, 2) digital skills-based and multidimensional literacy and 3) others consisting of internal or external factors for the users’ engagement in digital health. The findings from our study confirm that the basic approaches of DHL share the same scope with health literacy, but DHL included a broader context and new concepts such as technology-related ability. This study provides an integrated perspective on the status and influencing factors of DHL.

Using a qualitative design, this study aimed to explore the experience of physiotherapists' supporting patient health literacy in clinical practice, gain an understanding of their conceptualisation of health literacy, and make recommendations for improving health literacy support in clinical practice. Convenience sampling via social media was used to recruit eight participants who were all physiotherapists practicing in the United Kingdom. Semi-structured interviews took place on Zoom during the second Covid-19 lockdown. Interviews were audio-recorded, transcribed, coded, and thematically analysed to uncover physiotherapists' views on health literacy, experiences of supporting patients with health literacy and opinions and recommendations for practice. Of the eight participants, five were female and the mean years of clinical experience as a qualified physiotherapist was 5.8. Four main themes were identified: physiotherapists' conceptualisation of health literacy, identification of health literacy and skills required to support patients, training and barriers to providing health literacy-sensitive care and recommendations for improvement. The findings highlighted that physiotherapists identified a patient's health literacy abilities by picking up tacit clues throughout their consultations and they pre-dominantly viewed health literacy as the ability to read, write and communicate effectively. They reported having a limited exposure to health literacy training and recommended raising awareness and education as key to improve practice.