The Role of Health Belief and Health Literacy on Antibiotic Treatment Adherence Among Online Health Consultation Users

Understanding health information can be difficult, which can limit people's ability to manage their health and adopt healthy practices, leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative designed to support clear conversations between health service providers and users. The initiative incorporated Teach-back, Chunk and Check, Simple Language, and Open Questions, alongside implementation support from a health literacy officer. A concurrent mixed-methods evaluation was conducted across two health programmes serving a population of approximately one million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors within a regional government authority. The evaluation comprised five components: (1) Surveys of 110 service providers' perceptions of the training; (2) Observations of 11 service providers before and after training; (3) Two focus groups with 11 service providers six months post-training; (4) Change in 73 service users' health literacy levels using two domains of the Health Literacy Questionnaire; (5) Change in service users' health and wellbeing between baseline and programme completion. Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed. Both programmes were delivered in group settings. Teach-back was reported to be challenging to apply in this context but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was helpful but difficult to deliver to busy teams. Service users' health literacy levels improved by the end of their programme, but there was no evidence that the initiative improved health and wellbeing outcomes. For example, no significant difference was observed in the primary outcome for Weight Management participants in the intervention group compared with controls (0.2kg, - 2.3 to 1.9; p = 0.84). In this small evaluation, the initiative was well received and enhanced service providers' communication skills. Further evaluation of a strengthened initiative should focus on controlled before-and-after designs using larger samples to determine the effect on service users' health literacy and health and wellbeing outcomes.

Parents who are recent immigrants and/or non-native English speakers are at increased risk for poor health literacy. For example, misconceptions regarding treatment for upper respiratory infections (URIs), including nonjudicious use of antibiotics, have been described among Latinos. We sought to assess the influence of health literacy on knowledge and beliefs surrounding URI care and to explore the correlation between two health literacy measures among Latino parents in northern Manhattan. A descriptive survey design was used, and a total of 154 Latino parents were enrolled from four early head start programs between September 2009 and December 2009. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Newest Vital Sign (NVS); parental knowledge and beliefs regarding antibiotic treatment for URIs were also assessed. Analyses were conducted in 2010 with multivariable logistic regression performed to examine predictors of health literacy. Inadequate health literacy was observed in 83.8 % of respondents using NVS and 35.7 % with the S-TOFHLA. College education was significantly associated with adequate health literacy using either the NVS or S-TOFHLA; however, other results varied between measures. Using NVS, there was a greater likelihood of adequate health literacy with US birth status (AOR 13.8; 95 % CI, 1.99-95.1), >5 years US residency (AOR 7.6; 95 % CI, 1.3-43.1) and higher antibiotic knowledge scores (AOR 1.7; 95 % CI, 1.2-2.4). Using S-TOFHLA, the odds of adequate health literacy increased with access to a regular care provider (AOR 2.6; 95 % CI, 1.2-5.6). Scores consistent with adequate health literacy on the NVS, but not the S-TOFHLA, were associated with correct beliefs regarding antibiotic use for URIs in comparison to scores of participants with inadequate health literacy. Since health literacy levels were low in this population and the risk of viral URI was high during the first few years of life, targeted education to improve health literacy, knowledge, and beliefs about URI and related antibiotic treatment is needed.

BackgroundHealth literacy and health beliefs are factors that can effectively contribute to adoption of preventive behaviors among women. The present study was done to explore the role of health beliefs and health literacy in women's health promoting behaviors based on the health belief model (HBM).MethodsThe descriptive study was conducted in 2020 on 431 female students of Rafsanjan University of Medical Sciences (RUMS) who had been selected through stratified sampling. Data collection tool was a questionnaire which covered eight demographic information, 41 health literacy questions and 50 researcher-developed questions of health belief based on HBM constructs. Data were collected electronically and SPSS version 20 and independent t-test, one-way ANOVA, Pearson correlation coefficient and Multiple Linear Regression were used for data analysis at a significance level less than 0.05.ResultsThe preventive behaviors were adopted by 75.57% of the population and the total health literacy score was found to be 52.71 out of 100. According to the Multiple regression analysis, self-efficacy (β = 0.414, p = 0.001) and cues to action (β = 0.299, p = 0.001) were found to be the first and second robust predictors of behavior, respectively. Health literacy, self-efficacy, cues to action and perceived susceptibility constructs predicted 52.1% of preventive behaviors.ConclusionIt is recommended that researchers design, implement and evaluate interventions based on behavioral change theories, especially the self-efficacy theory, in order to promote women's health.

In the petrochemical industry, employees are exposed to various health hazards, which pose serious challenges to their health and hinder the sustainable development of the petrochemical industry. Investing in health has proved a potential strategy to enhance general health. However, global health investment is notably insufficient, mainly due to the public's limited intention to invest in their health. While past research has identified various determinants of health investment intentions, the relationship between health literacy and health investment intention remains somewhat controversial and needs more empirical validation. This study aims to assess the level of health literacy and health investment intention among employees in one of China's largest petrochemical companies and to explore the effect of health literacy on health investment intention. A cross-sectional study was conducted in a petrochemical company. The valid sample size for this study was 39,911 respondents. Data were collected using a designed questionnaire, including socio-demographic information, questions about health investment intention, and the "2020 National Health Literacy Monitoring Questionnaire." Several statistical analysis methods were employed, including descriptive analysis, Chi-square test, logistic regression, and multiple linear regression. The study disclosed an average health literacy score of 56.11 (SD = 10.34) among employees, with 52.1% surpassing the qualification threshold. The "Chronic Disease" dimension exhibited the lowest qualification rate at 33.0%. Furthermore, 71.5% of the employees expressed an intention to invest in health, yet a significant portion (34.5%) opted for the minimal investment choice, less than 2,000 RMB. Logistic regression analysis indicated a positive correlation between health literacy and health investment intention (OR = 1.474; p < 0.001). This association's robustness was further indicated by multiple linear regression analyses (β = 0.086, p<0.001). The employees' health literacy significantly exceeds the national average for Chinese citizens, yet the qualified rate in the "Chronic Disease" dimension remains notably low. A majority of employees have the intention to invest in health, albeit modestly. Furthermore, while health literacy does positively influence health investment intention, this effect is somewhat limited. Accordingly, personalized Health education should be prioritized, with a focus on improving chronic disease knowledge and facilitating the internalization of health knowledge into health beliefs.

The effects of parent\u2019s health literacy and health beliefs on vaccine hesitancy

Background:Although health literacy (HL) skills may change over time, most research treats HL as a constant, using baseline HL to predict other health-related constructs. Few studies have explored change in HL over time.Objective:We examined person-level differences in HL trajectories. We identified subgroups (latent classes) based on longitudinal assessments of HL and examined the association of class membership with demographic and oral health variables.Methods:We used four measurement waves of parental HL data, reflecting the risk of limited HL, collected as part of an intervention to reduce dental decay in American Indian children (N = 579 parent-child dyads at baseline). Repeated measures latent class analysis (RMLCA) models were estimated to identify subgroups of HL trajectories over time. We examined class membership in association with baseline demographics and with 36-month assessments of parental oral health knowledge, beliefs, and behaviors as well as pediatric oral health.Key Results:A four-class model best fit the data. The largest class (high HL; 49.7% of the sample) was characterized by high levels of HL at all waves. A second class (improving HL; 17.7%) improved over all waves. The remaining two classes were characterized as moderate HL (20%) and low HL (12.6%) and maintained relatively stable HL levels over time. Higher educational attainment was associated with membership in the high HL and improving HL classes. Older age among this young-adult sample and higher income also were associated with high HL class membership. Parents in the high HL and improving HL classes exhibited more favorable performance on measures of oral health knowledge, beliefs, and behavioral adherence than did those in the other classes. Class membership was not associated with pediatric oral health.Conclusions:RMLCA demonstrated person-level variability in HL trajectories. Longitudinal patterns were associated with baseline demographics and prospectively with parental oral health knowledge, beliefs, and behaviors, but not with pediatric oral health. [HLRP: Health Literacy Research and Practice. 2023;7(2):e89–e98.]

Background:This study was to investigate the health literacy and influencing factors of older population in pension institution of Xinjiang, China.Methods:Elderly people were selected from 44 pension institutions in Urumqi, Changji, Karamay and Shihezi and from September 2011 to June 2012 using random layer sampling method. The investigation was carried out by Chinese citizen health literacy questionnaire prepared by the China Health Education Center. Data were analyzed by Oneway ANOVA, multiple linear regression and Pearson correlation analysis.Results:A total of 1396 elderly people met the inclusion criteria and their average age was (77.37 ± 8.48) years. Their average health literacy score was (77.37 ± 8.48) points, which was at a low level. There was significant difference in health literacy score among the factors of age, gender, race, education, household income, marital status and occupation (P<0.05). The independent influencing factors of health literacy were education, race, occupation, household income, age and marital status (P < 0.05). Correlation analysis was conducted between the scores of health knowledge, health belief, health behavior, health skill and total scores of health literacy. Health knowledge scores and total scores had highest correlation (r=0.95), followed by health belief scores and total scores (r=0.81).Conclusion:The correlation between health behavior scores and health skill scores was the lowest (r=0.33). The major factors that lead to low health literacy in elderly people are femininity, minority and low levels of education.

Factors Influencing the Health Behavior During Public Health Emergency: A Case Study on Norovirus Outbreak in a University

Background:Prior studies suggest that parents with limited health literacy (HL) may be less likely to engage in oral health practices known to protect children's oral health. Earlier work has relied on cross-sectional data, however, so it is unclear whether HL influences parental behavior or is merely correlated with it.Objective:We sought to clarify the impact of HL on subsequent adherence to parental oral health practices.Methods:This secondary analysis used survey data from a randomized controlled trial designed to reduce dental decay in American Indian children (N = 579). We used path analysis to test a theoretical framework developed to clarify the mechanisms through which HL might influence parental oral health behavior. The framework proposed that HL (1) has a direct effect on parental oral health knowledge, beliefs (i.e., self-efficacy, perceived susceptibility, perceived severity, perceived barriers, perceived benefits), and behavior; (2) has an indirect effect on beliefs through knowledge; and (3) has an indirect effect on behavior through knowledge and beliefs. To test expectations regarding the temporal precedence of the constructs, we examined the association of HL at baseline with knowledge at the 12-month time point, beliefs at 24 months, and behavior at 36 months.Key Results:HL had significant direct effects on knowledge and specific beliefs (i.e., self-efficacy, perceived susceptibility, perceived barriers), but not on behavior. HL had significant indirect effects on beliefs—except perceived susceptibility—through knowledge. HL had significant indirect effects on behavior, through knowledge and beliefs. Both HL and knowledge had significant total effects on subsequent parental oral health behavior.Conclusions:HL influenced behavior measured 3 years later through its impact on parental oral health knowledge and beliefs. Our results highlight the importance of addressing HL in development of oral health promotion efforts aimed at protecting the teeth of young Native children. [HLRP: Health Literacy Research and Practice. 2021;5(4):e333–e341.]Plain Language Summary:It is unclear whether HL influences how parents care for their children's teeth. We analyzed data from a project to reduce dental decay in children. We found that HL impacted parents' oral health knowledge, beliefs, and behavior at later points in time. This suggests that HL may influence development of knowledge and beliefs that support positive behavior.

Online health consultation: Examining uses of an interactive cancer communication tool by low-income women with breast cancer

Physicians’ Roles in Creating Health Literate Organizations: A Call to Action

Aim: In this study, our aim is to investigate the antibiotics adherence of the patients who are prescribed antibiotics. Methods: This study was conducted on 353 patients between age 18-75 who were prescribed antibiotic and who were registered to Bursa Nilüfer 23 Nisan Family Health Center No: 34 between dates 01.10.2018- 30.09.2019, following the ethics committee approval. In order to collect data in this study, beside the medical history, Socio-demographic Data Form, Morisky Medication Adherence Scale and short version of European Health Literacy Scale which questioned their antibiotics adherence were applied to the patients. Results: Medication utilization loyalty was detected significantly higher in the participants with high health literacy. The disease for which antibiotics were most frequently prescribed was upper respiratory infection (32.3%). It was followed by lower respiratory infections (23.5%), acute sinusitis (13%) and urinary tract infections (7.6%) respectively. Most commonly prescribed antibiotics were Cephalosporines (32.3%), Penicillin (29.5%) and Macrolides (23.2%). The most common side effect was diarrhea (30.4%). Whereas high adherence rate was significantly high in the patients without fever, medium adherence rate was detected significantly higher in patients with fever. Percentage of high adherence was significantly high in case the antibiotic was recommended by the family physician. Conclusions: Antibiotic adherence is quite high in our region. Health literacy levels of the patients are associated with their medication adherence. High education level of our region enabled us to work with a more conscious patient portfolio. Antibiotics recommended by the family physicians were used more regularly. Family physicians must behave more carefully about rational drug use, must have a full knowledge of the guides and must meet the requirements of modern medicine.

Background:Mental health first aid programs show promise in reducing stigma and increasing help-seeking. However, the success of these and other mental health interventions are likely affected by health literacy. Yet, health literacy is understudied in the mental health literature and rarely considered in mental health interventions.Objective:This study explored the relationship between health literacy and mental health stigma, aversion to mental health help-seeking, and willingness to interact with individuals with mental illnesses.Methods:Adults (N = 601, mean age = 45.64) completed online surveys of their health literacy and mental health attitudes and beliefs. Hierarchal linear regression models were estimated to examine the relationship between health literacy and mental health attitudes and beliefs. Path models were estimated to determine if stigma mediated the relationship between health literacy and (1) aversion to help-seeking and (2) willingness to interact with individuals with mental illnesses.Key Results:Adults with higher functional and communicative health literacy had lower mental health stigma and aversion to mental health help-seeking. Adults with higher communicative health literacy and empowerment were more willing to interact with individuals with mental illnesses. Mental health stigma partially mediated the relationships between communicative health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. Mental health stigma fully mediated the relationships between functional health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses.Conclusions:Results support including health literacy in mental health interventions and reiterate addressing stigma in community and clinical settings. [HLRP: Health Literacy Research and Practice. 2022;6(4):e270–e279.]Plain Language Summary:Many adults with mental health problems do not get help because of negative beliefs about mental health. We found that adults with more skills for accessing, understanding, and using health information had fewer negative opinions and were more willing to interact with others with mental health problems. Improving those skills may reduce negative opinions about mental health and seeking help.

PurposeThe Active School Flag (ASF) is a multi-stage, multi-component, whole-of-school physical activity (PA) programme in Ireland. This study assessed health literacy, PA knowledge, beliefs about consequences of PA and programme awareness among ASF secondary school students. Survey findings prompted an inquiry with ASF programme implementers to explore the communication of PA in the school.MethodsSeventeen schools were invited to take part. Five schools took part in the survey (Nov 2021) assessing health literacy, knowledge and beliefs about consequences of PA, and programme awareness. Multiple linear regression was used to determine the factors influencing adolescents’ health literacy, 484 students were included in the analysis. Programme implementers from the 17 schools were invited to a focus group at the end of the year (May 2022). Ten schools engaged in the process aiming to understand how PA messages were communicated in the schools. Data were analysed using thematic analysis.ResultsComparisons between gender(s) showed significant differences for health literacy (p = .002), PA knowledge (p = .021) and beliefs about consequences (p = .007). No significant differences were found for school stage i.e. junior vs senior. The overall model significantly predicted health literacy, F(5, 478) = 56.08, p = <.001. Significant predictors included knowledge of PA (B= .869, p<.001) and beliefs about the consequences (B = 2.34, p<.001). Gender, year group and designated-disadvantage status were not significant predictors of health literacy.Findings described the manner in which PA messages are communicated in relation to the i) types of communication, ii) the content of the messages, and iii) the mode of delivery. However, disparities between schools highlighted the lack of a clear communication plan.ConclusionsLow levels of PA knowledge, its’ consequences and health literacy among adolescents in the ASF programme warranted further exploration into the methods used to communicate PA messages in ASF schools. The methods used to communicate PA in Irish secondary schools, varied and a clear communication plan was missing. Further research is needed to improve the communication of PA messages with adolescents and increase levels of knowledge, awareness and health literacy.Support/funding sourceMayo Education Centre and the Irish Research Council Government of Ireland Postgraduate Scholarship.

The internet is increasingly used as a source of health-related information by individuals making a medical decision. Online consultation services offer a safe and anonymous time- and place-independent space in which users can ask health-related questions combined with related individual health narratives, including associated emotions. Research on emotions in health narratives and medical communication is still at an early stage. This study investigates the users of an online consultation service themselves and the content of their inquiries related to health narratives, queried diseases, and the emotions expressed. An automated content analysis of all online inquiries to the University Hospital Zurich from 09/08/1999 to 07/06/2018 was conducted (N = 55,476 inquiries). The majority of users were female. Over time, however, significantly more men and older adults began to submit inquiries. The wide variety of medical inquiries submitted to the service extended across all categories in the International Statistical Classification of Diseases and correlated with the statistical incidence of diseases in Switzerland. In line with theoretical assumptions about mood management and mood adjustment, users’ health narratives most frequently expressed negative emotions like suffering, fear, worry, and shame. The results find support for a close link between health narratives and emotions. By providing an anonymous space where users can talk about diseases that may be a source of stigma or shame, online consultation services can empower patients and promote health literacy through the provision of individualized health information.