Addressing Health Literacy Research Articles

Health literacy interventions in adult speech and language therapy: A scoping review.

Reduced health literacy can negatively impact care seeking, satisfaction with careand overall health outcomes. These issues are particularly common among people living with communication difficulties who are seeking care from speech and language therapists (SLTs). As such, the SLT must be aware of and sensitive to health literacy needs within their clinical practice, proactively adapting materials and resources to the health literacy needs of their patients. Despite this required core competency, little is known about the health literacy interventions used by SLTs when working with adult patients, and as such, there is limited and unclear guidance for the practicing clinician, leading to potentially suboptimal care delivery. To explore the characteristics of health literacy interventions discussed in the literature for use by SLTs with adult patients. PubMed, CINAHL, Web of Scienceand The Cochrane Database of Systematic Reviews were searched. Conference proceedings of the annual scientific meetings of the European Society for Swallowing Disorders and the Dysphagia Research Society were also searched. Grey literature was searched via the Open Grey database and, hand-searches of reference lists from included studies were conducted by both authors. Published and unpublished research investigating health literacy interventions provided by qualified SLTs providing care to adult patients in any setting for any speech and language related concerns. No language, geographic, study designor publication date limitations applied. Eligible participants in these studies were classified as: (1) patientsand (2) professionals. Data werecharted in accordance with guidelines from the Joanna Briggs Institute and the PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) independently by both authors. A total of 1112 potentially eligible studies were identified in the initial search, with 15 studies ultimately included in the synthesis. Study design and quality varied significantly. Most explored basic functional health literacy or narratively described core components of health literacy, which an SLT should understand, without employing an investigative research design. Limited research has been conducted onthe use of health literacy interventions within adult speech and language therapy practices. This finding is significant as SLTs regularly work with people living with communication problems, and therefore, addressing health literacy should be a core tenet of service delivery. There is a need for valid, reliableand rigorous investigations of health literacy interventions within speech and language therapy to ultimately improve future patient access to and benefit from the care provided. Patient public involvement in review studies is an emerging area. Due to resource issues, it was not possible to include this element in this study.

Who chooses alternative sources of information about childhood vaccinations? A cross-sectional study.

Vaccine hesitancy can lead to problematic outcomes in terms of public health. A factor playing a fundamental role in this dynamic is the source of information considered by parents in the decision-making progress that leads to the acceptance or refusal of childhood vaccinations. This study aims to investigate the sources of information considered by the parents of children attending primary and secondary schools in two large Italian cities and to identify predictors that led to choosing alternative sources of information. An online questionnaire was administered to the parents of students attending elementary, middle, and high schools in Rome and Turin. Two validated tools were used: the Parent Attitudes about Childhood Vaccines Survey and the Vaccine Health Literacy of adults in Italian. Sources of information about vaccinations, trust toward the healthcare system, hesitancy and attitudes about COVID-19 vaccinations, were also investigated. A multivariable logistic regression model was built to identify predictors of the preferred sources of information on the topic. Totally, 2,301 answers to the survey were collected from June to October 2021. Of these, 1,127 came from parents in Rome (49%) and 1,174 from parents based in Turin (51%) with a mean age of 47.7 years (±6.4). The majority of the respondents were mothers (81%), married (73%), with two or more children (70.5%). The multivariable logistic regression model results showed that fathers were more inclined than mothers to use alternative sources of information (OR 1.48, 95% CI 1.29-2.00). Moreover, a higher level of vaccine hesitancy was a strong predictor for choosing alternative sources of information (OR 2.45, 95% CI 1.73-3.46). The HLVa-it scores show that parents with a lower Vaccine Literacy (VL) were more inclined to use alternative sources of information. Addressing health literacy issues and changing the official forms of communication could help improving vaccine acceptance. This study shows the importance of rebuilding a trusting relationship between patients and health care providers, which is fundamental in the fight against vaccine hesitancy.

Reasons for delay in reaching healthcare with severe abortion-related morbidities: Qualitative results from women in the fragile context of Jigawa state, Nigeria (AMoCo)

Maternal near-miss events are a key measure of maternal health; abortion-related complications are one source of near-miss events. To understand the pathway to care of women with severe abortion-related events in a fragile context, we conducted in-depth semi-structured interviews with women who obtained treatment at a referral hospital in Jigawa State, Nigeria, in 2020–2021 (n = 61). We used the Three Delays Model (Thaddeus & Maine, 1994) to examine impediments in reaching care.The first delay (from the onset of symptoms of the pregnancy loss to the decision to seek care) was characterized by the duration of time it took to recognize the pregnancy and pregnancy loss in addition to religious beliefs that it is the will of a higher power that she lost the pregnancy. The second delay (from the decision to seek care to arriving at a place that could provide adequate care for her complication, i.e. the study site); was due to lack of money, lack of passable roads and transport, use of traditional healers, challenges being seen by providers at lower-level facilities, referrals not being facilitated and misdirection by healthcare providers. The third delay was not present in our results. No respondent said she knowingly interfered with the pregnancy; understanding why these pregnancy losses resulted in near-miss complications is critical to reducing maternal morbidity and mortality in Northern Nigeria. Addressing health literacy as well as social and financial barriers holds the potential to get women to care sooner and avert these near-miss or potentially life-threatening events.

Disparities in public understanding, attitudes, and intentions during the Covid-19 pandemic: The role of health literacy

The Covid-19 pandemic has highlighted the need to address health literacy as a critical priority for public health. Health literacy is crucial during a pandemic for understanding and following health advice and for navigating vast amounts of information and misinformation. However, public health communication globally has inadequately met the needs of low literacy and culturally and linguistically diverse groups. This review examines the role of health literacy and how it is related to Covid-19 related outcomes, as well as how public health communication has routinely failed to follow basic health literacy principles. Lessons from the pandemic about health communication and recommendations for how health literacy needs can be addressed in the future are discussed. Improving public health communication requires an immediate short-term response and longer-term investment to build the health literacy responsiveness of public health units, health organisations, and government departments to meet health literacy population needs.

Smart Meds: Using Pharmacists to Address Health Literacy Disparities Among Medically- and Socially-Vulnerable Populations

Summary: Patients in historically underserved communities are most vulnerable to uncontrolled chronic conditions and report a lack of health knowledge to manage them. This report aims to describe the development of SMART MEDS, a pharmacy-led program implemented to address health literacy disparities among medically and socially vulnerable patients.

A mixed-method systematic literature review of health literacy interventions for people with disabilities.

To identify the components and characteristics of health literacy interventions for people with disabilities and to explore the outcomes in terms of health literacy competencies. A mixed-method systematic literature review. The search results were reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The quality appraisal was guided by the Mixed Methods Appraisal Tool. The contents of each intervention were mapped to the health literacy intervention model and the outcomes were annotated using the integrated model of health literacy. The literature search was conducted using several electronic databases, including PubMed, EMBASE, CINAHL, Cochrane library and PsycINFO in December 2022. Ten studies were selected for this systematic literature review. Seven studies were quantitative, two were qualitative and one was a mixed-methods study. The four components of the health literacy interventions included empowering individuals with low-health literacy (n = 10), strengthening individuals' social support system (n = 3), improving communication with health professionals (n = 1) and reducing barriers to access health systems (n = 3). No intervention addressed improving health professionals' health literacy competencies. Health literacy competencies identified as outcomes in the studies included access (n = 1), understand (n = 7), appraise (n = 1) and apply (n = 9) the health information. The significant findings of this systematic literature review provide baseline data and evidence for developing health literacy interventions for people with disabilities. However, this review demonstrates that only a handful of intervention studies have addressed the low-health literacy of people with disabilities. Further and more rigorous interventions addressing health literacy for people with diverse disabilities are warranted. This review provides insights into how health literacy interventions can be tailored to the type of disability. Further, efforts should be expanded to comprehensively promote all the four core competencies of health literacy to reduce health disparities for individuals living with disabilities. Systematic literature review.

Translation and validation of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) into the Slovenian language

BackgroundThe European Health Literacy Questionnaire (HLS-EU-Q47) is a self-assessment tool for standardised measurement of health literacy.AimTo translate HLS-EU-Q47 into the Slovenian language and to investigate its reliability and validity in Slovenia.MethodHLS-EU-Q47 was translated into Slovenian, back-translated, and subjected to a pilot test. The accepted Slovenian version of the questionnaire was mailed to 2500 randomly selected adult residents of the Republic of Slovenia. Reliability was examined using Cronbach’s alpha for the 1-, 3-, 4-, and 12-factor models addressing health literacy, three main health contexts, four health information processing competencies, and 12 combinations, respectively. Validity was explored with confirmatory factor analysis, univariate analysis, and multiple linear regression.ResultsA total of 517 responses were collected (21% response rate). The highest Cronbach’s alpha was obtained for the 1-factor model (0.950), followed by the 3-, 4-, and 12-factor models. In the confirmatory factor analysis, the 12-factor model provided the most valid results (CFI 0.812; RMSEA 0.067, CI 0.065 to 0.070), followed by the 3-, 4-, and 1-factor models. In the multiple regression model, only the association between self-assessment of health and the health literacy index was statistically significant (p < 0.001).ConclusionThe Slovenian version of HLS-EU-Q47 is a reliable instrument for measuring health literacy. All models of the questionnaire showed reasonable model fit, but none fully satisfied all validity criteria. Respondents differentiated better between the three main health contexts (health care, disease prevention, and health promotion) than the four health information processing competencies (access, understand, appraise, and apply).

Self-management interventions for chronically ill patients with limited health literacy: A descriptive analysis.

To support patients with limited health literacy with the challenges they face in the day-to-day management of their disease(s), numerous self-management interventions (SMIs) have been developed. To date, it is unclear to what extent SMIs have been developed for chronically ill patients with limited health literacy. This study aims to provide a description of these SMIs and to provide insight in their methodological components. A secondary analysis of the COMPAR-EU database, consisting of SMIs addressing patients with diabetes, chronic obstructive pulmonary disease, obesity and heart failure, was conducted. The database was searched for SMIs addressing health literacy, including cognitive aspects and the capacity to act. Of the 1681 SMIs in the COMPAR-EU database, 35 studies addressed health literacy, describing 39 SMIs. The overview yields a high variety in interventions given, with overlapping information, but also lacking of specific details. This descriptive analysis shows that there was a large variety in the extensiveness of the description of intervention characteristics and their justification or explanation. A focus on the broad concept of health literacy, including functional skills, cognitive skills and the capacity to act could improve the effectiveness. This should be taken into account in the future development of SMIs.

Pharmacy marketing for public health impact: Promoting preventive care and health literacy through strategic campaigns

Pharmacies are increasingly recognized as pivotal players in public health, capable of promoting preventive care and enhancing health literacy through strategic marketing campaigns. This research explores how pharmacies can effectively contribute to public health by aligning their marketing efforts with broader health initiatives. By leveraging their direct access to patients, pharmacies can raise awareness about vital preventive measures, such as vaccinations, disease screenings, and healthy lifestyle choices. This review examines the role of pharmacies in addressing health literacy gaps, particularly in simplifying complex medical information to ensure patients are better equipped to make informed health decisions. Strategic pharmacy marketing can promote preventive care by highlighting available services, encouraging early disease detection, and advocating for regular health check-ups. Through targeted campaigns, pharmacies can drive engagement and uptake of vaccinations and other preventive health measures, particularly among populations that might be less likely to access healthcare through traditional means. Furthermore, educational campaigns focused on improving health literacy are essential for empowering patients, helping them understand medication use, chronic disease management, and the importance of adhering to prescribed treatments. The research also highlights case studies where pharmacies have successfully led public health campaigns, demonstrating measurable improvements in community health outcomes. It discusses the importance of partnerships between pharmacies and public health organizations, fostering collaboration to amplify health messages. Finally, the review outlines strategies for effective campaign implementation, including the use of digital tools and data analytics to reach diverse patient populations. By integrating these approaches, pharmacies can serve as essential contributors to public health, promoting wellness, disease prevention, and improved patient outcomes.

A boot camp translation of Alzheimer's disease in Hispanic/Latino communities.

Hispanics/Latinos (H/Ls) are significantly underrepresented in Alzheimer's disease (AD) research participant samples. This exclusion limits our interpretation of research findings and understanding of the causes of brain health disparities. The Engaging Communities of Hispanics/Latinos for Aging Research (ECHAR) Network was created to engage, educate, and motivate H/Ls for participation in brain aging research by addressing several barriers to inclusion, including health literacy and AD-related communication. We used a novel community-engaged method-Boot Camp Translation (BCT)-to translate medical jargon into action-based, community-relevant messages. H/L community members (n=39) were recruited from three cities to work with local research teams and co-develop culturally responsive AD-related messaging. BCT meetings leveraged various techniques to identify key messages, the target audience for the messages, and methods to disseminate these messages. Themes were constructed collaboratively between BCT facilitators and community members as the group iteratively refined the conceptual framework and language for the main messages, with the goal to make AD messaging accessible for H/L community members. H/L community members showed significant improvements in subjective understanding (Cohen's d=0.75; P<0.001) and objective knowledge of Alzheimer's disease (Cohen's d=0.79; P<0.001) at BCT completion. H/L community members identified key messages that converged for all three cities. These were related to reducing stigma, emphasizing brain health and risk mitigation, and acknowledging the impact of AD on multi-generational families/households. Participants also recommended sharing these messages with H/Ls across the lifespan using multi-media avenues. The collaborative efforts identified culturally responsive and community-relevant messaging that may help address health literacy barriers contributing to AD-related disparities in H/L communities. Hispanics/Latinos are underrepresented in Alzheimer's disease and related dementias (ADRD) research despite increased risk.Limited ADRD health literacy may act as a recruitment barrier.Boot Camp Translation (BCT) is a process that targets health communication.We carried out BCT in three cities to co-develop ADRD messaging.Results highlight regional similarities and differences in ADRD communication.

Health literacy education programmes developed for qualified health professionals: a scoping review

ObjectivesBoth literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related...

A cross-sectional health literacy profile of Australian regional adults using the Health Literacy Questionnaire©

ObjectiveHealth literacy is the resources and abilities required to make and enact health decisions. This study aimed to describe the health literacy of a diverse cross-section of adults in regional Victoria. MethodsParticipants were recruited from two primary care clinics differing in socioeconomic scope and through non-clinical recruitment via the town’s largest football club. Health Literacy Questionnaire© measured nine distinct scales, and comprehensive demographic data were also collected. Effect-sizes and regression were used for health literacy comparison between groups. ResultsIn this sample of 351 adults, health literacy strengths were observed in Scale 1: ‘Feeling understood and supported by healthcare providers’ (mean 3.29/4 ±0.5) and Scale 9: ‘Understanding health information well enough to know what to do’ (mean 4.10/5 ±0.6). Challenging areas were Scale 5: ‘Appraising health information’ (mean 2.88/4 ±0.5) and Scale 7: ‘Navigating the healthcare system’ (mean 3.84/5 ±0.6). After adjustment, living alone predicted lower scores across most scales. ConclusionsThis study showed greater health literacy barriers experienced by certain groups, particularly those who live alone and those who weren’t clinically recruited. Implications for public healthThese findings have implications for further research into addressing health literacy barriers in marginalised individuals and non-clinical settings. Results from this study may inform interventions which address identified barriers.

Health literacy and the role of therapeutic professionals: A scoping review / Gesundheitskompetenz und die Rolle der Therapieberufe: Ein scoping Review

Abstract Background and aim Health literacy (HL) describes people’s knowledge, motivation, and competences to access, understand, appraise, and apply health information. Limited health literacy can clearly negatively impact health outcomes and therapeutic professionals are potentially important contact persons for patients and their relatives to address health literacy. The aim of this scoping review is to summarize the current literature regarding HL in the selected therapeutic professions (occupational therapy, physical therapy, and speech and language therapy). Methods (incl. inclusion criteria) We conducted an electronic database search in PubMed and CINAHL (EBSCO) up to September 2022. Two authors independently selected studies using the following inclusion criteria: (1) addressing the topic HL and (2) explicitly integrating therapeutic professionals. After extracting relevant information, the included articles were qualitatively analyzed using a narrative synthesis. Results We identified 39 research and non-research articles. The content analysis revealed the following 5 themes: (1) HL–related knowledge and skills, (2) Education and training regarding HL, (3) assessment of HL of their clients, (4) Preparation and communication of health-related information, and (5) HL in organizations. Discussion Most therapeutic professionals were familiar with the term HL, but a lack of deep understanding is described. However, therapeutic professionals are aware of the importance of addressing the needs of clients with low HL. An integration of HL-related issues in professional training and further research regarding concepts to screen and address HL in therapeutic practice are needed.

Factors Associated with COVID-19 Vaccine Hesitancy in South Central Appalachia.

The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall medical mistrust, few of these studies focus on Appalachia. This study identifies barriers and facilitators to adherence with COVID-19 mitigation, focusing specifically on vaccine hesitancy in South Central Appalachia. A secondary data study was conducted with a subset of Appalachian residents from the COVID-19 Public Health survey. Participants were grouped by county using ARC economic county designations for analysis. The dependent variable, vaccine hesitancy, was explored in relation to five categories of independent variable: (1) demographics (with four conceptual areas); (2) belief; (3) action; (4) medical mistrust; and (5) health literacy. Findings indicate vaccine hesitancy attributes include beliefs addressing COVID-19 threat, overstatement of severity of illness, risk of vaccines, vaccine safety information not present from manufacturer, and independent decision to vaccinate. Findings from this study are comparable to HPV vaccine studies in Appalachia. As interventions are developed for Appalachia, it is paramount to focus vaccine administration at the individual and population level.

Assessing COVID-19-related health literacy and associated factors among school teachers in Hong Kong, China.

The coronavirus disease 2019 (COVID-19) pandemic developed rapidly, with changing guidelines, misinformation, inaccurate health information and rumors. This situation has highlighted the importance of health literacy, especially among educators. The aims of this study were (i) to assess COVID-19-specific health literacy among school teachers in Hong Kong and (ii) to examine its association with demographic factors, self-endangering work behaviors (i.e., work intensification, work extensification and work quality reduction), secondary burnout symptoms (i.e., exhaustion related to work and psychosomatic complaints), the level of knowledge of COVID-19- or pandemic-related information and the level of confusion about COVID-19-related information. A self-report survey was administered to 366 Hong Kong school teachers from April 2021 to February 2022. COVID-19-specific health literacy was measured using the HLS-COVID-Q22 instrument. Other instruments, including self-endangering work behavior scales (i.e., extensification of work, intensification of work and work quality reduction) and two dimensions of the Burnout Assessment Tool (i.e., psychosomatic complaints and exhaustion) were also used for assessment. Data were analyzed using an independent samples Student's t-test, analysis of variance, correlation analysis and adjusted multilinear regression models. The results showed that 50.8% of school teachers had sufficient health literacy, 38.3% had problematic health literacy and 10.9% had inadequate health literacy. The HLS-COVID score did not vary by sex, but varied according to the type of school, the number of working hours per week and the number of students attending the school. Teachers with sufficient health literacy scored significantly lower for two types of self-endangering work behavior-intensification of work (p = 0.003) and work quality reduction (p = 0.007)-than those with insufficient health literacy. After excluding those who had already been vaccinated, respondents with sufficient health literacy felt more positive about COVID-19 vaccination than those with insufficient health literacy (t[180] = 4.168, p < 0.001). In addition, teachers with sufficient health literacy felt more informed (p < 0.001) and less confused (p < 0.001) about COVID-19-related information than those with insufficient health literacy. Multiple linear regression analysis revealed that age (β = 0.14, p = 0.011) and the number of teaching hours per week (β = -0.206, p < 0.001) were significant predictors of the HLS-COVID score. The findings of this study may serve as a guide for addressing health literacy gaps among school teachers.

Documenting limited health literacy in a clinical setting.

Health literacy is important in lung cancer care, where treatments and symptoms are difficult to navigate. This study aims to describe how a single-item measure of health literacy can facilitate health literacy system capacity. Data include retrospective medical records from 456 patients with lung cancer. Limited or adequate health literacy was based on participant response to the Single Item Literacy Screener (SILS). Data were collected over a 12-month period following diagnosis for each patient. One-third of patients had limited health literacy; they were more likely to have lung cancers of stage IIIB or higher and greater median levels of depression based on the PHQ-9 questionnaire. Patients with limited health literacy were also more likely to have at least one emergency department visit or unplanned hospitalization and had these visits sooner. These data document need for interventions to buffer the association between limited health literacy and poor health outcomes. Routine intake screens should include the SILS to measure health literacy among lung cancer patients. New models that address health literacy at the organizational and patient levels can be implemented in health care settings using the SILS.

Addressing health literacy to reduce inequalities among migrants: which profiles need our attention?

Abstract Health literacy, the ability to access, understand, appraise, remember and use health information and services, has great potential to reduce inequalities in access to and outcomes of care. People may have different patterns of health literacy needs and strengths. Yet, the design of interventions is frequently not responsive to the specificities of different segments of the population, including migrant groups. We aimed to identify profiles of migrants to inform the co-design of interventions targeting people at risk of poor outcomes. A cross-sectional survey was conducted with 1126 adult migrants living in Portugal. Data were collected using the 9-dimension HLQ (Health Literacy Questionnaire), and a sociodemographic questionnaire. A cluster analysis of data was performed. Semi-structured interviews were conducted with 15 migrants, stratified by the clusters. The optimal cluster solution yielded 16 profiles revealing diversity in combinations of strengths and needs across the HLQ domains. While 29.8% of migrants scored moderate to high on all 9 domains (profiles 2, 6, 8, 16), 63.4% of participants struggled with 1 or several aspects of health literacy, namely ‘Feeling understood and supported by healthcare providers'. Notably, 36.8% (6 profiles) exhibited difficulty across most of health literacy domains. The interviews provided a tangible description of the health literacy needs and resources with five main themes (access, understand, appraise, retrieve and use). Regarding ‘access', migrants expressed different preferred learning styles and needed to access different sorts of information at distinct times. The ‘use’ of information was rarely a one-time decision but a decision that people needed to make repeatedly. Health literacy is a highly diverse concept where subgroups exhibited diverse patterns. The cluster analysis can be used to inform the co-design, prioritisation and implementation of locally designed, fit-for-purpose solutions to improve health literacy. Key messages • Health literacy profiles can inform interventions to mitigate health inequalities among vulnerable migrant groups. • The identification of distinct profiles can contribute to minimise the disconnect between what people/communities need and what is developed to improve health and equity.

Tool-HLCA: An intervention to promote the health literacy of school-aged children

Abstract Background In the age of ‘infodemic,’ children and young people encounter health-related information in digital environments at an early age. They should therefore learn how to deal with these in a health-competent way while still at school. Above all, it is relevant that they learn how to distinguish good health information from false. This can be achieved by promoting health literacy. The intervention “Toolbox” combines areas of media education in schools and health literacy to be implemented in schools and curricula in the long term. Methods The intervention was designed to address existing health topics in the classroom while strengthening digital health literacy in grades 7 to 10. The Toolbox was piloted in three school classes in Germany and the feedback provided by teachers and students was implemented in a new version of the intervention. Results The basic understanding of health literacy in the Toolbox is finding, understanding, evaluating and using digital health information. These steps are followed through using quality criteria for good health information. Students learn that they need to find out the type of information, analyze the author, investigate the media provider, and also the sources given. If they are unsure, they can conduct an adapted questionnaire regarding identify misinformation and disinformation. In addition, the students and teachers receive working materials for group work. Conclusions Recognizing disinformation is a relevant skill already for children and adolescents. The intervention should make it easier for students to recognize good health information. For teachers it should be made easier to address health literacy in school without additional effort.

4.K. Workshop: Promoting and enhancing health literacy through school interventions

Abstract 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.

Sustained effect on diet quality of a self-care intervention to reduce cardiovascular disease risk among informal rural caregivers of people with chronic illnesses: does health literacy matter?

Abstract Background/Introduction Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. However, interventions are often not constructed with health literacy in mind. We previously found a moderation effect of health literacy on short-term (4-month) diet quality from a self-care intervention to reduce cardiovascular disease risk (RICHH) among rural caregivers. The RICHH intervention was designed to be equally effective in caregivers with marginal or adequate health literacy. Purpose To compare the impact of RICHH intervention on 12-month diet quality in rural caregivers with marginal versus adequate health literacy. Methods A total of 296 rural caregivers (54.5±13.7 years old, 76% female) of individuals with chronic illnesses participated. The newest vital sign (NVS) and Healthy Eating Index-2015 (HEI-2015) were used to determine health literacy and diet quality, respectively. The NVS was dichotomized using a cutoff score of 4. The HEI-2015 was computed based on food frequency questionnaires at baseline, 4-month, and 12-month. The RICHH intervention was delivered using video conferencing technology by nurse interventionists once a week for 12 weeks followed by bi-weekly and monthly booster sessions. A piecewise linear mixed-effect model, controlling for age, education, smoking status, and perceived stress, was used to evaluate the impact of the intervention on diet quality between the two health literacy groups. Results There was a significant difference in improvement in the HEI-2015 total scores at 4 months between control and intervention in the marginal health literacy group (beta estimate = 1.56, SE=0.74, P=0.039) but not in the adequate health literacy group (beta estimate = 0.27, SE=0.38, P=0.475). The improvement in the marginal health literacy group was sustained at 12-months (beta estimate = 8.12, SE=3.57, P=0.022). Conclusions The results of our study indicate that an intervention designed to address health literacy is effective in producing a sustained improvement in diet quality to reduce CVD risk in rural caregivers with marginal health literacy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health National Institute of Nursing Research