Adequate Health Literacy Levels Research Articles

Assessing the Future Assessors: A Health Literacy Assessment Using the Newest Vital Sign

Background & Aim: Health literacy (HL) has been defined as the ability to obtain, process, and understand basic information and services needed to make appropriate health decisions. This study aimed to determine the HL of undergraduate medical students using the Newest Vital Sign (NVS), a nutrition label-based HL tool. Method: This was a cross-sectional study conducted among newly admitted first year medical students using the Newest Vital Sign. Following informed consent, under supervision, the participants were handed over the nutrition label with six questions. Questions were asked in sequence, and continued even if the participant did not get the first or the second question right. If a participant got the first four questions right, it was considered a sign of adequate literacy. Results: The study involved 110 participants out of which 72 were females. Overall, 87% of the participants had adequate health literacy, 11% had a possibility of limited health literacy, and less than 2% had a likelihood of limited health literacy. The mean of the total time taken to answer the questionnaire was 9.89 ± 2.25 minutes. More than 50% of the participants answered the questionnaire in the time range of nine to eleven minutes. Only <25% participants took longer than ten minutes to solve the questionnaire. Conclusion: It was observed that more than 85% of the participants had an adequate level of health literacy. NVS, which is based on a nutrition label, is a very simple tool, and the test can be easily administered in ten minutes.

Low health literacy, poor knowledge, and practice among Turkish women patients undergoing cervical cancer screening.

The objective of this study is to evaluate health literacy level, cervical cancer knowledge, and practice among women patients undergoing screening. A cross-sectional study was conducted among 455 women family health center patients. Health literacy level was evaluated by Rapid Estimate of Adult Literacy in Medicine. Patients characteristics, health behaviors, cervical cancer knowledge, and practice were assessed by a questionnaire form. Chi-square test and logistic regression analyses were applied. This study has found that 19.3% women were in adequate health literacy level and 80.7% of were in low (inadequate or marginal) level. Health literacy levels were showed significant differences by age, education status, employment, self-perception of health, health condition and having health profession, smoking status, physical activity, body mass index, taking health care, skills and concern on materials. Inadequate health literacy was significantly higher among women patients with poor cervical cancer knowledge and practice. Based on binary regression analyses, adequate health literacy was significantly associated with younger ages. Adequate health literacy was poor among women patients. Health literacy levels were affected by patient characteristics, health behaviors, and cervical cancer knowledge and practice.

Health literacy in people undergoing treatment for alcohol abuse – A pilot study

The evidence suggests that limited health literacy (HL) may be associated with health risk behaviour such as smoking, alcohol drinking, or substance use. The aim of this study was to examine the level of HL in people undergoing treatment for alcohol abuse and to determine the most problematic domain of HL. The cross-sectional survey included 113 participants from two facilities in Prague (Department of Addictology and Bohnice Psychiatric Hospital). HL was measured using the HLS-EU-Q questionnaire developed by the European Health Literacy Consortium. The mean general health literacy (GHL) score of the sample was 34.1, indicating a sufficient level of HL. However, almost half of the sample showed a limited level of HL. Health promotion was identified as the most problematic domain of HL, with fifty percent of participants having a limited level. Outpatients achieved overall better scores than inpatients, although the difference was not significant. We found no statistical differences between tested variables. The results suggest that the prevalence of limited HL in people undergoing treatment for alcohol abuse is relatively high. Interventions should be carried out to increase the overall level of HL. An adequate level of HL may improve overall health, as well as the treatment outcomes of people addicted to alcohol.

Health Literacy and Knowledge of Chronic Diseases in Nepal.

Background:Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal.Objective:This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases.Methods:A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire.Key Results:The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (β = 0.32; p < .05), diabetes mellitus (β = 0.41; p < .05), and chronic obstructive pulmonary disease (β = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake.Conclusions:A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [HLRP: Health Literacy Research and Practice. 2018;2(4):e221–e230.]Plain Language Summary:Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary.

Oral health literacy and its determinants among adults in Southeast Iran.

Objectives:The present study aimed to assess oral health literacy level and its related factors among adult patients visiting Kerman Dental School.Materials and Methods:This cross-sectional study was conducted in Kerman Dental School clinic, among the first-time adult visitors. Individuals were selected randomly from volunteers who signed study consent forms. Background information and oral health literacy levels were acquired through the oral health literacy-adult questionnaire. Statistical analysis including the Chi-square test and independent t-test served for statistical evaluation of the study data.Results:Participants were 264 adults which consisted of 72.3% women and the mean age of 37 ± 8 years old. The mean oral health literacy score was 12.07 (out of 17), and 62.5% of the participants had an adequate oral health literacy level. There was a significant relationship between oral health literacy scores with gender, high level of education, and oral health behavior.Conclusion:The study participants had a good level of oral health literacy which can be correlated with their educational status and oral health information sources. An oral health educational program for less educated people is recommended.

Assessing health literacy among older adults living in subsidized housing: a cross-sectional study.

This study aimed to assess functional health literacy levels among older adults living in subsidized housing in Hamilton, Ontario, and to assess the relationships between health literacy and other important health indicators, such as education level, age, ethnicity, body mass index (BMI), and self-reported health status. Older adults (n = 237) living in subsidized housing buildings in Hamilton, ON, were assessed using the NVS-UK as a measure of functional health literacy in addition to a health indicator questionnaire through structured interview. Health literacy levels were analyzed using descriptive statistics and logistic regression to determine relationships between health literacy levels and other health indicators. Participants' mean age was 73years, 67% were female, 70% were not educated beyond high school, and 91% were white. Over 82% of participants had below adequate health literacy levels using the NVS-UK. Multivariable logistic regression revealed significant relationships between functional health literacy and BMI, education level, and pain and discomfort levels. No significant relationships were found between health literacy level and age group, anxiety and depression levels, CANRISK (Diabetes risk) score, gender, marital status, mobility issues, self-care issues, self-reported health status, or performance of usual activities. As the population of older adults continues to grow, the appropriate resources must be available to both improve and support the health literacy level of the population. Future health research should gather information on the health literacy levels of target populations to ensure more equitable health service. This research provides a significant opportunity to better understand populations with health literacy barriers.

Health literacy of hospital patients using a linguistically validated Croatian version of the Newest Vital Sign screening test (NVS-HR).

The Newest Vital Sign (NVS) is a simple, quick and accurate screening test for health literacy (HL). It has been validated for different languages but, to date, not for the Croatian language. The aim of this study was to develop a linguistically validated Croatian version of the NVS and to use it at a later stage in a pilot study of health literacy assessment of hospital patients in Croatia. A full linguistic validation procedure was applied, including forward and backward translation, expert panel review, cognitive interview with 10 respondents from general population, and full involvement in the procedure of one of the screening test developers, the lead author of the NVS-UK version. HL testing on 100 hospital patients (55% women, median age 63.5 years) revealed 58% of patients had less than adequate HL level (scores less than 4), and mean NVS total score was 3.34. A positive significant association was observed between HL and educational level (p = 0.002). A high percentage of patients (92%) did not object to being tested for HL by their primary care physician or in hospital, and 99% of patients would recommend HL testing among patients in general. The respondents' positive views on HL testing and mean completion time of 4 minutes indicate that the Croatian version of the NVS (NVS-HR) could be recommended for use in both clinical and research settings in Croatia.

Zdravstvena pismenost u populaciji starih osoba

Aging of the population is particularly notable in high-income countries, while the vulnerability of elderly is well described in the literature. Cognitive and social skills decline during the aging process, which affects the level of health literacy. Health literacy refers to the ability to obtain, process and understand basic health information, and act upon information within the healthcare system. Elderly with an adequate level of health literacy are empowered to manage their health, as opposed to those with a low level of health literacy who have the greater chance of developing chronic illnesses and premature death. Also, elderly with low level of health literacy rarely use preventive services, but seek emergency services more often, they know less about their basic chronic illness and are more often faced with difficulties in managing their own disease. They have worse health outcomes and self-perception of health than those with adequate health literacy. This indicates the necessity of creating specific interventions aimed to improve the health outcomes of older people.

Evaluation of Health Literacy in Veteran Affairs Outpatient Population: A Focus on Patient Self-Perceived Health Status

Health literacy is of great importance for clinicians to maximize patient involvement and in the effective delivery of healthcare services. Health literacy driven health communication strategies may encourage appropriate and optimal use of healthcare resources and medications. We evaluated health literacy level in veterans with unique population demographics and focused on patient self-perceived health status (SPHS). Veterans (N=194) were enrolled in this cross-sectional study. Only 40% had poor or inadequate health literacy level. Older individuals displayed poorer health literacy level. 57.2% of the patients had good/above SPHS. Patients with good or above SPHS had 1.7 times higher (OR: 1.68, 95% CI=0.79-3.54) compared to patients with below good SPHS. Veterans with hospitalization were 11% less likely (OR=0.89) to report good or adequate health literacy level compared to those not hospitalized. Veterans with good or adequate health literacy level perceived their health status to be better than veterans with poor or inadequate health literacy. Using plain and simple language by providers while counseling patients about their disease and medications, might have a positive ripple effect on the current patient-centered care delivery. Clinicians could use a tailored approach to improve communication with patients.

Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts.

BackgroundThe process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework.MethodsWe conducted 3 focus groups with individuals eligible for CRC screening (n = 22) and 2 focus groups with experts in the field of health literacy, oncology and decision making, including scientific researchers and health‐care professionals (n = 17). We used framework analysis to analyse our data.ResultsWe identified and specified ten health literacy skills, which varied from the ability to read and understand CRC screening information to the ability to weigh up pros and cons of screening for personal relevance. The skills were linked to 8 decision‐making stages in CRC screening within a conceptual framework. We found differences in perceptions between screening invitees and experts, especially in the perceived importance of CRC screening information for IDM.ConclusionsThis study provides insight into the decision‐making stages and health literacy skills that are essential for IDM in CRC screening. The proposed conceptual framework can be used to inform the development of context‐based measurement of health literacy and interventions to support IDM in cancer screening.

Health literacy among caregivers of patients with heart failure: A multicentre cross-sectional survey.

To assess the levels of health literacy of Italian caregivers of patients with heart failure. Health literacy is related to patients' health outcomes. Low health literacy has been found in older people with heart failure, and less is known on the health literacy of caregivers whose patients are suffering from heart failure. Observational, multicentre, cross-sectional study. From July 2015-May 2016, caregivers were recruited in five hospitals from Central and Southern Italy. To assess health literacy, the Italian version of the Short Test of Functional Health Literacy tool was used. A total of 173 caregivers participated in the research, the majority being females (60.1%), aged between 46-60years (52.6%) and 96 (55.5%) were from Central Italy. 33.5% of caregivers were patients' children, and 16.2% were paid caregivers of foreign origins. The average level of health literacy was adequate; however, lower levels were found among patients' spouses and those of older age. Our results, in contrast with previous studies, showed adequate health literacy levels of caregivers. However, caregivers older in age and with a low education level showed the lowest health literacy, emphasising the need for healthcare workers, to check caregivers' health literacy, before entrusting them with the care of patients. As this research gives, for the first time, an overview on Italian caregivers' levels of health literacy, its results may be used to improve Italian healthcare professionals' knowledge of caregivers' health literacy, before entrusting them with the care of patients.

Assessing the predictive power of psychological empowerment and health literacy for older patients\u2019 participation in health care: a cross-sectional population-based study

BackgroundResearch has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly’s willingness to engage in treatment decisions.MethodsA self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65–80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants’ preference to be active, collaborative or passive in decision-making.ResultsMost of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults’ preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator.ConclusionsAs older adults’ health literacy plays a role in individuals’ willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients’ involvement in healthcare.

Relation between Health Literacy Levels, Hypertension Awareness and Control among Primary-secondary School Teachers in Turkey.

ObjectiveHealth literacy plays a critical role in chronic disease self-management. This study aimed to determine the relation between health literacy levels, hypertension awareness and control among primary-secondary school teachers in Turkey.Materials and MethodsThis descriptive and cross-sectional research was conducted among school teachers with the participation of 500 volunteer teachers of both genders. The response rate was 86.2%. To determine health literacy levels, the Newest Vital Sign Scale and Blood Pressure Concept Test were used.ResultsThe mean scores of all individuals were 2.12 ± 1.82 over six points although this showed “limited” levels of health literacy. The mean scores obtained from the scale were 2.13 ± 1.83 in non-hypertensives, while it was 2.06 ± 1.77 in hypertensives. Nonetheless, disease knowledge and awareness were low in teachers. Adequate health literacy levels were low according to disease awareness and control. The measured health literacy levels of teachers didn't overlap with their own assessments about health literacy skills.RecommendationsLimited health literacy levels in educators gave an impression that our education system was poor in terms of health education programs.

„Hogy minden beteg megértse!” – Az egészségműveltség (health literacy) mérése Magyarországon

Inroduction: The efficiency of healing is determined by the ability of the patients to comprehend and to apply properly the information provided by the doctors. This ability is influenced by age, intelligence and social background, but above all by health literacy. Aim: The aim of the present study was to translate and adapt the Hungarian version of the Short-Test of Functional Health Literacy, which is a performance based measure and the perception-based Chew screening questions for health literacy in Hungary. Method: The sample consisted of 302 people, and it was closely representative for the Hungarian population. Results: The reliability of the reading part of the Short-Test of Functional Health Literacy was excellent, and it was also acceptable regarding the Chew screening questions, but it showed low internal consistency concerning the numeracy part of the Short-Test of Functional Health Literacy. Based on the Short-Test of Functional Health Literacy reading scores, participants were categorized into three groups: 8% had inadequate, 6% marginal and 86% adequate health literacy levels. Regarding participants without a chronic illness tended to possess higher health literacy levels based on all the three measurments. Conclusions: The availability of these measures of health literacy in Hungary can play a crucial role in doctor-patient communication as well as health promotion, that can contribute to develop health literacy policies leading to reduced health care costs in the future. Orv. Hetil., 2016, 157(23), 905–915.

Health literacy screening of patients attending a student-led osteopathy clinic: A pilot investigation

Adequate levels of health literacy (HL) are required for patients to access appropriate health services and develop an understanding of the options for managing their healthcare needs. There is limited literature on HL of patients seeking care for a musculoskeletal complaint. The present study sought to screen the HL of patients presenting to an Australian osteopathy student-led clinic using a single screening question ‘Are you confident completing medical forms?’. Less than 10% of patients attending the clinic were considered to have below adequate levels of HL using this question, consistent with other work in Australian populations. Logistic regression analysis identified that the most significant demographic variables associated with lower HL were patients who did not speak English at home, those with lower education levels, and those who were less satisfied with their life. Evaluation of a patients' HL may assist practitioners to improve patient education and management strategies.

Health literacy among schoolteachers in Çorum, Turkey.

Teachers' health literacy is an important part of school health promotion programmes. This study in 2013 assessed health literacy and related factors in schoolteachers in Çorum, Turkey. In a cross-sectional study, 500 primary and secondary teachers answered a questionnaire about self-reported health behaviours and completed the 6-item Newest Vital Sign tool. The mean score on the health literacy scale was 2.12 (SD 1.82). Overall, 44.0% of the teachers had very limited, 29.8% limited and 26.2% adequate health literacy. Adequate health literacy levels were significantly higher among those without chronic disease, non-smokers, non-alcohol users and those interested in healthy lifestyle topics in the media. In binary logistic regression analysis, the risk of limited health literacy was significantly greater in the older age groups, in men and in those whose partner was an educator or a housewife. In view of the low health literacy levels, we suggest that teacher candidates could benefit from health education programmes after graduation.

Health literacy in patients referred for transplant: do patients have the capacity to understand?

Adequate levels of health literacy are needed for transplant recipients to be able to understand and comply with medical recommendations. However, little is known about health literacy among transplant candidates. Therefore, the purpose of this study was to examine the levels of health literacy and cognitive functioning among patients being evaluated for various types of transplantation. There were 398 patients who completed a required psychological evaluation prior to being listed for transplant. This included a screen for cognitive impairment and limited reading and math ability. The prevalence of limited reading ability was 27.5%, limited math ability was 42.8%, and 30.7% had probable cognitive impairment. Rates of limited reading and math ability and cognitive impairment varied for each type of end-stage disease. Limited reading ability was related to poorer cognitive functioning. Those with a higher likelihood of limited reading ability included blacks and males. Those more likely to have cognitive impairment included blacks and patients who are older. Results from this study suggest that patients should be regularly screened for health literacy and cognitive impairment. Once patients with difficulties are identified, recommendations can be provided to these patients at a level that they are able to understand.

A Cross Sectional Assessment of Health Literacy among Cardiovascular Patients in Karachi, Pakistan

Background: An adequate level of health literacy is related to positive treatment outcomes. The current study is aimed to examine factors associated with health literacy among cardiovascular patients in Karachi city, Pakistan. Method: The study was designed as a cross sectional, descriptive survey. A pre-validated questionnaire was used for data collection. One hundred and sixty three patients attending the Cardiology Outdoor Patients Department of a tertiary care hospital in Karachi were recruited for the study. Descriptive statistics were used for data elaboration. SPSS v 21.0 was used for data analysis. Results: Out of 163 patients, the cohort was almost equal in term of gender distribution. Sixty-one percent had urban residency of Karachi city and 62 (38.04%) were categorized as elderly patients. Overall, poor health literacy status was reported among the study respondents. Health literacy was evident with patient’s knowledge about medications; knowledge of adverse effects; language barriers and perception about role of exercise in improving quality of life. Conclusion: Poor health literacy was associated with multiple factors that adversely affect patient’s pharmacotherapy plans. Urgent measures by using a collaborative approach of physicians, pharmacist and nurses are required to improve health literacy of Pakistani population.

Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults.

In recent years, colorectal cancer (CRC) screening rates have increased steadily in the USA, though racial and ethnic disparities persist. In a community-based randomized controlled trial, we investigated the effect of patient navigation on increasing CRC screening adherence among older African Americans. Participants in the Cancer Prevention and Treatment Demonstration were randomized to either the control group, receiving only printed educational materials (PEM), or the intervention arm where they were assigned a patient navigator in addition to PEM. Navigators assisted participants with identifying and overcoming screening barriers. Logistic regression analyses were used to assess the effect of patient navigation on CRC screening adherence. Up-to-date with screening was defined as self-reported receipt of colonoscopy/sigmoidoscopy in the previous 10years or fecal occult blood testing (FOBT) in the year prior to the exit interview. Compared with controls, the intervention group was more likely to report being up-to-date with CRC screening at the exit interview (OR 1.55, 95% CI 1.07-2.23), after adjusting for select demographics. When examining the screening modalities separately, the patient navigator increased screening for colonoscopy/sigmoidoscopy (OR 1.53, 95% CI 1.07-2.19), but not FOBT screening. Analyses of moderation revealed stronger effects of navigation among participants 65-69years and those with an adequate health literacy level. In a population of older African Americans adults, patient navigation was effective in increasing the likelihood of CRC screening. However, more intensive navigation may be necessary for adults over 70years and individuals with low literacy levels.

Clinical Pathways Using Map of Medicine – Experiences from Queensland and Across the Ditch

Clinical pathways have been in use worldwide since the early 1980s. According to Pearson, Goulart-Fisher, & Lee (1995) the care of approximately 60–80% of patient conditions in general hospitals should be suitable for pathway use. The purpose of Collaborative Clinical Pathways is to provide front line clinicians and other key stakeholders: • Rapidly accessible check of best practice; • Enhanced partnerships and collaboration across services; • Enhanced accuracy of referrals; and • Improved patient outcomes through seamless care across primary and secondary care. Coordinated electronic versions of collaborative clinical pathways, available across primary and secondary health care, have been available for a shorter time in Australia and New Zealand. In 2011, MidCentral District Health Board (DHB) became the first DHB in New Zealand to use Map of Medicine as a tool for clinical pathway development. By 2013, eight DHB’s were using the software tool. In 2013, the first Map of Medicine pathways in Australia were developed. Map of Medicine is a UK based software system used by the NHS. It houses a collection of approximately 400 clinical pathways based on existing evidence and international guidelines. It also houses approximately 1500 ‘localised’ pathways from around the world that can be accessed by all Map of Medicine users to share ideas and resources. Integration within local General Practice Management Systems (PMS) was seen as a key benefit for developing pathways using Map of Medicine. This presentation discusses the top “secrets” to successful implementation and discusses why clinical pathways have enabled substantial engagement across health sectors and led to meaningful improvements in collaboration and enhanced service delivery. In 2006, a nation-wide Australian survey found that 3 out of every 5 Australian adults have less than adequate levels of health literacy (Australian Bureau of Statistics, 2008). Statistics for New Zealand are no better showing that 56.2% of adult New Zealanders have poor health literacy skills, scoring below the minimum required to meet the demands of everyday life and work (Ministry of