Communicative Health Literacy Research Articles

Health information literacy awareness and capacity building: Present and future

Health literacy is increasingly important in today’s complex information ecosystem, both nationally and globally. Across the world, whether people live in “information rich” or “information poor” societies, the role of our profession is a vital one. In the developed world, the ubiquitous nature of health information creates a wealth of accessible content and simultaneously has created confusion as to what information is reliable, how health information can be utilized, and whether or not information is produced in a meaningful manner. In the developing world, content may be non-existent, culturally inappropriate or inaccessible in terms of language and other barriers. In order to mitigate the health information crisis we are now facing, we need to collaborate and respond to the challenges raised by the complexity of health information. Librarians and other information professionals can and must play an important role in improving health literacy in their communities. This paper considers international efforts towards improving health in both information poor and information rich settings, including work showcased in recent years at IFLA’s Health & Biosciences Libraries Section Open Sessions at the World Library & Information Congress (WLIC). It discusses health literacy in the US and other developed economies, and looks in detail at innovative work by the University of North Carolina at Chapel Hill (UNC)where the Health Sciences Library (HSL), a part of the University Libraries, has strengthened efforts surrounding health literacy in local communities and throughout the state. This paper provides examples of how to partner with multiple constituencies on health literacy and discusses future opportunities for growth and engagement.

Post-disaster mental health servicing in Pacific Island communities: An integrative review

BackgroundThe aim of this review was to explore post-disaster mental healthcare in Pacific Island countries by describing: i) the mental health impacts following disaster; ii) general and post-disaster mental healthcare services; and iii) strategies to enhance general and post-disaster mental healthcare throughout Pacific Island communities. MethodsA systematic approach was undertaken to search the literature. Articles describing mental health in the ethnogeographic regions of Melanesia, Micronesia and Polynesia were included. Both thematic analyses and critical appraisal were undertaken to identify prominent themes and evaluate the quality of each article. ResultsOf the 14 articles, seven (50%) were classified as Primary Data Articles and seven were Secondary Data Articles. Seven studies focused on individual island nations and four (29%) focused on the Pacific Island region as a whole. Three articles had a global focus with reference to Pacific Island countries (21%). Six (43%) of the articles discussed post-disaster mental health impacts and eight (57%) identified the current services available to address mental illness in Pacific Island communities. Four articles (29%) proposed future strategies to improve mental healthcare in disaster-prone countries of the Pacific. ConclusionThe review identified that post-disaster mental healthcare services are impeded by underdeveloped infrastructure, a scarcity of mental health practitioners and limited funding. Strategies are necessary to develop: i) services to address post-disaster mental health for children and other vulnerable sub-groups; ii) approaches to enhance mental health literacy in Pacific Island communities; iii) methods to decentralise mental health services, and iv) the presence of quantifiable data describing the incidence of post-disaster mental illness in the Pacific.

Skills for Shared Decision-Making: Evaluation of a Health Literacy Program for Consumers with Lower Literacy Levels.

Background:Shared decision-making (SDM) has been found to be significantly and positively associated with improved patient outcomes. For an SDM process to occur, patients require functional, communicative, and critical health literacy (HL) skills.Objective:This study aimed to evaluate the impact of a program to improve health literacy skills for SDM in adults with lower literacy.Methods:An HL program including an SDM component (HL + SDM) and teaching of the three “AskShareKnow” questions was delivered in adult basic education settings in New South Wales, Australia. The program was evaluated using a partially cluster-randomized controlled trial comparing it to standard language, literacy, and numeracy (LLN) training. We measured the effect of these programs on (1) HL skills for SDM (conceptual knowledge, graphical literacy, health numeracy), (2) types of questions considered important for health decision-making, (3) preferences for control in decision-making, and (4) decisional conflict. We also measured AskShareKnow question recall, use, and evaluation in HL + SDM participants.Key Results:There were 308 participants from 28 classes enrolled in the study. Most participants had limited functional HL (71%) and spoke a language other than English at home (60%). In the primary analysis, the HL + SDM program compared with the standard LLN program significantly increased conceptual knowledge (19.1% difference between groups in students achieving the competence threshold; p = .018) and health numeracy (10.9% difference; p = .032), but not graphical literacy (5.8% difference; p = .896). HL + SDM participants were significantly more likely to consider it important to ask questions that would enable SDM compared to standard LLN participants who prioritized nonmedical procedural questions (all p < .01). There was no difference in preferences for control in decision-making or in decisional conflict. Among HL + SDM participants, 79% (n = 85) correctly recalled at least one of the AskShareKnow questions immediately post-intervention, and 35% (n = 29) after 6 months.Conclusions:Teaching SDM content increased participants' HL skills for SDM and changed the nature of the questions they would ask health care professionals in a way that would enable shared health decisions. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S58–S74.]Plain Language Summary:We developed a health literacy program that included a shared decision-making (SDM) section. The program was delivered in adult basic education classes by trained educators and compared to standard language, literacy, and numeracy training. Teaching SDM content increased participants' health literacy skills for SDM and changed the nature of the questions they would ask health care professionals.

Association of Health Literacy Levels Between Family Members.

Background: Health literacy (HL) is not solely an individual skill but a distributed resource available within individual's social networks. This study explored the associations between individual and family member HL using two separate self-report measures of HL: the European Health Literacy Survey Questionnaire (HLS-EU-Q47) and the Communicative and Critical Health Literacy scale (CCHL).Methods: A self-administered questionnaire survey was conducted with 501 pairs of Japanese residents aged 30 to 79 and their family members whom they most often consulted for help with health issues. HL was measured using HLS-EU-Q47 and CCHL.Results: The HL scores of individuals and their family members were positively correlated for both measures. The correlation was stronger for the HLS-EU-Q47, presumably because it measures the perceived manageability of health-related tasks that implicitly depend on the availability of support for an individual. In contrast, the CCHL measures a single individual's perceived abilities. Both individual and family member CCHL scores were independently related to individual HLS-EU-Q47 scores, particularly when an individual had a family member with a higher CCHL score than his/her own.Conclusions: Limited individual ability to achieve health-related tasks might be compensated for by the higher ability of other family members. In addressing problems with limited health literacy, future studies should focus not only on the individual but also on people who can provide an individual with support.

Impact of functional, communicative and critical health literacy on glycemic control among patients with type 2 diabetes, and the mediating role of self-care.

Background: Health literacy (HL) could influence self-care behaviors and further affect HbA1c values. Understanding the mechanism relationships between HL, self-care behaviors and HbA1c could provide the valuable knowledge for developing evidence-based interventions in diabetic patients. In this study, we hypothesized that HL and its subscales would be related to self-care behaviors and that HL would be indirectly related to glycemic control (HbA1c) via relations with self-care behaviors among diabetes patients.Methods: This cross-sectional study was performed on 300 patients with type 2 diabetes referred to five educational hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2018. The Persian version of Functional, Communicative, and Critical Health Literacy (FCCHL) questionnaire and the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire were used. Also, recent HbA1c values were extracted from patients’ medical records. Structural equation modeling (SEM) was also used to investigate the relationships between the variables.Results: The SEM results showed the direct standardized path of the total HL score, functional HL, communicative HL and critical HL on HbA1c were nonsignificant in the model with mediator. While the indirect effect of the total HL score (β = −0.24, P=0.042), functional HL (β = −0.15, P=0.01), communicative HL (β = −0.16, P=0.01) and critical HL (β = −0.22, P=0.03) on HbA1c through the mediation of self-care behaviors were significant.Conclusion: The results of this study indicated that HL and particularly critical HL are significant factors in reducing HbA1c in patients with type 2 diabetes through the mediation of self-care behaviors.

Women's health literacy and the complex decision-making process to use complementary medicine products in pregnancy and lactation.

BackgroundLittle is known about women's decision‐making processes regarding using complementary medicine products (CMPs) during pregnancy or lactation.ObjectivesTo explore the decision‐making processes of women choosing to use CMPs in pregnancy and lactation; and to investigate how women's health literacy influences their decisions.Design, setting and participantsIn‐depth interviews and focus group discussions were held with twenty‐five pregnant and/or breastfeeding women. Data were analysed using thematic analysis.ResultsKey to women's decision making was the desire to establish a CMPs safety and to receive information from a trustworthy source, preferably their most trusted health‐care practitioner. Women wanted positive therapeutic relationships with health‐care practitioners and to be highly involved in the decisions they made for the health of themselves and their children. Two overarching components of the decision‐making process were identified: (a) women's information needs and (b) a preference for CMP use. Women collated and assessed information from other health‐care practitioners, other mothers and published research during their decision‐making processes. They showed a strong preference for CMP use to support their pregnancy and breastfeeding health, and that of their unborn and breastfeeding babies.Discussion and ConclusionsComplex decision‐making processes to use CMPs in pregnancy and lactation were identified. The participants showed high levels of communicative and critical health literacy skills in their decision‐making processes. These skills supported women's complex decision‐making processes.

Multiple health literacy dimensions are associated with physicians’ efforts to achieve shared decision-making

ObjectivesShared decision-making (SDM) in health care is widely encouraged. However, for SDM to occur patients need to be able to obtain, understand and apply medical information. Our aim was to assess the relationship between health literacy (HL), numeracy and SDM (using French translations of validated measures). MethodsA cross-sectional survey using a self-administered online questionnaire was proposed to all members of the Seintinelles association. Several scales were used to measure HL (FCCHL and 3HLQ/SILS), numeracy (SNS-3), the SDM process (CollaboRATE) and explore their inter-relationships. ResultsData from 2 299 respondents (96.7% women, 46.1% with a history of cancer) were analysed. All measurement scales showed adequate psychometric properties. Functional HL, communicative HL and numeracy were positively associated with SDM while no significant relation was observed between critical HL and SDM. Furthermore, perceived difficulties in asking physicians’ questions and deprivation were negatively associated with SDM. ConclusionPatient support to reach SDM requires high levels of HL, particularly in the functional and communicative domains. Efforts must be made to improve access and understanding of health information. Practice implicationsBrief self-reported measures could be used to screen for low levels of health literacy, tailor information accordingly and improve patient involvement in healthcare decision-making.

The impact of self-efficacy and health literacy on outcome after bariatric surgery in Sweden: a protocol for a prospective, longitudinal mixed-methods study

IntroductionA person-centred approach, to know about a person’s individual weaknesses and strengths, is warranted in today’s healthcare in Sweden. When a person suffers from obesity, there are not only risks...

The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis.

Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

The effect of health literacy on treatment adherence in maintenance haemodialysis patients: a cross-sectional study

Background: Treatment non-adherence may be prevalent in patients requiring haemodialysis (HD). Health literacy plays an important role in self-management. However, most research has only assessed basic literacy skills in the haemodialysis cohort. Aim: To determine the association between a multidimensional concept of health literacy and self-reported treatment adherence in HD patients. Method: A cross-sectional survey was undertaken with 42 maintenance HD patients from two South Australian dialysis centres. The Functional, Communicative and Critical Health Literacy (FCCHL) tool was used to assess health literacy. Treatment adherence was measured using a self-report tool developed by the researchers. Results: Higher overall health literacy was associated with increased adherence to food (OR 3.66; 95% CI 1.08–12.43; p=0.038), fluid (OR 4.92; 95% CI 1.13–21.35; p=0.033) and medications (OR 11.88; 95% CI 2.26–62.44; p=0.003). Conclusion: Interventions should be designed to facilitate a multidimensional concept of health literacy to assist patients to follow treatment recommendations.

Modeling patient empowerment and health literacy to glycemic control in insulin-treated patients: A prospective study

ObjectiveTo model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design. MethodsInsulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model. ResultsBaseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL. ConclusionCommunicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients. Practice ImplicationsHealthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.

Relationship of health literacy with utilization of health-care services in a general Japanese population.

Many studies have explored the association between health literacy and health-care utilization; however, the majority assessed functional health literacy in terms of basic skills. Japan's health-care and medical examination system in workplaces is different from that of other major countries. This study examined the relationship of health literacy with health-care use (emergency visit, hospitalization, dental checkup, and health checkup or cancer screening); it focused on differences by occupation and health-care service utilization among general Japanese using the communicative and critical health literacy scale. We conducted a cross-sectional observational study of 1002 Japanese residents. Through a questionnaire, we investigated socioeconomic status, health status, health-care use, and health literacy. Among all participants and non-workers, logistic regression analyses revealed that health literacy was significantly associated with health checkup or cancer screening after adjusting for sex, age, marital status, education, and having a disease or disorder (adjusted odds ratio [OR] = 1.431, 95% confidence interval [CI], 1.131–1.810; adjusted OR = 1.614, 95% CI, 1.114–2.339, respectively). Among workers, we observed no significant association between health literacy and health-care utilization. These results indicate that health literacy is closely related to use of preventive health-care. Japan's health-care system in workplaces may promote use of preventive health-care services regardless of health literacy, whereas improving health literacy may be more critical among non-workers.

India's health and wellness centres: realizing universal health coverage through comprehensive primary health care.

In common with other countries in the World Health Organization South-East Asia Region, disease patterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases. This epidemiological transition has been a major driver impelling a radical rethink of the structure of health care, especially with respect to the role, quality and capacity of primary health care. In addition to the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and most vulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on an ambitious programme of transforming India's 150 000 public peripheral health centres into health and wellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of 2022. This transformation to facilities delivering high-quality, efficient, equitable and comprehensive care will involve paradigm shifts, not least in human resources to include a new cadre of mid-level health providers. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India's flagship programme for strengthening health systems. Expanding the scope of these components to address the expanded service delivery package will require reorganization of work processes, including addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, newborn and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; and using information and communications technology for better reporting, focusing on health promotion and addressing health literacy in communities. Although there are major challenges ahead to meet these ambitious goals, it is important to capitalize on the current high level of political commitment accorded to comprehensive primary health care.

Attitudes towards deprescribing and the influence of health literacy among older Australians.

This study aimed to explore attitudes, beliefs and experiences regarding polypharmacy and discontinuing medications, or deprescribing, among community living older adults aged ≥65 years, using ≥5 medications. It also aimed to investigate if health literacy capabilities influenced attitudes and beliefs towards deprescribing. Polypharmacy use is common among Australian older adults. However, little is known about their attitudes towards polypharmacy use or towards stopping medications. Previous studies indicate that health literacy levels tend to be lower in older adults, resulting in poor knowledge about medications. A self-administered survey was conducted using two previously validated tools; the Patients' Attitude Towards Deprescribing (PATD) tool to measure attitudes towards polypharmacy use and deprescribing and the All Aspects of Health Literacy Scale (AAHLS) to measure functional, communicative and critical health literacy. Descriptive statistical analysis was conducted. The 137 responses showed that 80% thought all their medications were necessary and were comfortable with the number taken. Wanting to reduce the number of medications taken was associated with concerns about the amount taken (P<0.001), experiencing side effects (P<0.001), or believing that one or more medications were no longer needed (P<0.000). Those who were using ten or more medications were more likely to want to reduce the number taken (P=0.019). Most (88%) respondents would be willing to stop medication/s in the context of receiving this advice from their doctor. Willingness to consider stopping correlated with higher scores on the critical health literacy subscale (P<0.021) and overall AAHLS score (P<0.009). Those with higher scores on the overall AAHLS measure were more likely to report that they understood why their medications were prescribed (P<0.000) and were more likely to participate in decision-making (P=0.027). Opportunities to proactively consider deprescribing may be missed, as one third of the respondents could not recall a recent review of their medications.

Validity and measurement invariance across sex, age, and education level of the French short versions of the European Health Literacy Survey Questionnaire.

BackgroundShort versions of the European Health Literacy Survey (HLS-EU) questionnaire are increasingly used to measure and compare health literacy (HL) in populations worldwide. As no validated versions of these questionnaires have thus far appeared in French, this study aimed to study the psychometric properties of the French translation of the 16- and 6-item short versions (HLS-EU-Q16 and HLS-EU-Q6), including their measurement invariance across sex, age, and education level.MethodsA consensual French version of the HLS-EU-Q16 and HLS-EU-Q6 was developed by following the current recommendations for transcultural questionnaire adaptation. It was then completed by 317 patients recruited in waiting rooms of general practitioners in the Paris area (France). Structural validity was studied with the Rasch model for the HLS-EU-Q16 and confirmatory factorial analysis (CFA) for the HLS-EU-Q6. Concurrent and convergent validity, respectively, were assessed by scores on the Functional Communicative Critical Health Literacy (FCCHL) questionnaire and the physicians’ evaluations of their patient’s HL.ResultsThe 16 items of the HLS-EU-Q16 were Rasch homogenous but meaningful differential item functioning (DIF) was found across sex, age, and/or education level for eight items. The CFA model fit for the HLS-EU-Q6 was poor. The overall scores for both HLS-EU short versions correlated poorly with the FCCHL scores. Similarly, HL levels defined using either short-version score did not agree with physicians’ HL assessments.ConclusionThe French version of the HLS-EU-Q16 has acceptable psychometric properties, despite meaningful DIF for age, sex and education level and a poor discriminative power among subjects with average to high HL level. We recommend its use to measure HL in populations with sufficient reading skills to discriminate between subjects with low to average HL. Also, sensitivity analyses should be performed to evaluate the potential measurement bias due to DIF. Our results did not demonstrate the validity of the HLS-EU-Q6.

Health literacy practices in social virtual worlds and the influence on health behaviour

This study explored how health information accessed via a 3D social virtual world and the representation of ‘self’ through the use of an avatar impact physical world health behaviour. In-depth interviews were conducted in a sample of 25 people, across 10 countries, who accessed health information in a virtual world (VW): 12 females and 13 males. Interviews were audio-recorded via private in-world voice chat or via private instant message. Thematic analysis was used to analyse the data. The social skills and practices evidenced demonstrate how the collective knowledge and skills of communities in VWs can influence improvements in individual and community health literacy through a distributed model. The findings offer support for moving away from the idea of health literacy as a set of skills which reside within an individual to a sociocultural model of health literacy. Social VWs can offer a place where people can access health information in multiple formats through the use of an avatar, which can influence changes in behaviour in the physical world and the VW. This can lead to an improvement in social skills and health literacy practices and represents a social model of health literacy.

Tingkat Literasi Kesehatan Pasien Diabetes Mellitus Tipe 2 Di Puskesmas Kota Tomohon

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic disease with high level of complexity that requires extensive education and self-care management. The demands on individuals with T2DM are complicated by the fact that self-care often depends on printed educational materials and high health literacy skills. Every individual who needs health information and services also needs health literacy skills to find health information and services, communicating needs, respond to and using the information and obtaining health services, understanding health information, and finding realible health information and services to suit all needs, making the right decision to act. This study aims to determine the level of functional, communicative, and critical health literacy of T2DM patients at Pangolombian and Kakaskasen Public Health Centre of Tomohon City, as well as factors related to the level of health literacy. Method: Quantitative descriptive to describe the level of health literacy and correlation to see factors related to the patient's health literacy level. The sample of this study was a patient of T2DM who followed prolanis, amounted to 34 people, determined by using purposive sampling. Data were obtained by interview and using demographic characteristics questionnaire and Functional, Communicative, and Critical Health Literacy questionnaires. Result: Generally, health literacy level of T2DM patients is still low both for functional, communicative, and critical. This can happen because of various factors but the most related is the low access to health information and patient education level. Conclusion: The results of this study showed that health literacy level of T2DM patient in Tomohon city is still very low. This happened because access to health information is still less obtained by patients and also their education level is still low. These results can be used as recommendations for health workers to pay more attention to how to educate patients who should be adjusted to the level of education so that the information provided can be put to good use by the patient.

Improving access to quality services for vulnerable older people in Kyrgyzstan through engaging volunteers and establishing self-help groups

Very often older people are being excluded from community life and are therefore particularly prone to disorientation in a changing world. In this connection, a Model designed by the Red Crescent Society of Kyrgyzstan engages community volunteers to improve access to quality services for vulnerable older people. RCSK is supporting older people through creating new opportunities and better access to existing services for them while at the same time, fostering the capacity of elderly people to address and solve their problems. This requires that the target beneficiaries know where they can receive support and how to apply for it by demonstrating skills necessary to solve their problems and support other community members. Positive impact of this approach could be demonstrated in a project including 400 vulnerable older people supported by 200 community volunteers providing social and household support, according to the IFRC minimal standards of Community Based Home Care for Older people. 120 older people act as members of elderly clubs, 20% of the beneficiaries are participating in community initiatives. The people feel more confident to share their feelings and opinions. 100% of beneficiaries with low mobility requesting for support receive assistance with special equipment helping to stay socially active and as independent as possible. By the end of 2017, 1450 people were informed on services available for older people in their communities. 120 of them have moved from being “beneficiaries” to becoming “active community members” who are able to support others, develop and implement initiatives. Members of 5 elderly clubs volunteer to improve health literacy of communities through health promotion and disease prevention activities. Importance is given to a close collaboration with existing services in order to complement rather than duplicate activities. Social workers provided by the state are the key persons assisting to vulnerable older people. But due to time limitations (each social worker provides services up to 20 wards) and prioritizing the most urgent needs, the RC volunteers are working in pairs with them using participatory approach. Plans of service provision are designed jointly by a social worker and a coordinator. RC volunteers are helping to establish links between social care services and health institutions. Volunteers regular visits help to monitor persons’ health state. If changes are noticed, coordinator reveals the personal data, contacts the family doctor and assists with further observation and controls timeliness of procedures. In addition, Family doctors and nurses to design individual plans for older people integrating social, psychological and health related needs and particularities can be made available. Community volunteers are engaged in spreading the practices of healthy ageing, supporting self-management of older people in terms of monitoring of their state of health, building environment in the community and reducing the burden of already stretched public health system. Sustainability of the action is achieved by transferring the lead action to beneficiaries. Beneficiaries are empowered to retake the action through establishing self-help groups. This approach turns the beneficiaries into enthusiastic and energetic volunteers who are able to contribute to development of their community.

A new comprehensive diabetes health literacy scale: Development and psychometric evaluation

BackgroundThe prevalence of diabetes is close to reaching an epidemic level, and health literacy has recently emerged as a concept that can influence the health outcomes of patients with diabetes. Health literacy was once defined from the perspective of basic reading and understanding skills, but this has now become more comprehensive to include the abilities and skills to assess, understand, appraise, communicate, and use health information. Nevertheless, there is no instrument reflecting the comprehensive health literacy relevant to diabetes. ObjectivesThe aims of this study were to develop a comprehensive Diabetes Health Literacy Scale and to evaluate its psychometric properties. DesignAn instrument-development study was applied that comprised three steps: conceptualization, item generation and content validity, and field testing of the psychometric properties. SettingsA convenience sample of 462 participants was recruited from December 2016 to September of 2017 at outpatient clinics in 2 Korean university hospitals. ParticipantsThe inclusion criteria for participants were being aged at least 19 years, articulate in the Korean language, and diagnosed with diabetes, while the presence of gestational diabetes was applied as an exclusion criterion. Approximately half of the participants were female (51.1%). The participants were aged 54.5 (SD, 11.0) years, 67.1% of them were taking an oral hypoglycemic agent, and 21.9% of them had well-controlled blood-glucose levels. MethodsThe content validity, factorial structure validity, convergent validity, criterion validity, internal consistent reliability, and test–retest reliability of the Diabetes Health Literacy Scale were evaluated. Data were analyzed using exploratory and confirmatory factor analyses, Pearson’s correlation, Cronbach’s alpha, and the intraclass correlation coefficient. ResultsThe content validity was assessed by five experts. Exploratory and confirmatory factor analyses yielded a three-factor solution. Convergent validity was demonstrated using measures of diabetes knowledge and self-efficacy. Criterion validity was demonstrated with generic health-literacy questions. Internal consistency reliability and test–retest reliability were found to be acceptable, as indicated by a Cronbach’s alpha of 0.91 and an intraclass correlation coefficient of 0.89, respectively. ConclusionsThe Diabetes Health Literacy Scale is a new instrument that measures comprehensive aspects of informational, numeracy, and communicative health literacy. It is a short instrument, comprising only 14 items scored on a 5-point Likert scale. The instrument exhibits good psychometric properties for four validity metrics (content, structural, convergent, and criterion validity) and two reliability metrics (internal consistency and test–retest reliability). These findings indicate that the instrument can be applied in both research and clinical practice.

Validating the Functional, Communicative, and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis.

The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.