Construct Of Health Literacy Research Articles

Development of a health literacy questionnaire for Taiwanese hemodialysis patients.

BackgroundDialysis has long been a critical issue in the field of nephrology, though the burden this lifesaving technology places on society can be immense. Effectively increasing the health literacy of hemodialysis patients can be beneficial for their health outcomes and self-care abilities. Thus, the aims of this study are to: (1) develop a health literacy assessment tool in Chinese for patients receiving hemodialysis treatment; (2) assess the health literacy level of the Taiwanese hemodialysis population using the tool developed.MethodsThe questionnaire was developed based on Nutbeam’s three constructs of health literacy and seven sub-constructs identified for the purposes of this study. Experts were consulted for content validity assessment. The questionnaire then was used to conduct a census study at six hospitals and one dialysis clinic that provide hemodialysis treatment in the Taipei area (urban northern Taiwan). To be included, patients must have been at least 18 years old and receiving hemodialysis treatment at the time of the study. 468 eligible respondents were included in the analysis.ResultsThe reliability of the tool was 0.81 and the confirmatory factor analysis indicated good construct validity. The mean literacy score for the sample was 19.7 (SD = 4.61) out of a maximum of 26 points, and the median was 21 (range from 6 to 26). Age, education level, primary language, primary caregiver identity, and willingness to receive a transplant were all factors that showed significant association to health literacy level in multiple categories.ConclusionsThe health literacy assessment tool developed in this study is the first health literacy assessment instrument to be made available for a specific patient group in Taiwan. Hemodialysis patients’ knowledge of day-to-day care practices is satisfactory, while their critical literacy is weak.

Validation of the short assessment of health literacy for spanish-speaking adults test in Chile

Health literacy is defined as the degree to which individuals obtain, process and understand basic health information and services. It is necessary to make appropriate decisions about their health. Evidence has shown that the level of health literacy is critical to the prognosis of chronic diseases. The Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA-50) is a short and simple health literacy adult assessment. To determine the validity and reliability indicators of SAHLSA-50 in Chilean adults. The survey was applied to 84 older adults living in high and low income neighborhoods. The survey had an adequate construct validity and reliability, its Comparative Fit Index was 0.93, its Tucker-Lewis index was 0.927 and its Root Mean Square Error of Approximation was 0.044. “Close fit” was not statistically significant (p = 0.828). Reliability was estimated by K-Richardson, which reported a good outcome (0.9255). Despite the good global indicators obtained, it is necessary to pay attention to some items that would fail to explain the “Health literacy” construct or were beyond the parameters of difficulty and discrimination proposed by the authors of the test. We propose this test as a useful tool to assess health literacy in the adult population in Chile. Its use and incorporation into local research can be especially recommended in the areas of education and health promotion.

Examining the Meaningfulness of Healthcare Organizations in the Light of Patient Empowerment

The role played by patient empowerment in health reform has been widely discussed by the scientific literature. In fact, patient empowerment has been variously presented as a new paradigm emerging in the healthcare service system, which involves a reconceptualization of the patient from a mere consumer of health services to a value co-creator. However, to the authors’ knowledge, until now most of the attention has been paid to the process of patient enablement, that is to say to the activation and the enhancement of the patients’ functional, interactive, and critical skills to navigate the healthcare service system. Alternatively, the meaningfulness of healthcare organizations, that is to say the ability of healthcare organizations to effectively communicate with patients and to establish with them a comfortable and co-creating relationship has been neglected. Drawing from the organizational health literacy construct, this paper is aimed at discussing the facilitators and the impediments to the meaningful...

What are judgment skills in health literacy? A psycho-cognitive perspective of judgment and decision-making research.

ObjectiveThe aim of this review is to summarize current research relating to psychological processes involved in judgment and decision-making (JDM) and identify which processes can be incorporated and used in the construct of health literacy (HL) in order to enrich its conceptualization and to provide more information about people’s preferences.MethodsThe literature review was aimed at identifying comprehensive research in the field; therefore appropriate databases were searched for English language articles dated from 1998 to 2015.ResultsSeveral psychological processes have been found to be constituents of JDM and potentially incorporated in the definition of HL: cognition, self-regulation, emotion, reasoning-thinking, and social perception.ConclusionHL research can benefit from this JDM literature overview, first, by elaborating on the idea that judgment is multidimensional and constituted by several specific processes, and second, by using the results to implement the definition of “judgment skills”. Moreover, this review can favor the development of new instruments that can measure HL.Practical implicationsFuture researchers in HL should work together with researchers in psychological sciences not only to investigate the processes behind JDM in-depth but also to create effective opportunities to improve HL in all patients, to promote good decisions, and orient patients’ preferences in all health contexts.

Understanding barriers to optimal medication management for those requiring long-term dialysis: rationale and design for an observational study, and a quantitative description of study variables and data.

BackgroundRates of medication non-adherence in dialysis patients are high, and improving adherence is likely to improve outcomes. Few data are available regarding factors associated with medication adherence in dialysis patients, and these data are needed to inform effective intervention strategies.Methods/designThis is an observational cross-sectional study of a multi-ethnic dialysis cohort from New Zealand, with the main data collection tool being an interviewer-assisted survey. A total of 100 participants were randomly sampled from a single centre, with selection stratified by ethnicity and dialysis modality (facility versus home). The main outcome measure is self-reported medication adherence using the Morisky 8-Item Medication Adherence Scale (MMAS-8). Study data include demographic, clinical, social and psychometric characteristics, the latter being constructs of health literacy, medication knowledge, beliefs about medications, and illness perceptions. Psychometric constructs were assessed through the following survey instruments; health literacy screening questions, the Medication Knowledge Evaluation Tool (Okuyan et al.), the Beliefs about Medication Questionnaire (Horne et al.), the Brief Illness Perception Questionnaire (Broadbent et al.). Using the study data, reliability analysis for internal consistency is satisfactory for the scales evaluating health literacy, medication knowledge, and beliefs about medications, with Chronbach’s α > 0.7 for all. Reliability analysis indicated poor internal consistency for scales relating to illness perceptions. MMAS-8 and all psychometric scores are normally distributed in the study data.DiscussionThis study will provide important information on the factors involved in medication non-adherence in New Zealand dialysis patients. The resulting knowledge will inform long-term initiatives to reduce medication non-adherence in dialysis patients, and help ensure that they are addressing appropriate and evidence based targets for intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0097-2) contains supplementary material, which is available to authorized users.

Promoting health literacy in secondary schools: A review

Schools provide a key platform for promoting health literacy in young people. Despite a long history of initiatives to create health promoting schools, and extensive literature on the construct of health literacy, there is much less research on using the school nursing workforce to promote health literacy, particularly in the English school context. In this paper we review the relevant literature and distil key messages. The school nursing workforce is small, and needs to work in partnership with other agencies. While there are clear opportunities there are also constraints on what can be achieved. As well as providing basic health information, for real health literacy to develop young people need to learn skills and become empowered to take action. More research is needed to establish how school nurses can contribute to this in the broader context of health promoting schools.

Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health.

The evolution of health literacy assessment tools: a systematic review.

BackgroundHealth literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument.MethodsWe performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE.ResultsWe identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline.ConclusionsScholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear “consensus” on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1207) contains supplementary material, which is available to authorized users.

Is health literacy an example of construct proliferation? A conceptual and empirical evaluation of its redundancy with general cognitive ability

During the last 20years, health literacy has been promoted as an important determinant of individual and group differences in health outcomes. Despite a definition and pattern of associations with health outcomes highly similar to ‘g’ (i.e., the general cognitive ability factor), health literacy has been conceptualized as a distinct construct. This study evaluates the conceptual and empirical distinctiveness of health literacy. A sample of 167 students from a southeastern urban university (117 females and 50 males) between the ages of 18 and 53 (M=21.31, SD=5.61) completed a cognitive ability battery, three health literacy tests, two knowledge tests, and a questionnaire assessing 12 health behaviors and health outcomes. Across 36 tests of criterion-related validity, cognitive ability had an effect in all 36 cases, where the health literacy tests only showed measureable incremental validity in 6 of 36 cases. Factor analysis revealed only three factors defined by the traditional ability tests with the health literacy measures loading on the ability factors as predicted by the content validity analysis. There was no evidence of a health literacy factor. The combined results from a comparative content analysis, an empirical factor analysis, and an incremental validity analysis cast doubt on the uniqueness of a health literacy construct. It is suggested that measures of health literacy are simply domain-specific contextualized measures of basic cognitive abilities. Implications for linking these literatures and increasing our understanding of the influence of intellectual factors on health are discussed.

On the Validity of the Shortened Rapid Estimate of Adult Literacy in Medicine (REALM) Scale as a Measure of Health Literacy

Originally developed to measure the literacy level of patients, the Rapid Estimate of Adult Literacy in Medicine (REALM) scale is one of the most widely used instruments to measure the construct of health literacy. This article critically examines the validity of the REALM as a measure of health literacy. Logical analysis of content coverage led to the conclusion that scores on the REALM should not be used to make inferences about a person's level of health literacy. Rather, the REALM should be used to make inferences about the ability of a person to read and pronounce health related terms. Evidence from an analysis of a sample of 1,037 respondents to the REALM with a cancer diagnosis supports the quality of the REALM as a measure of reading and pronunciation ability. Other uses of the REALM in health literacy research are discussed.

The Health Literacy Management Scale (HeLMS): A measure of an individual's capacity to seek, understand and use health information within the healthcare setting

ObjectiveHealth literacy refers to an individual's ability to seek, understand, and use health information. This paper describes the development and psychometric testing of the Health Literacy Management Scale (HeLMS). MethodsContent areas were identified from a conceptual framework derived from interviews and concept mapping. Items were generated from statements from concept mapping participants. Construction (N=333) and replication (N=350) samples were participants in chronic disease self-management programs and emergency department attendees. Factor analysis was used to refine constructs and define psychometric properties. ResultsConsultations generated 8 scales each with 4–5 items: Understanding health information, Accessing GP healthcare services, Communication with health professionals, Being proactive and Using health information, Patient attitudes towards their health, Social support, and Socioeconomic considerations. Confirmatory factor analyses indicated good fit of the data with the model (RMSEA=0.07, SRMR=0.05, CFI=0.97) and all domains had high internal consistency (Cronbach alpha>0.82). ConclusionThe HeLMS has acceptable psychometric properties and assesses a range of health literacy constructs important to patients when seeking, understanding and using health information within the healthcare system. Practice implicationsThe HeLMS presents a new approach to assessing health literacy in healthcare settings.

Assessing Health Literacy: A New Domain for Collaboration Between Language Testers and Health Professionals

Health literacy, defined as an individual's capacity to process health information in order to make appropriate health decisions, is the focus of increasing attention in medical fields due to growing awareness that suboptimal health literacy is associated with poorer health outcomes. To explore this issue, a number of instruments, reported to have high internal consistency and strong correlations with general literacy tests, have been developed. However, their validity as measures of the target construct is seldom explored using multiple sources of evidence. The current study, involving collaboration between health professionals and language specialists, set out to assess the validity of the Rapid Estimate of Adult Literacy in Medicine (REALM), which describes itself as a “reading recognition” test that measures ability to pronounce common medical and lay terms. Drawing on a sample of 310 respondents, including both native and non-native speakers of English, investigations were undertaken to probe the REALM's validity as a measure of understanding the selected terms and to consider associations between scores on this widely used test and those derived from other recognized health literacy tests. Results suggest that the REALM is underrepresenting the health literacy construct and that the test may also be biased against non-native speakers of English. The study points to an expanded role for language testers, working in collaboration with experts from medical disciplines, in developing and evaluating health literacy tools.

Effects of health literacy to self‐efficacy and preventive care utilization among older adults

This study examined the relationships between health literacy, self-efficacy and preventive care utilization among older adults in Taiwan. The data were from a longitudinal survey, "Taiwan Longitudinal Study in Aging" in 2003 and 2007. A total of 3479 participants who completed both two waves were included for analysis. Health literacy first was constructed through education, cognitive function and disease knowledge through structural equation modeling (SEM); then, the associations of health literacy to later self-efficacy and preventive care were examined. The model fit of SEM was good, indicating that the construct of health literacy was appropriate. Healthy literacy showed a moderate positive effect on self-efficacy and a small positive effect on preventive care utilization. Health literacy increases self-efficacy and utilization of preventive care. Promoting people's health knowledge and health literacy is suggested.

Comprehensibility of patient consent forms for radiation therapy of cervical cancer

ObjectiveThe construct of Health Literacy (HL) deals with patients' capacity to understand their health-related instructions, consent forms, and other documents. A significant challenge of providing healthcare to patients with low HL is the complex nature of the disease process, and of requisite treatments. In radiation oncology specifically, the delivery of ionizing radiation is difficult enough to describe; describing radiation toxicity in terms of the underlying physics and biology is daunting. A multimodal analysis of a small sample of patient consent forms was undertaken in order to address this issue more closely, and identify the extent to which such literature contributes to the challenges faced by patients with low HL. MethodsMembers of national cooperative group panels dealing with gynecologic cancer were asked to submit copies of consent forms provided to patients with stage II cervical cancer. Four such forms were submitted and reviewed by a single person with expertise in linguistics using standard tools. ResultsThree of the four consents scored within the lower portion of the “adequate“ range. One consent was not suitable. Consent readability ranged from grades 12.18 to 16.13; this means that they required at least a high school education to interpret, and in two cases required post-graduate coursework. ConclusionThere is significant room for improvement in consent form design and structure. When considering cultural and socioeconomic appropriateness of patient consent forms, input of staff with expertise in linguistics should be sought.

Critical health literacy: A review and critical analysis

Though there has been a considerable expansion of interest in the health literacy concept worldwide, there has also been criticism that this concept has been poorly defined, that it stretches the idea of “literacy” to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion. This paper takes as a starting point the expanded model of health literacy advanced by Nutbeam (2000) and addresses these concerns by interrogating the concept of “critical health literacy” in order to draw conclusions about its utility for advancing the health of individuals and communities. The constituent domains of critical health literacy are identified; namely information appraisal, understanding the social determinants of health, and collective action, and as far as possible each are clearly delineated, with links to related concepts made explicit. The paper concludes that an appreciation of work undertaken in a range of different disciplines, such as media studies, medical sociology, and evidence-based medicine can enhance our understanding of the critical health literacy construct and help us understand its usefulness as a social asset which helps individuals towards a critical engagement with health information. There is some evidence that aspects of critical health literacy have indeed been found to be a resource for better health outcomes, but more research is needed in this area, both to develop quantitative and qualitative approaches to evaluating health literacy skills, and to offer convincing evidence that investment in programmes designed to enhance critical health literacy are worthwhile.

Listening to patients: How understanding health information use can contribute to health literacy constructs

This panel focuses on expanding concepts of health literacy by exploring how the acquisition and use of health information through the context of people's daily lives significantly enhances their understanding and implementation of both acute and chronic health treatment and management. Prevalent health literacy initiatives emphasize core information literacy skills and concerns by addressing issues such as readability, clarity in communication, and appropriate vetting of online health information sources; however, these measures do not address the intricate ways in which people interact with and use information when making decisions about their health. In this session, researchers working within a variety of cross-disciplinary arenas and contexts, including information science, communications, nursing, medicine, health services, and public health, will engage with the question of how information behavior-based studies can impart additional dimensions to an understanding of health literacy beyond basic literacy skills and information delivery. We argue that information behavior perspectives can enrich the conceptual base of health literacy, contributing a deeper understanding of people's engagement with and use of health information in the context of their lived experience with health conditions. The six panelists will provide insight into additional dimensions of experience relevant to health literacy, including how people identify and understand their information needs, how interpersonal sources are considered as health information, the value of experience-based or peer information, and how engagement in online communities, families, and social networks contributes to how health information is experienced, considered, evaluated, used, and applied in negotiating health and illness.