Critical Health Literacy Scale Research Articles

Cross-sectional and Correlational Examination of Patients’ Preoperative Anxiety, Information Need, and Health Literacy in a Presurgical Consultation

PurposeThis study elucidates the preoperative anxiety (PA), information need (IN), and health literacy (HL) levels of an elective preoperative sample in Switzerland and examines the possible associations between PA and the patients’ characteristics. By knowing these patient dimensions, which can influence perioperative outcomes, one can tailor individualized nursing interventions to improve patients’ surgical experience. DesignThis was a cross-sectional and correlational study. MethodsThe sample consisted of 88 patients who underwent a preoperative consultation at a Swiss tertiary hosptial. Patients’ PA and IN were assessed using the Anxiety Preoperative and Information Scale, and their HL was measured using the Functional, Communicative, and Critical Health Literacy Scale. Data on other patient characteristics were collected from the patients, physicians, and electronic patient records. Association tests, as well as univariate regressions, were performed on PA, IN, HL, and patient characteristics. FindingsAmong participants, 40.91%, 78.41%, and 59% reported having PA, IN, and low HL, respectively. Finally, PA was associated with IN, HL, solitary living, and the American Society of Anesthesiology score. ConclusionsA high proportion of patients scheduled for presurgical consultation were found to be anxious. They presented high IN and low HL. An examination of patients’ PA–associated characteristics can help improve their surgical experience. More studies should examine PA–associated characteristics.

Health literacy and its association with mental and spiritual well-being among women experiencing homelessness.

Low health literacy (HL) has been linked to low self-rated health, reduced efficacy of behaviour change, and challenges in preventing, treating, or managing health conditions. People experiencing homelessness are at risk of poor HL; however, few studies have investigated HL in relation to mental and spiritual well-being among people experiencing homelessness in general, or women experiencing homelessness specifically. This cross-sectional study of 46 women experiencing homelessness in Stockholm, Sweden, recruited during the period October 2019-December 2020, aimed to examine how HL was associated with mental and spiritual well-being among women experiencing homelessness. Participants answered questions about socio-demographic characteristics (age, length of homelessness, education) and digital technology (mobile phone/the Internet) use, in addition to Swedish language versions of three questionnaires administered through structured, face-to-face interviews: the Communicative and Critical Health Literacy Scale, the General Health Questionnaire 12 and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. Data were analysed using linear regression, which revealed statistically significant associations between HL and mental well-being (p = .009), and between HL and spiritual well-being (p = .022). However, neither socio-demographic characteristics nor digital technology use were significantly associated with HL. In conclusion, promoting HL may improve mental and spiritual well-being in this vulnerable population. An advisory board of women with lived experiences of homelessness (n = 5) supported the interpretation of the findings and emphasised the need to consider HL in relation to basic needs such as 'housing first'. Moreover, health information and services should be accessible to people with different degrees of HL.

Association between physical activity and health literacy in patients with Parkinson’s disease: an online web survey

BackgroundFor patients with Parkinson's disease (PwPD), promotion of habitual physical activity (PA) assists in the prevention of disease progression. Patients' health literacy (HL) is integral for meeting PA standards and turning it into a habit. This study evaluated the association between PA level and each HL domain in PwPD.MethodsOnline web-based assessment instruments and self-administered questionnaires, including the PA Questionnaire (IPAQ) Short Form and the Functional, Communicative, and Critical Health Literacy (FCCHL) scale, were used to assess PA levels and health literacy domains of PwPD.ResultsThe mean age of PwPD (n = 114) was 65.9 (SD = 11.6) years; 59.6% female, and the mean duration of disease was 6.4 (SD = 5.1) years. Of participants, 47.4% met the recommended criteria for PA. When comparing each HL domain by PA level, participants with lower PA had significantly lower critical HL (p = 0.03). Logistic regression analysis revealed that PA level correlated with critical HL (OR = 2.46; 95% CI = 1.16–5.19; p = 0.02).ConclusionsAdherence to recommended PA standards was associated with critical HL, but not other HL domains. Proactive attitudes to critically evaluate and utilize as well as understand health information may positively influence the promotion of PA.

Patients' Individualized Care Perceptions and Health Literacy Using an Interactive App During Breast and Prostate Cancer Treatment: Two Parallel Randomized Controlled Trials.

The use of symptom management mobile apps can reduce patients' symptom burden during cancer treatment, but the evidence is lacking about their effect on care. Moreover, if patients' health literacy can be improved, it needs to be more rigorously tested. This study aimed to evaluate patients' perceptions of individualized care and health literacy using an interactive app in two randomized trials. Patients undergoing neoadjuvant chemotherapy for breast cancer (N = 149) and radiotherapy for prostate cancer (N = 150) were consecutively included and randomized into one intervention or control group. Outcome measures were Individualized Care Scale, Swedish Functional Health Literacy Scale, and Swedish Communicative and Critical Health Literacy Scale. In the breast cancer trial, no group differences were observed regarding individualized care or health literacy. Most patients had sufficient health literacy levels. In the prostate cancer trial, intervention group patients rated higher perceived individualized care regarding decision control at follow-up than the control group. Less than half had sufficient health literacy levels and intervention group patients significantly improved their ability to seek, understand, and communicate health information. Education level explained significant variance in health literacy in both trials. Using an interactive app can positively affect individualization in care and health literacy skills among patients treated for prostate cancer, although further research is warranted.

Associations of health literacy with dental care use and oral health status in Japan

BackgroundThe concept of health literacy has gained prominence in the context of oral health. In Japan, curative dental care is generally under universal health coverage, while preventive dental care requires effort. We used this situation to test the hypothesis that high health literacy is associated with preventive dental care use and good oral health status, but not with curative dental care use, in Japan.MethodsA questionnaire survey was conducted from 2010 to 2011 among residents aged 25–50 years in Japanese metropolitan areas. Data from 3767 participants were used. Health literacy was measured using the Communicative and Critical Health Literacy Scale, and the total score was categorized into quartiles. Poisson regression analyses with robust variance estimators were conducted to examine the associations of health literacy with curative dental care use, preventive dental care use, and good oral health, adjusted for covariates.ResultsThe percentages of curative dental care use, preventive dental care use, and good oral health were 40.2%, 28.8%, and 74.0%, respectively. Health literacy was not associated with curative dental care use; the prevalence ratio (PR) of the highest relative to the lowest quartile of health literacy was 1.04 (95% confidence interval [CI], 0.93–1.18). High health literacy was associated with preventive dental care use and good oral health; the corresponding PRs were 1.17 (95% CI, 1.00–1.36) and 1.09 (95% CI, 1.03–1.15), respectively.ConclusionsThese findings may provide clues for the design of effective interventions to promote preventive dental care use and improve oral health status.

Effect modification by geographic area on the association between health literacy and self-rated health: a nationwide cross-sectional study in Japan

BackgroundHealth literacy (HL) has gained increasing attention as a factor related to health behaviors and outcomes. This study aimed to investigate geographic differences in HL levels and effect modification by geographic area on their relationship with self-rated health in the Japanese population using a nationwide sample.MethodsData for this study were derived from a nationally representative cross-sectional survey on health information access for consumers in Japan using a mailed self-administered questionnaire in 2020 (INFORM Study 2020). Valid responses from 3,511 survey participants, selected using two-stage stratified random sampling, were analyzed in this study. HL was measured using the Communicative and Critical Health Literacy Scale (CCHL). Multiple regression and logistic regression analyses were conducted to examine the associations between geographic characteristics and HL and effect modification on the association between HL and self-rated health by geographic area, controlling for sociodemographic characteristics.ResultsThe mean HL score was 3.45 (SD = 0.78), somewhat lower compared with previous studies on the Japanese general population. HL was higher in Kanto area than in Chubu area, after controlling for sociodemographic factors and municipality size. Furthermore, HL was positively associated with self-rated health after controlling for sociodemographic and geographic factors; however, this association was more evident in eastern areas than in western areas.ConclusionThe findings indicate geographic differences in HL levels and effect modification by geographic area on the relationship between HL and self-rated health in the general Japanese population. HL was more strongly associated with self-rated health in eastern areas than in western areas. Further investigation is needed to explore the moderating effects of areal features, including the distribution of primary care physicians and social capital, when formulating strategies to improve HL in different contexts.

Association between community-level health literacy and frailty in community-dwelling older adults.

We aimed to investigate whether high community-level health literacy, beyond individual-level health literacy, is associated with a low prevalence of frailty among community-dwelling older adults. A large cross-sectional questionnaire survey was conducted among citizens in Maizuru City, Kyoto, Japan, aged 65years or older who were not certified as "support" or "care" level according to Japan's public long-term care insurance system, who could perform basic activities of daily living, and who did not have dementia or Parkinson's disease. Frailty status was assessed using the Kihon Checklist, with a score ≥ 8 indicating frailty. Health literacy was assessed using the Communicative and Critical Health Literacy Scale. The mean health literacy score of 20 school districts was used as the community-level health literacy index. We investigated demographic data and other potential confounding factors, including education, living arrangement, body mass index, comorbidity, smoking status, depressive symptoms, social networks, and community-level covariates. The primary analysis included 6230 individuals (mean age = 74.3years [SD = 6.1]). In each school district, the prevalence of frailty was 21.2-34.2% (mean: 26.2%), and community-level health literacy index was 3.1-3.5 (mean: 3.4). Multilevel logistic regression model including school district as random effect showed that the community-level health literacy was significantly associated with frailty (odds ratio [95% confidence interval] = 0.28 [0.08 to 0.96]) after adjusting for the covariates. Not only high individual-level health literacy but also high community-level health literacy is associated with a low prevalence of frailty in community-dwelling older adults.

Economic, cognitive, and social paths of education to health-related behaviors: evidence from a population-based study in Japan.

There is substantial evidence on the association between lower education and unhealthy behaviors. However, the mechanism underlying this association remains unclear. This study aimed to examine whether income, health literacy, and social support mediate the association between education and health-related behaviors. A questionnaire survey was conducted in metropolitan areas in Japan from 2010 to 2011 among residents aged 25-50 years. Data from 3663 participants were used in this study. Health literacy was measured using the Communicative and Critical Health Literacy scale. Health-related behaviors were current smoking, poor dietary habits, hazardous drinking, and lack of exercise. Poisson regression analyses with robust variance estimators were conducted to examine the associations between education and these health-related behaviors. Multiple mediation analyses were conducted to estimate the magnitudes of the mediating effects of income, health literacy, and social support on these associations. Less educated participants had higher risks of all unhealthy behaviors. Income mediated the associations of education with smoking (6.4%) and exercise (20.0%). Health literacy mediated the associations of education with dietary habits (15.4%) and exercise (16.1%). Social support mediated the associations of education with dietary habits (6.4%) and exercise (7.6%). The education-drinking association was mediated by income in the opposite direction (-10.0%). The proportions of the total effects mediated by income, health literacy, and social support were 9.8% for smoking, 24.0% for dietary habits, -3.0% for drinking, and 43.7% for exercise. These findings may provide clues for designing effective interventions to reduce educational inequalities in health-related behaviors.

PS-P12-3: RELATIONSHIP BETWEEN SOCIOECONOMIC STATUS AND HEALTH LITERACY AMONG HEALTHY JAPANESE PEOPLE

Objective: In today's society, people are encouraged to take more active roles in their own health. For that purpose, a wide range of health information has become available to the public, and increased attention is being paid to health literacy worldwide. The World Health Organization defines health literacy as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health. On the other hand, low socioeconomic status is associated with higher blood pressure. Clarifying the relationship between socioeconomic status and health literacy could be useful to develop appropriate interventions to prevent hypertension in people with low socioeconomic status. This study clarified the relationship between socioeconomic status and health literacy among healthy Japanese people. Design and Method: This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal National Health Insurance aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions (n = 8,174) and those with missing data (n = 690), the analysis included 3,582 participants. Socioeconomic status (education level, self-reported economic status, and occupation) and health literacy were obtained using the self-administered questionnaire. Health literacy was measured using the Communicative and Critical Health Literacy (CCHL) scale. Participants were classified into two groups, low and medium/high health literacy groups, by their CCHL scale scores. The study protocol was approved by the Institutional Review Boards. Results: In this study, 53.0% of those had < = 12 years of education, and 14.4% of those did not have an occupation. Regarding self-reported economic status, 18.3% were categorized as good, 22.3% as average, and 59.4% as poor. After adjusting for confounding factors, low education level [multivariable-adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38–1.88, < = 12 years vs. > 12 years], poor economic status [multivariable-adjusted OR 1.75, 95% CI 1.39–2.19, poor vs. good], and no occupation [multivariable-adjusted OR 1.45, 95% CI 1.18–1.78, absence vs. presence] were positively associated with low health literacy. Conclusions: Low socioeconomic status was associated with low health literacy among healthy Japanese people. In order to prevent hypertension in people with low socioeconomic status, it may be useful to develop easy-to-understand materials.

Health literacy and digital health information-seeking behavior – a cross-sectional study among highly educated Swedes

BackgroundThe benefits of digital development in health care may be obscured by unequal opportunities to make use of digital resources. The aim of this study was to investigate the association of health literacy with I) accessing health check test results in the Patient Electronic Health Record (PAEHR), II) searching for information to better understand individual test results, and III) using the national health information online portal provided by the Swedish national health care system.MethodsThis cross-sectional study included data from 434 individuals, 50–64 years old, randomly selected from the Swedish population during the year 2017 to a cohort study including health examination and a web-based survey. Health literacy was assessed at baseline using the Swedish Communicative and Critical Health Literacy scale. Digital information outcomes were assessed after three months. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) for the separate outcomes were computed using logistic regression. Covariates included sex, age, education, country of birth, cardiovascular risk factors at baseline, general health, risk perception, referral, and new cardiovascular risk factors detected at health examination.ResultsAbout a third of the participants (35%) had limited health literacy, while 65% had sufficient health literacy. Sufficient health literacy was associated with accessing the PAEHR (adjusted OR 1.81 95% CI 1.07–3.06) and use of the online national health information portal provided by the Swedish national health care system (adjusted OR 2.91 95% CI 1.13–7.52) but not with searching information to better understand individual test results (adjusted OR 1.29 0.75–2.20).ConclusionsIndividuals with limited health literacy do not access their personal health information nor search for health information on the online national health information portal provided by the Swedish national health care system to the same extent as individuals with sufficient health literacy. More research is needed about how the level of health literacy relates to differences in online health information-seeking behavior and how digital health information sources and e-health services can be designed to ensure that the entire population has equal access to trustworthy and quality-ensured health information.

Health literacy among older adults 77+ in Sweden

Abstract Background Health literacy (HL) is an essential component of an individual’s ability to gain access to, understand and use information to improve and maintain good health and is an important prerequisite for managing health and care needs. Therefore, knowledge on older people’s HL is vital to meet the care needs of the rapidly aging population efficiently and equitably. Knowledge on HL in the older population is limited, both in an international perspective and in Sweden. Challenges linked to limited HL are expected to increase with advanced age, emphasizing the importance of conducting a study using a nationally representative sample of older adults. The aim of the study was to explore the level of HL in older adults living in Sweden. Methods A cross sectional study using data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), which is a nationally representative sample of the Swedish population aged 77+ years (N = 1500). SWEOLD covers areas such as health, socioeconomic and social factors. HL is assessed with the communicative and critical health literacy scale. The data was collected through telephone interviews in fall 2021 and spring 2022. Respondents not able to answer themselves were excluded. Results Preliminary results show that 49 % of the participating adults aged 77+ have limited HL. HL was significantly associated with age (77-85 years OR: 1.80; 86+ OR: 3.04), education level (OR: 1.76), vision (OR: 2.40) and cognitive ability (OR: 0.88). HL was not significantly associated with sex. Conclusions These preliminary results shows that a large proportion of Swedish older people might face difficulties related to accessing, understanding, appraising, and applying health information in ways which promote and maintain good health, and stresses the importance of examining the topic in greater detail. Key messages • A high proportion of older adults in Sweden have limited health literacy. • Health literacy among older adults in Sweden varies with age, level of education, vision and cognitive ability.

Relationship between communicative and critical health literacy, health information sources, and participation in health checkups among middle-aged Japanese community residents

We assessed the relationship between health literacy and participation in health checkups among middle-aged Japanese community residents. Additionally, we explored the health information sources related to participation in health checkups among those with low, medium, and high health literacy. This mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents with National Health Insurance (NHI), aged 40–64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3582 participants. Health literacy was measured by the Communicative and Critical Health Literacy (CCHL) scale, and participants were classified into three groups (low, medium, and high health literacy groups) by the tertiles of CCHL scale score. After adjusting for confounding factors, the multivariable-adjusted odds ratios for non-participation in health checkups were 1.20 (95% CI 1.01–1.43, p = 0.039) in the medium health literacy group and 1.47 (95% CI 1.20–1.80, p < 0.001) in the low health literacy group compared with the high health literacy group. Additionally, some health information sources were associated with participation in health checkups in the medium and high health literacy groups, whereas none of the health information sources were associated with participation in health checkups in the low health literacy group. We believe that it is important to develop materials and interventions aimed at low health literacy populations to promote participation in health checkups.

Association between health literacy and purpose in life and life satisfaction among health management specialists: a cross-sectional study

Purpose in life is anchored as a goal in national health promotion plans in several countries. Health literacy is the ability to find, understand, use, and evaluate health-related information; this ability has been investigated in terms of its effect on health outcomes and is said to play a critical role in health promotion. In the context of national health promotion, the effect of health literacy on purpose in life and life satisfaction remains unclear; therefore, this study aims to determine the effect of health literacy. A cross-sectional study was conducted on Japanese health management specialists (N = 1920). Health literacy was measured using the Communicative and Critical Health Literacy scale. Purpose in life and life satisfaction were measured using the Ikigai-9 scale and a Likert scale, respectively. We analyzed the associations between health literacy and purpose in life and life satisfaction with regression analyses. Age, sex, income, education, marital status, psychological stress, and diseases as present illness were adjusted in the statistical models. Our multiple linear regressions indicated that health literacy was significantly associated with purpose in life (β = 0.199, p < 0.001), after adjusting for covariates (age, sex, income, education, marital status, psychological factor, and disease status). Life satisfaction was also significantly associated with health literacy (β = 0.126, p < 0.001). Health literacy is associated with purpose in life and life satisfaction among specialists in health management. Health literacy plays a critical role in lifestyle-related disease prevention and health promotion. Interventions to improve health literacy may be warranted in the context of national health promotion.

Effect of Different Educational Interventions on Knowledge of HPV Vaccination and Cervical Cancer among Young Women: A Preliminary Report.

The incidence and mortality rates of cervical cancer are rising among young women in Japan. In November 2021, the Japanese Ministry of Health, Labour, and Welfare reinstated the active recommendation for the human papillomavirus (HPV) vaccine, which was discontinued in June 2013 due to reports of adverse reactions, including chronic pain and motor dysfunction, following vaccination. However, vaccine hesitancy among the younger generation remains, and it is essential to identify the barriers in vaccination uptake. Therefore, we aimed to conduct a randomized study using different methods of providing educational contents to improve health literacy regarding cervical cancer and HPV vaccination among female students in Japan. Here, we present the results of our preliminary report and discuss current topics related to HPV vaccination in Japan. Data were collected from 27 female students—divided into three groups: no intervention, print-based intervention, and social networking service-based intervention—using the health literacy scale and communicative and critical health literacy scale. Our primary results indicate that participants’ knowledge and health literacy improved post-intervention. Therefore, medical professionals must provide accurate scientific knowledge regarding routine HPV vaccination and the risk of cervical cancer to young women to improve their health literacy and subsequently increase the HPV vaccination rates.

Functional, communicative and critical health literacy among older Polish citizens.

The level of health literacy possessed by an individual (functional, communicative, critical) determines their ability to effectively self-manage a chronic disease. The aim of the study was to assess the level and functional, communicative, and critical determinants of health literacy in the group of chronically ill older adults. The study was conducted on a representative sample of chronically ill people (N = 400) aged ≥65 years, living in Poland. Three levels of health literacy were measured on the basis of the Functional, Communicative and Critical Health Literacy scale (FCCHL), employed in Polish social research for the first time. The conducted research showed that the average health literacy score of the surveyed older adults, measured on the basis of the FCCHL scale, was 2.81±0.71 (M±SD), whereas for the functional subscale of health literacy it was 3.06±0.58 (M±SD), for communicative health literacy it was 2.82±0.86 (M±SD), and for critical health literacy - 2.71±0.92 (M±SD). In terms of functional health literacy, the surveyed seniors most frequently reported problems with reading health-related information, resulting from the use of inadequate font size in information leaflets and brochures. Questions included in the subscale representing communicative health literacy revealed that the majority of the respondents understood the provided information about diseases, nevertheless they were reluctant to share thoughts about their health with other people. Within the framework of critical health literacy, one-third of the respondents did not search for any additional information, trusting that the information obtained was accurate and reliable. The surveyed elderly people rated worse their level of communicative and critical health literacy compared to the functional level. As a consequence of the low level of communicative and critical health literacy of the surveyed older adults, a certain deficit in their self-managing a disease entity is forecast. Med Pr. 2022;73(3):191-9.

Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study

ObjectivesThe aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery.DesignA prospective cross-sectional...

Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study.

BackgroundSelf-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.ObjectiveThis study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.MethodsThe eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months’ access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.ResultsThree main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants’ experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.ConclusionsFindings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.Trial RegistrationClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016851

The Relationship between Subjective Cognitive Decline and Health Literacy in Healthy Community-Dwelling Older Adults.

Few studies have examined the effects of health literacy on people at risk of developing dementia; its effects on the pathogenesis of subjective cognitive decline (SCD) are particularly unclear. This study aimed to clarify the relationship between health literacy and SCD in a population of healthy community-dwelling older adults. SCD status was assessed using the Cognitive Function domain of the Kihon Checklist (KCL-CF). Health literacy, in turn, was evaluated using the Communicative and Critical Health Literacy (CCHL) scale. Global cognitive function and depressive symptoms were evaluated using the Mini-Mental State Examination (MMSE) and a five-item version of the Geriatric Depression Scale (GDS-5), respectively. Participants who were suspected of having SCD were significantly older than their non-SCD peers, and scored significantly worse on the CCHL, MMSE, and GDS-5. In addition, SCD status was found to be associated with CCHL and GDS-5 scores, as well as age, according to a logistic regression analysis. These findings suggest that low health literacy is linked to SCD morbidity in healthy community-dwelling older adults and should prove useful in the planning of dementia prevention and intervention programs for this population.

Personality and health literacy among community-dwelling older adults living in Japan.

Previous studies have demonstrated that health behaviours may be one of the major mechanisms underlying the relationship between personality and health outcomes. Such health behaviours may be established by consciousness toward one's health that include health literacy. Thus, this study aimed to explore the relationship between health literacy and its correlates, including personality, among community-dwelling older adults. This was a cross-sectional study with 683 older individuals (aged 60-84 years; 326 men and 357 women). A questionnaire was used to assess health literacy, personality, socioeconomic status, health status, and lifestyles. Health literacy was measured using the Communicative and Critical Health Literacy Scale, which is a self-report questionnaire comprising five items assessing degrees of health literacy. The Big Five personality traits were measured using the Japanese version of the Ten-Item Personality Inventory. Other variables were measured as factors associated with health literacy, including age, gender, education, subjective economic status, social isolation, chronic diseases, functional capacity, smoking and drinking. Multiple regression analysis showed that education (β = 0.10), subjective economic status (β = -0.09), social isolation (β = -0.08), functional dependence (β = -0.22), neuroticism, (β = -0.08), extraversion (β = 0.10), openness (β = 0.17), and conscientiousness (β = 0.09) were independently and significantly associated with health literacy (coefficient of determination = 0.28). This study found significant and independent associations of personality, socioeconomic status, and health status with health literacy. These results may help facilitate the development of efficient strategies to improve health status by promoting health literacy in community-dwelling older adults.

Relationship of Social Support and Coping Strategies with Post-Traumatic Growth and Functional Disability Among Patients with Cancer: Meditating Role of Health Literacy

Background: Psychological factors play important roles in mental and physical outcomes of cancer, like disability and positive growth after exposure to cancer trauma. Objectives: This study aimed to investigate the mediating role of health literacy in the relationship of social support and coping strategies with post-traumatic growth and functional disability among patients with cancer. Methods: The present descriptive, cross-sectional study included 265 patients (142 women and 123 men) with various types of cancer selected by a convenience sampling method among patients referring to the Cancer Clinics of Imam Khomeini Hospital in Tehran, Iran. Data were collected by the “WHO Disability Assessment schedule”, “post-traumatic growth inventory”, “Functional, Communicative, and Critical Health Literacy scale”, “Social Support scale”, and “Brief Cope scale”. Data were analyzed by structural equation modeling (SEM) using AMOS-24 and SPSS-20 software. Results: The results showed that social support had a significant positive correlation with post-traumatic growth (P ≤ 0.001) and health literacy (P ≤ 0.001) and a significant negative correlation with functional disability (P ≤ 0.001). There was a significant positive correlation between avoidance-coping strategies and post-traumatic growth (P ≤ 0.001) and functional disability (P ≤ 0.051). Problem-focused coping strategies had a significant positive correlation with health literacy (P ≤ 0.051) and there was a significant negative correlation between health literacy and functional disability (P ≤ 0.001). Additionally, health literacy had a mediating role in the relationship between social support and functional disability (P ≤ 0.001) and between problem-focused coping strategies and functional disability (P ≤ 0.001). Conclusions: Social support and coping strategies directly or through the mediating role of health literacy are important predictors of post-traumatic growth and functional disability among patients with cancer, suggesting the need for intervening and educating in these areas to improve patients’ physical and mental status.