Critical Health Literacy Scale Research Articles

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.

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.

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.

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.

Validation of the French version of the Functional, Communicative and Critical Health Literacy scale (FCCHL)

BackgroundHealth literacy is a key asset, defined as the capacity to acquire, understand and use information in ways which promote and maintain good health.ObjectivesTo assess the reliability and validity of the French translation of the Functional, Communicative and Critical Health Literacy (FCCHL) scale.Methods/participantsA cross-sectional survey using an online questionnaire was proposed to all members of Seintinelles association. Exploratory and confirmatory factorial analyses were conducted.ResultsData from 2342 respondents (45.8% had cancer history) were analysed. The FCCHL scale was well-accepted (missing value by item ≤0.7%). Factor analysis revealed an acceptable fit of three-factor model (comparative fit index = 0.922, root mean square error of approximation = 0.065 and standardized root mean square residual = 0.052). The FCCHL showed satisfactory reliability (α = 0.77) and scalar invariance was reached for education and deprivation, but not for age. Known group validity was verified as mean scale scores differed according to education, deprivation and age, as expected.ConclusionThe French version of the FCCHL provides a brief reliable and valid measure to explore the dimensions of health literacy. It could be used by health professionals to screen for health literacy level in order to develop this skill and to tailor health communication.

Health literacy assessment in adults with neurofibromatosis: electronic and short-form measurement using FCCHL and Health LiTT.

Determining health literacy level is an important prerequisite for effective patient education. We assessed multiple dimensions of health literacy and sociodemographic predictors of health literacy in patients with neurofibromatosis. In 86 individuals with a confirmed diagnosis of neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2), or schwannomatosis, we assessed health literacy status using two HL tools-the adapted functional, communicative, and critical health literacy scale (adapted FCCHL) and health literacy assessment using talking touchscreen technology (Health LiTT). Factor analyses of the adapted FCCHL in NF patients showed factor structure and psychometric properties similar to pilot work in other patient populations. As a group, patients with NF had moderate scores on the Health LiTT and moderate to high scores on the adapted FCCHL, with the highest score on the functional health literacy subscale. Patients with NF1, those with lower education and those with learning disabilities had lower scores on Health LiTT; in multivariate analysis, learning disability and education remained significant predictors of HealthLiTT scores. Only lower education was associated with lower adapted FCCHL scores. Results suggest utilizing health literacy tools in NF patients is feasible and could provide physicians with valuable information to tailor health communication to subpopulations with lower health literacy levels.

Impact of Health Literacy, Self-efficacy, and Outcome Expectations on Adherence to Self-care Behaviors in Iranians with Type 2 Diabetes.

Diabetic patients with higher health literacy (HL) may feel more confident in their ability to perform self-care behaviors and may have strong beliefs that diabetes-related behaviors will lead to specific outcomes. Our study aimed to document the relationships between HL, self-efficacy, outcome expectations, and diabetes self-care of patients with type 2 diabetes mellitus (T2DM) in Iran. We conducted a cross-sectional observational study of 187 patients with T2DM. Participants completed the Functional Communicative and Critical Health Literacy scale, the Summary of Diabetes Self-Care Activities, the Diabetes Management Self-Efficacy Scale, Outcome Expectations Questionnaire, and a demographic questionnaire. Participants who received diabetes education (t = 5.79, p<0.001) and were married (F = 3.04, p<0.050) had better diabetes self-care behavior. There was a significant positive correlation between self-care behaviors and communicative HL (r = 0.455, p<0.010), critical HL (r = 0.297, p<0.010), self-efficacy (r = 0.512, p<0.010) and outcome expectations (r = 0.387, p<0.010). Diabetes education and marital status accounted for 16.9% of the variance in diabetes self-care. Self-efficacy, outcome expectations, communicative, and critical HL explained 28.0%, 1.5%, 3.7%, and 1.4% of the variance, respectively. This study revealed that the potential impact of self-efficacy, outcome expectations, communicative, and critical HL should be considered in the education program for patients with diabetes. We found self-efficacy to be the most important predictor of diabetes self-care. Therefore, the use of self-efficacy theory when designing patient education interventions could enhance diabetes self-care. It is essential that health care providers assess patient's HL levels to tailor health-related information specific to a domain of HL. This would fully inform patients and promote empowerment rather than simple compliance.

Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management

ObjectiveTo provide insight into the level of health literacy among chronic disease patients in the Netherlands, to identify subgroups with low literacy and to examine the associations between health literacy and self-management. MethodsSelf-report questionnaires were sent to a nationwide sample of 1.341 chronic disease patients. The Dutch Functional Communicative and Critical Health Literacy scale (FCCHL), the Partners in Health scale (PIH) and Perceived Efficacy in Patient–Doctor Interactions (PEPPI-5) were used to assess health literacy and aspects of self-management. ResultsIn general, health literacy skills were good. A higher age, lower education, lower income, multi-morbidity and/or functional limitations were associated with lower levels of health literacy. Communicative and critical health literacy were related to some aspects of self-management but not to all. Functional health literacy was less important. ConclusionCommunicative and critical health literacy play a role in successful self-management of chronic disease but the impact differs by context. Health literacy levels vary according to socio-demographic and disease characteristics of patients. Practice implicationsHealth care professionals should tailor their information and support to the health literacy skills and personal context of their patients.

The Communicative and Critical Health Literacy Scale – Swedish Version

Health literacy (HL) is an important determinant for health and a valuable health indicator within public health. As such, it is a significant outcome variable of health promotion efforts. Valid and reliable instruments are needed to evaluate health promotion interventions and to assess levels of HL in a population. One of the few measurements of communicative and critical HL is the Japanese Communicative and Critical Health Literacy scale (C & C HL scale). To make it possible to use this instrument in Sweden, the C & C HL scale was translated into Swedish and different aspects of validity, including test-retest reliability, of the translated version were tested. After translation and back-translation, The Swedish C & C HL scale was tested for content validity and test-retest reliability. Data were collected from a committee consisting of public health experts and bilingual people, and from a test group of 35 persons. The Swedish C & C HL scale was understandable and showed evidence of content validity. The test-retest confirmed that it was stable over time, percentage agreements for the items ranging from 66% to 89% (M = 74%). The Swedish C & C HL scale is equivalent to the Japanese C & C HL scale in terms of language and content. The items cover the major aspects of communicative and critical HL and are understandable and stable over time, i.e., reliable.