Determinants Of Health Literacy Research Articles

Health literacy status and its relationship with physical therapy and rehabilitation applications in patients with knee osteoarthritis

Objectives: The study aimed to determine the level of health literacy in patients with knee osteoarthritis and investigate the relationship between health literacy and exercise approaches and physical therapy use. Patients and methods: The cross-sectional study included 203 patients (143 females, 60 males; mean age: 63.5±9.2 years) between November 2018 and September 2019. Sociodemographic data, exercise habits, the number of applications to the physical medicine and rehabilitation outpatient clinic, and physical therapy applications were recorded. The Turkish Health Literacy Scale-32 (THLS-32), was used to determine health literacy. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to evaluate pain and physical function. The relationship between THLS-32 and the number of admissions to the outpatient clinic, the number of physical therapy applications, exercise frequency, and WOMAC scores were investigated. Results: The median THLS-32 of the patients was 33.8 (13-46.8). A statistically significant negative correlation was found between THLS-32 scores and the number of admissions to the physical medicine and rehabilitation outpatient clinic for knee pain in the last year, the number of physical therapies, the exercise frequency, and total WOMAC scores. Conclusion: Increasing health literacy strengthens the capacities and participation of patients, reduces the costs of physical therapy, as well as medication costs, and consequently increases efficiency in the use of health services.

The Effectiveness of Participatory Health Literacy Promoting Programs among Diabetes Risk Groups in Community, Thailand

Introduction: The prevalence and incidence of diabetes are increasing worldwide. In Thailand, emphasis is placed on measures to enhance awareness of preventing the disease among high-risk groups and the general population. This study aims to determine health literacy (HL), health behavior patterns, awareness, and knowledge of diabetes prevention, and the effectiveness of promoting HL programs among diabetes risk groups in the Thai community. Methods: This study was designed for the research and development method and was conducted in April–October 2023. A cross-sectional study was conducted with 105 DRGs, selected using stratified random sampling from 10 villages. Data were collected through interviews and self-report questionnaires. In addition, a participatory program involving 43 stakeholders was designed to enhance diabetes prevention knowledge, using brainstorming sessions for activity planning, implementation, and evaluation. Pre- and post-test scores were analyzed using paired t-tests. Results: The analysis shows that nearly half of the DRGs are at a moderate level of HL, while the overall score falls below 55% of the total points. In addition, the health behavior patterns of the DRGs (3E2S) pose a risk for diabetes development. However, the results obtained from program utilization indicate that the potentiality for improved HL levels and promoting positive health behaviors are statistically significant (P < 0.001). Conclusion: Healthcare professionals, particularly within the primary healthcare system, should devise strategies to enhance HL and consistently implement programs targeting diabetes prevention in the community’s at-risk groups.

Health Literacy, Contact Points, Unmet Subjective Needs and Treatment Satisfaction of those Affected by Long Covid with Long-Lasting Neuropsychiatric Symptoms

The bejective was to determine health literacy (HL) and care aspects of those affected by Long-COVID. 407 patients with Long-COVID and long-term neuropsychiatric symptoms were interviewed in the LIFE study center. In addition to descriptive analyses, regression models were calculated to examine the relationships between health literacy (HLS-EU-Q16) and various aspects of care (RehaQ-N1). The results show that 35.8% had problematic and 17.9% had inadequate HL. The majority of subjective needs were unmet and 47.7% of those affected were dissatisfied with the therapy they received. Among those affected by Long-COVID, subjective HL is rather reduced. The healthcare system appears to be unprepared for these patients, which is reflected in unmet needs and low treatment satisfaction. This was even more pronounced among those exhibiting lower HL.

Inequalities in patients’ experiences with cancer care: the role of economic and health literacy determinants

BackgroundPatients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients’ experiences with cancer care.ObjectiveTo examine whether patients’ experiences with cancer care differ according to their economic status and health literacy.MethodsSecondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients’ economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors.ResultsAdjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of ‘respect for patients’ preferences’ and ‘physical comfort’ where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of ‘respect for patients’ preferences’, ‘physical comfort’ and ‘emotional support’ were associated with health literacy.DiscussionThis study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.

Determinants of health literacy and its impact on glycemic control among women with gestational diabetes mellitus in a tertiary care hospital, Puducherry - A cross-sectional analytical study.

Health literacy is vital during pregnancy, as maternal health knowledge and behavior have a significant impact on the health of both mother and child. Hence, this study aimed to assess the health literacy status of pregnant women diagnosed with gestational diabetes mellitus (GDM), as well as its associated factors and impact on glycemic control. The facility-based Cross-sectional analytical study was conducted among 200 pregnant women with GDM in a tertiary care hospital. The eligible participants were consecutively selected for the study. The study was conducted from September 2022 to March 2023. A validated semi-structured questionnaire, the Health Literacy Questionnaire (HLQ) for GDM, was used to measure health literacy status. Stata V.17 software was used for data analysis. Out of 200 pregnant women with GDM, the mean (SD) age of the participants is 29.5 (±5.5) years. It was observed that 164 (82%) of the participants had adequate health literacy, whereas 36 (18%) had inadequate health literacy about Gestational Diabetes. Adequate health literacy (HL) was observed among 88.5% of women with controlled blood sugar and 55.1% of women with uncontrolled blood sugar. Results of multivariate logistic regression analysis revealed that pregnant mothers' educational status (PR: 1.8; 95% CI: 1.2-2.5) and glycemic control (PR: 1.4; 95% CI (1.2-1.7) were associated with adequate HL. In conclusion, this study supports the association between adequate HL and glycemic control in pregnant women with GDM. Addressing this gap is essential for healthcare officials and planners to implement programs that promote women's HL during pregnancy, with a focus on low-educated groups.

Cross-sectional survey of health literacy among health science students in Singapore.

Health literacy proficiency is essential for health care professionals to provide quality patient care. There is limited research exploring health literacy proficiency among undergraduate health science students. To determine health literacy among health science students in Singapore using the electronic Health Literacy Questionnaire (HLQ). A cross-sectional survey using purposive sampling was conducted among undergraduate health science students. This study hypothesises that health literacy is influenced by gender, and it increases with the level of health science education, attributed to the increased exposure to the health care system and health care education as undergraduates progress through the years of study. Eligible students from the 4-year entry-level programmes of diagnostic radiography, dietetics, occupational therapy, physiotherapy, radiation therapy and speech and language therapy, aged from 21 to 50, were invited. Exclusion criteria were students who were no longer studying due to dropping out or having immediately graduated from these programmes and students in the accelerated programmes whose studies would be completed in less than 4 years. In total, 111 respondents (72 females and 37 males) completed surveys (response rate, 7.7%) returned from physiotherapy (n = 69), occupational therapy (n = 25), diagnostic radiography (n = 12) and dietetics (n = 5), with nil from radiation therapy and speech and language therapy. All participants were English literate. Female participants demonstrated higher HLQ with a mean total score of 30.67 (standard deviation (SD) = 0.61) versus male participants 29.83 (SD = 0.53). Year 2, 3 and 4 students generally scored higher than Year 1 across all nine HLQ scales. Overall, dietetics students had the highest total score on the HLQ, while the diagnostic radiography students had the lowest scores for all the nine HLQ scales. This study established the health literacy level of health science students in Singapore. Gender and years of study influenced health literacy levels, supporting the hypothesis.

Health Literacy in Ethiopia: Evidence Synthesis and Implications.

Health literacy plays a pivotal role in healthcare utilization and health-related lifestyle choices. This makes health literacy a pressing concern, particularly in low-income countries like Ethiopia, where there are intricate health challenges. Despite its significance, there is a dearth of studies on the issue in Ethiopia. This study aimed to provide a comprehensive synthesis of the available evidence on health literacy in Ethiopia, and to discuss the implications for healthcare practice, health promotion, and research endeavors. A systematic scoping review was conducted to achieve the purpose of this study. A comprehensive search of databases such as PubMed, CINAHL, AJOL, and PLOS Global Public Health was conducted for eligible evidence. Searches were conducted from May 12 to September 9, 2022. The PRISMA flow diagram guideline was utilized to ensure transparent reporting of the reviews process. The data extraction tool used was based on the JBI methodology guidance for reviews. The search in total yielded 543 records. However, only 16 studies met the eligibility criteria after a thorough screening process. All eligible studies were conducted in health facilities and schools with limited scopes. The main findings of the eligible studies focused on health literacy levels, health information sources, and health literacy determinants among the studies participants. Many of the studies reported low health literacy levels and multiple predicting factors ranging from personal to socioeconomic conditions among the respondents. This review has provided critical insights into the state of health literacy in Ethiopia. There is a need for comprehensive research and the development of context-appropriate health literacy measurements tailored to the Ethiopian context, as well as evidence-based health literacy interventions. Prioritizing health literacy as a key research and intervention area is essential for improving the health of individuals and populations and achieving health-related Sustainable Development Goals in Ethiopia.

Prevalence and determinants of health literacy among the adult population of Qatar.

Health literacy (HL) is both a direct determinant and a mediator of health outcomes. Research on the prevalence and determinants of HL in terms of its functional, communicative, and critical domains is scarce in the state of Qatar and its surrounding regions. Thus, this study aims to fill the knowledge gap in this area, estimate the levels of functional, communicative, and critical health literacy among the general adult population, and identify its determinants in the state of Qatar. An analytical cross-sectional study with a disproportionate stratified random sampling technique was conducted in 2022. A representative sample of phone numbers was obtained from the Cerner database at Hamad Medical Corporation and approached via well-trained data collectors. A socio-demographic and health-relevant factor questionnaire and the validated All Aspects of Health Literacy scale (AAHLS) were used to collect the data on functional, communicative, and critical HL and their determinants. Descriptive analysis, independent sample t-test, ANOVA, and linear regression were used and yielded the outcomes on HL levels as low, adequate, and high in percentages and the HL determinants. A total of 770 participants were included. The study found that 41.5%, 29.3%, and 29.2% of them have adequate, high, and low overall HL levels consecutively. People who participated in the study are older adult, are of Arabic ethnicity, are of Qatari ethnicity, have a lower level of education, have close relatives with a lower level of education, have a lower income, are non-migrants, are not living within a family, sought medical care within the last week, and who do not know if they have a chronic disease or do not have lower overall HL levels compared to the other groups. After linear regression analysis, only the participant's level of education and "last time sought medical care within last week" variable predict the overall HL score. Almost half of Qatar's adult population has an adequate HL level, comparable to the HL levels in other regions, despite the limitation in comparison due to variation in context and the HL measurement tools used. The possible determinants are amenable factors to focus on while designing HL interventions and providing healthcare.

Employment status, presence of chronic disease and daily screen time are determinants of healthy diet literacy

Aims: While it has become easier for consumers to reach information with the developments in technology, however, to be able to find the right resources for the information has become difficult. It is known that this situation is related to the health and nutrition literacy of individuals. In this study, it was aimed to determine health literacy, digital healthy diet literacy and healthy eating attitudes of adult individuals. 
 Methods: Study data were collected with the help of a questionnaire form from 150 individuals (106 females and 44 males, mean age 32.1±10.62 years) who live in Türkiye and voluntarily agreed to participate in the study between January and June 2023. 
 Results: More than half of the participants (56%) were found to have more than six hours of daily screen time. The most common sources of information on health and nutrition are reported as academic databases and Instagram (both 30.7%). In both genders, individuals' eating attitudes towards healthy eating were found to be high. When the factors affecting health literacy and digital healthy diet literacy were examined, it was seen that daily screen time, working status and having chronic diseases were statistically important factors (p

Self-perceived and calculated health literacy score in long-term unemployed people

Abstract Introduction Recent studies show that low levels of health literacy are widespread in Germany, especially among socioeconomically disadvantaged groups such as long-term unemployed individuals. At the same time, it is unclear to what extent commonly used health literacy tools are tailored to the needs and literacy skills of socioeconomically disadvantaged populations. Therefore, we examined to what extent self-perceived and calculated health literacy scores of long-term unemployed people in Germany correlate. Methods We conducted 171 semi-structured interviews between November 2022 and February 2023 with long-term unemployed people in 11 occupational reintegration settings in Bremen, Germany. Health literacy was measured by the HLS-EU-Q16 (self-report health literacy score) and the Newest Vital Sign (calculated health literacy score). Descriptive and correlation analyses were performed with R. Results According to HLS-EU-Q16, 37% of the 171 participants (male=112, female=59) had sufficient health literacy, according to NVS only 29%. An inadequate health literacy score was shown by 19% according to HLS-EU-Q16, and by 48% according to NVS. The applied tools did not show a statistically significant correlation (r = 0.105, p = 0.17). Conclusions Self-reported health literacy data (e.g., measured by the HLS-EU-Q16) could underestimate deficits in health literacy and may be insufficient as a sole assessment tool to determine health literacy among low-literate populations as long-term unemployed people. Key messages • Various tools exist to measure health literacy. Not all measures might be suitable for all population groups. Literate skills should be considered while applying different health literacy measures. • More health literacy data on low-literate populations is needed in the literature. Health literacy tools applied in these population groups should be short and easy to understand.

Health Literacy, General Health, and Lifestyle among Infertile Men and Women in the Southeastern Iran.

Infertility is a growing social problem, and health literacy is one of the factors that affects infertility, thereby affecting life quality. On the other hand, lifestyle factors exert a considerable impact on reproductive capacity and general health. Against this backdrop, this study aims to determine health literacy, general health, and lifestyle in infertile people in Zahedan, Iran. In this descriptive cross-sectional study, 86 male and 181 female participants who referred to Molod Infertility center (AliIbnAbiTalib Hospital) in Zahedan were randomly selected. Health Literacy Standard Questionnaires (HELIA), the General Health Questionnaire (GHQ), and the Miller-Smith Lifestyle Assessment Inventory (LSI) were used to collect data. In addition, data were analyzed by SPSS V.22. The participants' mean age was 30.87±7.5. Besides, 39% and 70% of the participations did not have enough health literacy and had a moderate lifestyle, respectively. In addition, the general health of 68.9% was exposed to damage. Moreover, there was a significant relationship between the three aforementioned factors, with the participants of higher levels of health literacy having had higher levels of general health and lifestyle. According to the findings of this study, the infertile people's health literacy was not enough, and most of them had a moderate lifestyle. In addition, their general health was exposed to damage in most cases. Thus, it is necessary to pay attention to providing proper education and health services to infertile men and women to improve their level of health literacy and healthy fertility in order to support childbearing in the society.

Health literacy and nutrition literacy among mother with preschool children: What factors are effective?

Children's obesity behaviors are associated with parents' low health literacy. Nutrition Literacy (NL) is an essential component to enhancing nutrition quality, as well as health and well-being. The study's objective was to determine health literacy (HL) and NL among mothers with children preschool children (under 7 years old in Zanjan city, Iran).Participants in this cross-sectional were 162 mothers with preschool children referred to Ayatollah Mousavi Hospital's pediatric clinic in Zanjan, Iran, during July and August 2022. The sample technique was convenient. In IBM SPSS 20 software, a two-step cluster analysis, the Chi-square\\ Fisher exact, and Man-Whitney tests were used.HL and NL had a mean ± SD of 71.26 ± 15.84 and 71.78 ± 11.86, respectively. The two-step cluster analysis identified two clusters, with mothers in cluster 1 (n = 141) having sufficient HL and NL and mothers in cluster 2 (n = 21) having insufficient HL and NL. Cluster 1 mothers were older, had a college degree, lived in a city, were employed, and had a better financial situation. They obtained health and nutrition information from the Internet, either alone or in conjunction with other sources.Based on clustering analysis, it was observed that the low level of education, living in the village and being a housewife of the mothers, is related to the low level of HL and NL. By increasing the level of education of mothers, it is possible to help protect children from malnutrition or overfeeding in the future. Also, providing suitable job opportunities for mothers can help in this matter.

A prospective evaluation of patient perspectives and financial considerations during prostate cancer treatment decision-making.

In universal healthcare systems, patients may still encounter financial obstacles from cancer treatments, potentially influencing treatment decision-making. We investigated the relationship between socioeconomic status and treatment decision-making as it pertains to patient values, preferences, and perceived barriers to care for localized prostate cancer. We conducted a prospective study of patients undergoing a prostate biopsy for the initial detection of prostate cancer. Sociodemographic variables were collected, with validated instruments used to determine health literacy levels. Patients were divided into two groups using self-reported income; those with a positive identification of prostate cancer underwent additional surveys to ascertain their knowledge of their diagnosis, treatment-related preferences, and socioeconomic barriers to care. Descriptive statistics were used. Of 160 patients, approximately one-third were classified as having low health literacy. Within the low-income group, education levels were lower (34.6% had less than high school education vs. 10.2% in the high-income group) and unemployment rates higher (75.0% unemployed vs. 38.9% in the high-income group). Low-income patients with prostate cancer placed greater importance on indirect out-of-pocket expenses related to treatment (78.3% vs. 33.3%, p=0.001), higher emphasis on treatment-related travel time (50% vs. 15.1%, p=0.004), and more often had difficulty paying for healthcare services in the past (30.9% vs. 9.1%, p=0.02). Patients with lower household incomes have unique treatment values and decision-making preferences. They may experience additional challenges and barriers to obtaining cancer care, at least partly related to indirect costs. These findings should be considered when framing prostate cancer treatment discussions and designing patient-facing health information.

Determining Health Literacy Level of Women with Gynecological Cancer and Affecting Factors

Aim: This study was conducted to determine the health literacy levels of women with gynecological cancer and the affecting factors. Method: The sample of this descriptive and cross-sectional study consisted of 128 women who volunteered to participate in the study and were treated in the gynecological oncology service of the Oncology Center of a Training and Research Hospital in Izmir between January and June 2021. Data were collected by face-to-face interview method using a questionnaire and HLS. Results: In the study, the mean age of women with gynecological cancer is 60.81±11.18. The mean total score of the women's HLS is 94.38±13.91. The factors that are found to be significantly (p<0.05) associated with the level of health literacy are the education level of the women, the number of children, the employment status, and the number of hospital admissions in a year. In the study, the type of gynecological cancer, the number of regimens, the type of treatment, the duration of the disease, the age of onset of the disease, and the period without treatment were not associated with health literacy (p>0.05). Conclusion: In the study, it was concluded that the health literacy level of women was sufficient, the factors affecting health literacy were generally socio-demographic variables, and the disease characteristics and health behaviors did not affect the health literacy level.

Content and Clinical Validation of the Nursing Outcome “Health Literacy Behaviour”: A Validation Protocol

To validate the contents of the nursing outcome 'Health Literacy Behaviour (2015)' in order to use them in nursing care plans, and to evaluate their psychometric properties, application level, and effectiveness in nursing care to detect low health literacy patients. a methodological two-phased study: (1) an exploratory study and content validation by expert consensus, who will evaluate revised content of nursing outcomes; (2) methodological design by clinical validation. The validation of this nursing outcome in NOC will enable the generation of a helpful tool that would facilitate nurses to set individualised and efficient care interventions and identify low health literacy populations.

Sustained effect on diet quality of a self-care intervention to reduce cardiovascular disease risk among informal rural caregivers of people with chronic illnesses: does health literacy matter?

Abstract Background/Introduction Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. However, interventions are often not constructed with health literacy in mind. We previously found a moderation effect of health literacy on short-term (4-month) diet quality from a self-care intervention to reduce cardiovascular disease risk (RICHH) among rural caregivers. The RICHH intervention was designed to be equally effective in caregivers with marginal or adequate health literacy. Purpose To compare the impact of RICHH intervention on 12-month diet quality in rural caregivers with marginal versus adequate health literacy. Methods A total of 296 rural caregivers (54.5±13.7 years old, 76% female) of individuals with chronic illnesses participated. The newest vital sign (NVS) and Healthy Eating Index-2015 (HEI-2015) were used to determine health literacy and diet quality, respectively. The NVS was dichotomized using a cutoff score of 4. The HEI-2015 was computed based on food frequency questionnaires at baseline, 4-month, and 12-month. The RICHH intervention was delivered using video conferencing technology by nurse interventionists once a week for 12 weeks followed by bi-weekly and monthly booster sessions. A piecewise linear mixed-effect model, controlling for age, education, smoking status, and perceived stress, was used to evaluate the impact of the intervention on diet quality between the two health literacy groups. Results There was a significant difference in improvement in the HEI-2015 total scores at 4 months between control and intervention in the marginal health literacy group (beta estimate = 1.56, SE=0.74, P=0.039) but not in the adequate health literacy group (beta estimate = 0.27, SE=0.38, P=0.475). The improvement in the marginal health literacy group was sustained at 12-months (beta estimate = 8.12, SE=3.57, P=0.022). Conclusions The results of our study indicate that an intervention designed to address health literacy is effective in producing a sustained improvement in diet quality to reduce CVD risk in rural caregivers with marginal health literacy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health National Institute of Nursing Research

Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019-2021.

Health literacy entails the knowledge, motivation, and competencies to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning health care, disease prevention, and health promotion to maintain or improve quality of life throughout the life course. It has become an essential concept in public health. It is considered a modifiable determinant of health decisions, health behaviors, health, and healthcare outcomes. Prior studies suggest highly variable levels of health literacy across European countries. Assessing and monitoring health literacy is critical to support interventions and policies to improve health literacy. This study aimed to describe the process of adaptation to Portugal of the short-form version of the Health Literacy Survey (HLS19-Q12) from the Health Literacy Population Survey Project 2019–2021, also establishing the health literacy levels in the Portuguese population. The sample comprised 1247 valid cases. The survey consisted of a brief questionnaire on the determinants of health literacy, plus the HLS19-Q12 questionnaire and the specific health literacies packages on digital health literacy, navigational health literacy, and vaccination health literacy. The results suggest that 7 out of 10 people in Portugal (mainland) have high health literacy levels and support the results of other studies concerning the main socioeconomic determinants of general health literacy. Furthermore, the results suggest that “navigation in the health system” tasks are the most challenging tasks regarding specific health literacies. The overall data suggest the HLS19-Q12 as a feasible measure to assess health literacy in the Portuguese population. Thus, it can be used in Portugal to assess the population’s needs and monitor and evaluate policies and initiatives to promote health literacy by addressing its societal, environmental, personal, and situational modifiable determinant factors.

Health literacy of cardiology patients: determinants and effects on patient outcomes

ABSTRACT Health literacy is important for the management of chronic cardiovascular diseases. Comprehensive studies related to health literacy of cardiac patients are limited. The aims of this study were to determine the determinants of health literacy and its effects on patient outcomes in cardiology patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q- 47 items) was applied to 530 patients who presented to cardiology polyclinics of a university hospital in Ankara. Correlation coefficients, univariate and multi-linear regression analyses were used in the study. Determinants of health literacy were sex, education level, place of residence and perception of social status (p < .05). Although adjustments were made based on relevant control variables in multivariate analyses, health literacy was found to affect 14 of 26 patient outcomes within the scope of the study (p < .05). Higher education level and perception of social status, residing in the city center and being female were among the determinants of high health literacy. Higher health literacy was associated with more positive patient outcomes. Health literacy affected health behaviors and risks, drug use habits, health status, use of preventive health services and patient satisfaction.

Health literacy and associated factors among undergraduates: A university-based cross-sectional study in Nepal.

Health literacy is one of the most critical aspects of health promotion. Limited health literacy is also accounted for adverse health outcomes and a huge financial burden on society. However, a gap exists in the level of health literacy, especially among undergraduates. This study aimed to assess the levels of health literacy and its socio-demographic determinants among undergraduate students of Tribhuvan University, Nepal. A web-based cross-sectional survey was conducted among 469 undergraduate students from five institutes of Tribhuvan University, Nepal. The 16-item short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) was used to measure students' health literacy levels. Associated factors were examined using Chi-square tests followed by multivariate logistic regression analyses at the level of significance of 0.05. Nearly 61% of students were found to have limited health literacy (24.5% had "inadequate" and 36.3% had "problematic" health literacy). Female students (aOR = 1.6, 95% CI: 1.1-2.5), students from non-health related majors (aOR = 1.9, 95% CI: 1.2-3.0), students with unsatisfactory health status (aOR = 2.8, 95% CI: 1.7-4.5), students with poor financial status (aOR = 2.9, 95% CI: 1.2-6.8) and students with low self-esteem (aOR = 2.5, 95% CI: 1.5-4.1) were significantly more likely to have limited health literacy. The majority of the undergraduates were found to have limited health literacy. Gender, sector of study, self-rated health status, self-rated financial status, and self-esteem were significantly associated with limited health literacy. This study indicates university students should not be assumed to be health-literate and interventions to improve students' health literacy especially for those whose majors are not health-related should be implemented. Further studies using a longer version of the health literacy survey questionnaire and qualitative methods to explore more on determinants of health literacy are recommended.

Health literacy in phases of health information processing in the Czech population

Abstract Background Low level of health literacy (HL), defined as an individual's ability to process health information, is strongly associated with higher mortality and morbidity. In earlier analysis of cross-sectional survey in Czechia in 2014, 59% of subjects showed a low level of HL, with particularly worrying results in area of health promotion (64% with low levels of HL). The levels of HL in phases of health information processing, however, were not included. Aim To describe the level of HL in phases of obtaining, understanding, evaluating, and applying health information, and to assess social determinants of HL in these phases. Methods 18 to 65 years old subjects from a random population-based Czech sample from 2014 were evaluated using a cross-sectional design. The level of HL was determined by Health Literacy Index (HLI, range 0-50). A low level of HL was defined as HLI &amp;lt;33. Logistic regression was used to assess the association between a low level of HL and social status. Results In total, 996 participants (51% females) were included. The prevalence of low level of HL was 64% in obtaining, 56% in understanding, 70% in evaluating and 64% in applying. A low level of HL was associated with a low perceived social status in all phases of information processing even after adjustment for age, gender, education, self-reported health condition, physical activity, BMI and smoking status (ORs 3.2, 2.0, 3.4 and 2.8, respectively, for obtaining, understanding, evaluating and applying, all p-values&amp;lt;0.05). Conclusions People with lower social status have a higher risk of a low level of HL in all phases, with the highest risk in the phase of health information evaluation which was determined as the most problematic. Further intervention should aim to support individual skills in decision making and actions in fields of healthcare, disease prevention, and health promotion including the availability of relevant understandable information for all social groups in the population. Key messages The most problematic area of health literacy is health information evaluation. People with lower social status have a higher risk of a low level of health literacy.