Dimensions Of Health Literacy Research Articles

The Relationship between Health Literacy and Health Behaviour in People with Diabetes: A Danish Population-Based Study.

Background. People with diabetes who have poor health behaviours are at greater risk for a range of adverse health outcomes. We aimed to investigate the relationship between health literacy and health behaviour (smoking, alcohol, physical activity, and diet) in people with diabetes. Methods. The study was based on respondents aged 25 years or older from a population-based survey in 2013 who reported having diabetes (n = 1685). Two dimensions from the Health Literacy Questionnaire were used: “understand health information” and “actively engage with healthcare providers.” We used logistic regression to examine the association between health literacy and health behaviour. Results. After adjustment for sociodemographic factors, individuals with diabetes who found it difficult to understand information about health had higher odds of being physically inactive (OR: 3.43, 95% CI: 2.14–5.51) and having unhealthy dietary habits (OR: 3.01, 95% CI: 1.63–5.58). Similar results were observed for individuals who found it difficult to actively engage with healthcare providers. No associations were found between the two dimensions of health literacy and smoking and alcohol consumption. Conclusion. When developing health services and interventions to improve health behaviour among people with diabetes, our results suggest that they may benefit by including focus on health literacy.

A new questionnaire for the assessment of parental health literacy

Parental health literacy is an important factor of pediatric health. Although it is thorougly studied in other countries, neither proper definition, nor adequate tool for its measurement exists in Hungarian. The aim of this work was to define the dimensions of parental health literacy and to introduce a questionnaire for its measurement. Opinions of parents, pediatric nurses and pediatricians on parental health literacy were used to establish the definition and basic components. Based on these and previously standardized tests a new questionnaire was developed. Four dimensions of parental health literacy were formulated such as knowledge, functional literacy, self-confidence and motivation. The new questionnaire assesses all four dimension through eight topics. This is the first culturally adapted definition and test of parental health literacy in Hungarian. With its application the efficacy of both primary care services and health education may be improved and the correlation between parental health literacy and pediatric health may be properly studied.

The effectiveness of health literacy interventions on the informed consent process of health care users: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The aim of this systematic review is to establish the best available evidence of the effectiveness of health literacy interventions on the informed consent process for health care users. The specific review question is: What is the effectiveness of health literacy interventions on health care users' informed consent to health procedures processes? INCLUSION CRITERIA Types of participants This review will consider all studies that include adults (18 years or over) receiving care or adults who are proxies of incompetent health care users or of children (parents or guardians) who have been actively involved in an informed consent process regarding health care procedures. Participants may be healthy or may have any kind of physical disability, be recruited in any type of health care environment, including acute (hospital), primary care, psychiatric and aged care, in any health specialty, including medicine, dentistry and pharmacy. Studies whose participants have cognitive impairment will be excluded. Studies on informed consent processes for research participants will be also excluded. Types of intervention(s) The interventions, methods, and strategies will be included if: - they aim to improve the informed consent process related to health issues among health care users or their proxies, - they are designed taking into consideration health literacy as a main concept, and - the intervention is provided by any health care provider. Such interventions my focus on either the material provided (e.g. readability, processability), or the supportive procedure of informed consent (e.g. video) in order to decrease the health literacy TRUNCATED AT 250 WORDS

Using health literacy profiles to tailor interventions to the needs of chronic disease patients

Health literacy (HL) is an important prerequisite for successful self-management and a determinant of health care use in chronic disease. HL is a multidimensional concept covering several functional, social and psychological dimensions. When developing interventions to improve HL it is an important question on which of these dimensions one should focus to offer care that best fits the needs of individual patients. We surveyed both the health literacy and self-management capabilities of a representative sample of 1.826 patients with chronic conditions or long term disabilities in the Netherlands. The Health Literacy Questionnaire (HLQ) assessed 9 independent HL dimensions. Using cluster analysis we looked for subgroups of patients across the 9 different HL profiles. Cluster analysis produced a 7-cluster solution, identifying stable and clinically meaningful subgroups of patients. In each subgroup patients had at least some strengths but also reported limitations on others HL dimensions. These pattern offering concrete suggestions to tailor support to the needs of patients. In addition, we found that patients in the 7 subgroups differed significantly with respect to educational level, number and type of chronic diseases, severity of disability, living situation and the level of urbanity of their residence pointing to the importance of taking context factors into account when developing interventions to improve HL skills. For example, people with chronic illnesswho were living alone require more support with getting help from their social environment and finding and understanding health information compared with people we had a partner or children. While some subgroups might have a similar total score, the actions for improving their outcomes would differ.

Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy.

BackgroundHealth literacy, or the ability to access, understand, appraise and apply health information, is central to individuals’ health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.MethodsA total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.ResultsInternal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.ConclusionsThis study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan.Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1835-x) contains supplementary material, which is available to authorized users.

National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults.

BackgroundHealth literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.MethodsA population-based survey was conducted between January and April 2013 in the Central Denmark Region. Postal invitations were sent to a random sample of 46,354 individuals >25 years of age. Two health literacy dimensions were selected from the Health Literacy Questionnaire (HLQ™): i) Understanding health information well enough to know what to do (5 items), and ii) Ability to actively engage with health care providers (5 items). Response options ranged from 1 (very difficult) to 4 (very easy). We investigated the level of perceived difficulty of each task, and the associations between the two dimensions and socio-economic characteristics.ResultsA total of 29,473 (63.6%) responded to the survey. Between 8.8%, 95% CI: 8.4-9.2 and 20.2%, 95% CI: 19.6-20.8 of the general population perceived the health literacy tasks as difficult or very difficult at the individual item level. On the scale level, the mean rating for i) understanding health information was 3.10, 95% CI: 3.09-3.10, and 3.07, 95% CI: 3.07-3.08 for ii) engagement with health care providers. Low levels of the two dimensions were associated with low income, low education level, living alone, and to non-Danish ethnicity. Associations with sex and age differed by the specific health literacy dimension.ConclusionEstimates on two key dimensions of health literacy in a general population are now available. A substantial proportion of the Danish population perceives difficulties related to understanding health information and engaging with healthcare providers. The study supports previous findings of a socio-economic gradient in health literacy. New insight is provided on the feasibility of measuring health literacy which is of importance for optimising health systems.

Health Literacy Measurement: An Inventory and Descriptive Summary of 51 Instruments

This article aimed to provide a descriptive review of the psychometric properties and conceptual dimensions of published health literacy measurement tools. PsycINFO and PubMed search from 1999 through 2013, review of the grey literature, and an environmental scan was conducted to identify health literacy measurement tools. For each tool, we evaluated the conceptual dimensions assessed, test parameters, and psychometric properties. Of the 51 tools identified, 26 measured general health literacy, and 15 were disease or content specific, and 10 aimed at specific populations. Most tools are performance based, require in-person administration, and are exclusively available in a pencil and paper testing mode. The tools assess 0 (proxy measure) to 9 of the 11 defined dimensions of health literacy. Reported administration times vary, from less than 1 to 60 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups (i.e., race, age, ethnicity, and gender). The health literacy measurement tools currently available generally represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools lack information on key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. As researchers develop new measures, inclusion of a full range of conceptual dimensions of health literacy, more representative sampling for testing, and additional modes of administration will allow a more refined and flexible approach to research in this field.

Association between Cancer Literacy and Cancer-Related Behaviour: Evidence from Ticino, Switzerland.

BackgroundThis paper details the role of different dimensions of health literacy in the relationship between health literacy and cancer-related health behaviours. In particular, Cancer Literacy is studied as an exemplar of a dimension of health literacy beyond basic reading and writing skills. The link between functional health literacy, Cancer Literacy and cancer-related health behaviours is investigated in a sample of Ticino (Switzerland) residents (n=639).Design and methodsDetailed data is collected about respondents’ functional health literacy, Cancer Literacy, cancer information seeking behaviour, engagement in cancer preventive behaviours, participation to cancer screenings, and intention to adhere to current screening recommendations.ResultsResults confirm the added value of Cancer Literacy – compared to functional health literacy – in explaining people’s cancer information seeking behaviour, their participation to several cancer screenings and their screening intention, underscoring the need to take into account dimensions of health literacy beyond basic functional skills.ConclusionsFrom a public health perspective, findings provide further evidence on the importance of adapting informational and educational communication intervention designed to improve cancer prevention and screening to different audiences.Significance for public healthFrom a public health perspective, our findings underscore the importance of adapting informational and educational communication interventions designed to improve cancer prevention and screening to different audiences, which could differ not only in their functional health literacy, and in particular to put into place strategies to evaluate their success, including the actual transformation of information in relevant knowledge that can be used as a basis for health decision making. Moreover, the cancer literacy score is able to provide researchers and public health officials with detailed information on which are the main gaps in cancer knowledge and to identify the segments of the population that are more at risk. This information could be used to design and develop targeted informational campaigns for low health literate citizens.

Judgment skills, a missing component in health literacy: development of a tool for asthma patients in the Italian-speaking region of Switzerland

BackgroundHealth literacy has been recognized as an important factor influencing health behaviors and health outcomes. However, its definition is still evolving, and the tools available for its measurement are limited in scope. Based on the conceptualization of health literacy within the Health Empowerment Model, the present study developed and validated a tool to assess patient’s health knowledge use, within the context of asthma self-management.MethodsA review of scientific literature on asthma self-management, and several interviews with pulmonologists and asthma patients were conducted. From these, 19 scenarios with 4 response options each were drafted and assembled in a scenario-based questionnaire. Furthermore, a three round Delphi procedure was carried out, to validate the tool with the participation of 12 specialists in lung diseases.ResultsThe face and content validity of the tool were achieved by face-to-face interviews with 2 pulmonologists and 5 patients. Consensus among the specialists on the adequacy of the response options was achieved after the three round Delphi procedure. The final tool has a 0.97 intra-class correlation coefficient (ICC), indicating a strong level of agreement among experts on the ratings of the response options. The ICC for single scenarios, range from 0.92 to 0.99.ConclusionsThe newly developed tool provides a final score representing patient’s health knowledge use, based on the specialist’s consensus. This tool contributes to enriching the measurement of a more advanced health literacy dimension.

Health literacy among young adults: a short survey tool for public health and health promotion research

Health literacy (HL) is context-specific. In public health and health promotion, HL in the private realm refers to individuals' knowledge and skills to prevent disease and to promote health in everyday life. However, there is a scarcity of measurement tools explicitly geared to private realm contexts. Our aim was to develop and test a short survey tool that captures different dimensions of HL in the context of family and friends. We used cross-sectional data from the Swiss Federal Surveys of Adolescents from 2010 to 2011, comprising 7983 males and 366 females between 18 and 25 years. HL was assessed through a set of eight items (self-reports). We used principal component analysis to explore the underlying factor structure among these items in the male sample and confirmatory factor analysis to verify the factor structure in the female sample. The results showed that the tested item set represented dimensions of functional, interactive and critical HL. Two sub-dimensions, understanding versus finding health-relevant information, denoted functional HL. Interactive and critical HL were each represented with two items. A sum score based on all eight items (Cronbach's α: 0.64) showed expected positive associations with own and parental education among males and females (p < 0.05). The short item set appears to be a feasible measurement tool to assess HL in the private realm. Its broader application in survey studies may help to improve our understanding of how this form of HL is distributed in the general population.

Health Literacy and Nursing

Health literacy refers to a patient's knowledge and skill in making informed health care decisions. Low health literacy is associated with poor health outcomes that nurses have the potential to affect. Screening tools are available to assess a patient's health literacy, but not all are easy to use. Recently health literacy experts have recommended that all patients be treated as if they have low health literacy. The authors review the recent definitions and dimensions of health literacy, the prevalence and characteristics of patients with low health literacy, and strategies nurses can use in clinical settings.

Are we training residents to communicate with low health literacy patients?

Introduction: A third of Americans have low health literacy (HL). Research indicates a significant knowledge and skills gap among residents pertaining to management of patients with low HL.Objectives: The objective of this study was to assess the teaching and evaluation methods around HL in community-based internal medicine residency programs. In addition, the study compared the teaching and evaluation practices used for doctor–patient communication skills to those used for HL skills.Method: A structured questionnaire was completed by faculty of community-based internal medicine residency programs through the ‘Community Hospital Education and Research Network’ website and the Association of Program Directors in Internal Medicine community hospital assembly meeting in October 2011.Results: Less than 50% of the programs provided any formal teaching on HL. HL was primarily taught via didactics (75%) followed by clinical observation (42%) and role-playing (25%). On the contrary, patient–provider communication skills were taught primarily using clinical observations (90%) and standardized patients (46.7%). The HL dimensions that programs focused on were the use of teach-back technique (100%), prevalence of low HL (83.3%), association between low HL and patient outcomes (83.3%), and use of plain language (83.3%). The areas that were least taught included helping patients navigate the health system (33.3%) and choosing effective written material for low HL patients (50%).Conclusion: Health literacy is not being taught consistently as part of the core curricula of the community-based internal medicine residency programs. There is a need for professional and technical resources to incorporate HL teaching in their curricula. There is a wide variation in terms of how HL skills are being taught and evaluated by community-based internal medicine residency programs.

Developing an Instrument to Measure the Social Impact of Sport: Social Capital, Collective Identities, Health Literacy, Well-Being and Human Capital

The objective of this study is to develop an instrument to measure the social impact of sport. While there is a rich literature suggesting and measuring the ways in which sport contributes to society, no broad, encompassing scale has been developed. A measure of this type is useful if sport initiatives are to gain social, political and financial support, especially in the form of corporate sponsorship. The proposed “Social Impact of Sport Scale” includes the dimensions of social capital, collective identities, health literacy, well-being and human capital. In addition to development of a detailed 75 item composite scale stemming largely from past measurement, a shorter set of global measures is also examined. A convenience sample of university students is used in scale development as well as a partial test of the scale in context. Results find support for the detailed scale and for the short global measure instrument. In addition, the partial test of the scale in a context of sport experience relevant to students is reported. The value of the scale in use and areas of future research are discussed.

Addressing the “Other” Health Literacy Competencies—Knowledge, Dispositions, and Oral/Aural Communication: Development of TALKDOC, an Intervention Assessment Tool

Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply one's skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to “obtain, process, and understand basic health information and services needed to make appropriate health decisions,” other health literacy dimensions should be assessed: a person's knowledge and attitudes about a health issue affects his or her ability to and interest in participating in his or her own care. In patient care settings, the abilities to listen, ask questions and check one's understanding are crucial to making appropriate decisions and carrying out instructions. Although literacy is a skill associated with educational attainment and therefore difficult to change in a short time, health education interventions can address health literacy domains such as knowledge, attitudes and oral communication skills. For this reason, an instrument that can assess these constructs is a valuable part of a health educator's toolbox. The authors describe the development and process and outcomes of testing a novel instrument targeted to assess HPV and cervical cancer health literacy competencies, TALKDOC, including its validation with the Health Activities Literacy Scale.

Health literacy and public health: A systematic review and integration of definitions and models

BackgroundHealth literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.MethodsA systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model.ResultsThe review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.ConclusionsBased upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT): A New Item Response Theory-Based Measure of Health Literacy

The importance of health literacy has grown considerably among researchers, clinicians, patients, and policymakers. Better instruments and measurement strategies are needed. Our objective was to develop a new health literacy instrument using novel health information technology and modern psychometrics. We designed Health LiTT as a self-administered multimedia touchscreen test based on item response theory (IRT) principles. We enrolled a diverse group of 619 English-speaking, primary care patients in clinics for underserved patients. We tested three item types (prose, document, quantitative) that worked well together to reliably measure a single dimension of health literacy. The Health LiTT score meets psychometric standards (reliability of 0.90 or higher) for measurement of individual respondents in the low to middle range. Mean Health LiTT scores were associated with age, race/ethnicity, education, income, and prior computer use (p < .05). We created an IRT-calibrated item bank of 82 items. Standard setting needs to be performed to classify and map items onto the construct and to identify measurement gaps. We are incorporating Health LiTT into an existing online research management tool. This will enable administration of Health LiTT on the same touchscreen used for other patient-reported outcomes, as well as real-time scoring and reporting of health literacy scores.

Medical Providers as Global Warming and Climate Change Health Educators: A Health Literacy Approach

Climate change is a threat to wildlife and the environment, but it also one of the most pervasive threats to human health. The goal of this study was to examine the relationships among dimensions of health literacy, patient education about global warming and climate change (GWCC), and health behaviors. Results reveal that patients who have higher levels of health literacy are more likely to engage in mitigation behaviors. An empirically based set of recommendations for providers to educate patients about the health risks of global warming and climate change is proposed.

African American Men’s Understanding and Perceptions About Prostate Cancer: Why Multiple Dimensions of Health Literacy are Important in Cancer Communication

Prostate cancer (PrCA) is the most diagnosed cancer among men in the United States, especially among African American (AA) men. The purpose of this formative study was to explore the implications of applying Nutbeam's multidimensional health literacy framework to AA men's understanding of PrCA information. Participants were 25 AA men aged 45 and older in South Carolina. Their functional health literacy was assessed using two modified Cloze tests and the Shortened Test of Functional Health Literacy in Adults (S-TOFHLA). Men also participated in interviews or focus groups during which they were asked questions about PrCA risk, prevention, and screening. Transcripts were reviewed for recurrent themes and analyzed qualitatively using NVivo7. Mean S-TOFHLA was 28.28 (+/-1.98), implying "adequate" comprehension. Mean Cloze was .71 (+/-.05) for a Grade 8 document and .66 (+/-.04) for a Grade 13 document, also showing "adequate" comprehension. Cloze scores for the Grade 8 resource were lower for participants with less education (P = .047). Despite having satisfactory literacy test scores, results from interviews and focus groups revealed participants' limited understanding and misconceptions about PrCA risk. Many wanted information about screening and family history delivered word-of-mouth by AA women and church pastors as few of them had ever received or actively sought out PrCA resources. Using Nutbeam's framework, gaps in health literacy which were not adequately captured by the validated tools emerged during the interviews and focus groups. Study findings provide important implications for PrCA communication with AA men to correct misperceptions about cancer risk and motivate preventive behaviors.