Prior studies of patient decision aids in urogynecology have not shown benefit, but these tools may have been written at a reading level above that of the average patient. The primary aim was to determine if consent using an audiovisual decision aid (AVDA) written below eighth-grade reading level in English or Spanish affects patient preparedness for surgery. Secondary aims included correlating health literacy with preparedness and assessing patient satisfaction with the decision for surgery. We conducted a randomized controlled trial on patients undergoing surgery for pelvic organ prolapse or urinary incontinence. We compared standard informed consent (control) with watching the AVDA. The primary outcome was the overall response on the "Preoperative Preparedness For Surgery" questionnaire. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. Postoperatively, satisfaction with the decision for surgery was assessed. One hundred fifty-one participants completed the study. In each group, 98.7% of participants strongly agreed or agreed that they felt prepared for surgery (AVDA 74/75, control 75/76, P = 0.364). Most participants had adequate health literacy (AVDA 82.1%, control 81.8%). Among those with low health literacy, there was no significant difference in preparedness for surgery between AVDA and control (P = 0.363). Most participants in both groups were satisfied with their decision for surgery (AVDA 98.6%, control 100%, P = 0.737). Use of an audiovisual decision aid written below eighth-grade reading level did not significantly affect preparedness for surgery, even among participants with low health literacy. Preparedness for surgery was high in both groups.

Background: Functional health literacy enables individuals to navigate health information and resources to make health decisions to choose and to use appropriate health services. It promotes self-health care management and to cope with crisis like Coronavirus disease 2019 (COVID-19). However, teachers’ functional health literacy about COVID-19 study was scant. This study aimed to measure teachers’ functional health literacy and its association with their socio-demographic characteristics. Methods: This study was cross-sectional survey conducted among since June 29 to August 28, 2023. Sample size was 732. Multi-stage cluster sampling was used. Tool was developed by modified Delphi technique. Firstly, items about access to and apply health information for preventive measures of COVID-19 were developed from guidelines about COVID-19 remaining under functional health literacy framework. Then school teachers, health, language experts, and supervision were consulted for improvement. Tool consisted of socio-demography, access to and use of health information about COVID-19 prevention. Tool was piloted and correlation coefficient was calculated. Tool was self-administered at leisure period after taking informed consent from school head teachers and teachers for data collection. Data were entered and analyzed in SPSS version 27. Both descriptive and inferential statistics like Chi-square test was used to analyze data at 5% level of significance. Study proposal was approved by school of medical science, Kathmandu University Results: Results showed that 59.2% of participants had adequate functional health literacy about COVID-19. Gender, ethnicity, and involvement in social health insurance were significantly associated with functional health literacy about COVID-19. Conclusion: This study revealed that teachers have inadequate functional health literacy about COVID-19. This study results suggest interventions from authority of school education and health sector focusing gender, ethnicity and economy to promote teachers’ functional health literacy and to make school and community resilient for future pandemic.

Background: Early childhood is a key period for the development of health literacy, and school textbooks play an important role in shaping early health-related understandings. Objectives: This study examines how health is represented in Grade 1 primary school textbooks in Greece and how children are positioned in relation to health within the curriculum. Methods: Multimodal critical discourse analysis was conducted on thirteen state-approved Grade 1 textbooks (n = 1.271 pages) published by the Ministry of Education and distributed free-of-charge to all public primary schools in Greece. The dataset covers seven subject areas: Language, English Language, Environmental Studies, Physical Education, Visual Arts, Music and Literature. Analysis was informed by Nutbeam's typology of functional, interactive and critical health literacy. Results: Health-related content appeared across all subject areas but was unevenly framed. Language textbooks and workbooks emphasized prescriptive routines and functional health literacy. Environmental Studies and Literature offered more opportunities for reflective and relational engagement with health. Physical Education and Visual Arts supported well-being through activity and creativity but included limited explicit reflection. Across the curriculum, critical health literacy was minimally represented. Conclusions: Grade 1 textbooks in Greece promote basic health behaviors but provide limited support for the development of critical health literacy in early primary education.

BACKGROUND: Parkinson disease (PD) is the second most prevalent neurodegenerative condition and has a profound impact on patients' quality of life. Effective management requires active self-care, in which health literacy (HL) plays a critical role by enabling patients to acquire, interpret, and apply knowledge about their condition. This review aimed to map the existing literature on HL in PD and assess its impact on disease management. METHODS: A scoping review was conducted in accordance with Joanna Briggs Institute guidelines and reported following Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Review. Relevant studies were identified through systematic searches of 7 major databases. Eligibility criteria were structured using the Population-Concept-Context framework. RESULTS: Sixteen studies were included, most published between 2016 and 2024 and predominantly from high-income countries. The studies investigated key HL dimensions, including knowledge of motor and nonmotor symptoms, medication management, and patient-provider communication. Findings revealed substantial gaps in functional HL, particularly in recognizing nonmotor symptoms and understanding pharmacological regimens, while interactive and critical HL were rarely assessed. Across studies, age, education level, and disease duration consistently influenced HL levels. Importantly, no standardized or personalized HL interventions for PD were identified. CONCLUSIONS: HL in PD remains underdeveloped, with current research largely focused on functional HL and limited exploration of interactive or critical domains. Integrating HL assessment into routine care and developing nursing-led, personalized interventions may improve self-care, treatment adherence, and long-term outcomes for people with PD. Future research should prioritize validated measurement tools, multimodal interventions, and studies in diverse populations to address existing gaps.

BackgroundUncontrolled type 2 diabetes results in major complications that threaten patients’ life. Patients with uncontrolled type 2 diabetes often have inadequate health literacy, making them less motivated to perform self-management behaviors for glycemic control. Earlier health literacy interventions were effective in promoting self-management behaviors and reducing blood glucose, but evidence is lacking for those with uncontrolled type 2 diabetes.ObjectiveThis study aimed to investigate the effect of a health literacy program on self-management behaviors of patients with uncontrolled type 2 diabetes.MethodsThis two-group quasi-experimental study with pre-posttest design was done between September 2024 and June 2025. The participants were 64 patients with uncontrolled type 2 diabetes who lived in a community in a province in central Thailand selected using simple random sampling. The experimental group (n = 32) underwent the health literacy program with eight weekly sessions along with usual care while the control group (n = 32) was given usual care only. Data were collected using a Demographic Data Questionnaire, the Functional, Communicative and Critical Health Literacy Scale, the Self-Management Behavior Scale, and hemoglobin A1C (HbA1C) testing. Data analysis was performed with descriptive statistics, paired t-test and independent t-test.ResultsNo significant between-group differences were noted in baseline data. At post-test, the experimental group had a significantly higher mean score of overall health literacy (t = 3.720, Cohen’s d = 2.67), functional health literacy (t = 0.399, Cohen’s d = 2.43), communicative health literacy (t = 7.90, Cohen’s d = 1.76), and critical health literacy (t = 12.972, Cohen’s d = 3.14), and self-management behavior (t = 21.862, Cohen’s d = 2.84), and a significantly lower level of HbA1C (t = 3.436, Cohen’s d = -0.82) than before receiving the program and than the control group (all p <0.01).ConclusionThis study offers evidence for the program's efficacy in raising health literacy, which in turn improves self-management behavior and decreases HbA1C in patients with uncontrolled type 2 diabetes. Nurses can incorporate program activities in empowering patients for diabetes control by promoting their ability to seek and comprehend health information, communicate effectively during medical visits, and develop critical thinking abilities on diverse health determinants.Trial Registry NumberThai Clinical Trials Registry (TCTR20250624001)

In the digital age, patients with type 2 diabetes mellitus (T2DM) are exposed to extensive health information, leading to information overload (IO). This overload results in decision-making difficulties, increased cognitive burden, and reduced health literacy (HL). This study investigates the complex relationship among IO, cognitive fusion (CF), and HL, emphasizing the moderating role of CF. A cross-sectional survey was conducted involving 233 patients with T2DM. Participants completed a general information questionnaire, the Information Overload Scale (IOS), the Cognitive Fusion Questionnaire (CFQ), and the Diabetes Health Literacy Scale (DHLS). A moderated network analysis was used to explore the bidirectional associations between IO and HL and to verify the moderating effect of CF. Network analysis revealed several significant bidirectional relationships between IO and HL, with CF showing a significant moderating effect. Reduced CF strengthened the positive effects of "perceived diabetes information overload" and "multi-channel diabetes information stress" on "functional health literacy", as well as the effect of "increased diabetes information device maintenance" on "interactive health literacy". "perceived diabetes information overload" had the highest centrality index in the network model, which demonstrated overall good stability. This study advances understanding of the relationships among IO, CF, and HL in patients with T2DM. The findings suggest that interventions aimed at alleviating cognitive rigidity should adopt comprehensive strategies targeting the IO symptom network to enhance HL in this population.

This study aimed to develop a measure of functional health literacy (FHL) using Item Response Theory (IRT) to collect validity evidence of the created measure (convergent validity) and to propose cut-off points for the latent FHL trait. A methodological study was carried out with data from a population-based cross-sectional study. Data were collected from October 2023 to March 2024 in households in five Brazilian municipalities. A reduced and adapted version of the health literacy test was used to create the Functional Health Literacy test (FHLT) with the Samejima Gradual Response Model and IRT. Convergent validity was assessed by comparing functional health literacy measures with age, schooling, and economic class. The latent class model was used to categorize the scores generated by IRT. The sample consisted of 1,181 participants, half of whom were aged from 30 to 59 years. All FHLT items showed good discrimination. Convergent validity analysis showed a significant decrease in the means of the latent functional health literacy trait in participants with older age, low education, and lower socioeconomic classes. The model of three latent classes showed the best fit, defining three functional health literacy levels: inadequate, limited, and adequate. The FHLT was made available on an app for research and clinical practice. The results indicated the good psychometric performance of the FHLT in assessing functional health literacy levels, providing the first evidence of its validity.

Background: Chronic constipation (CC) adversely impacts quality of life (QoL). Health literacy (HL) may positively influence QoL, but evidence of this is limited in patients with CC. We examined the association between HL and QoL in patients with CC and explored sex differences. Methods: An online cross-sectional survey was conducted among 423 Japanese patients with CC who had been prescribed laxatives for at least 6 months. HL and QoL were assessed using the 14-item Health Literacy Scale and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QoL), respectively. Results: Females had higher functional HL ( p = 0.004, Cohen’s r = 0.14), poorer QoL (indicated by higher PAC-QoL scores; p &lt; 0.001, Cohen’s r = 0.17), and greater constipation severity ( p = 0.002, Cohen’s r = 0.15) than males. Multivariable regression showed that higher functional HL (regression coefficient [ β ] = −1.06, 95% confidence interval [CI] [−1.53, −0.60]) was associated with better QoL, whereas higher critical HL ( β = 1.34, 95% CI [0.71, 1.94]), female sex ( β = 3.73, 95% CI [0.05, 7.18]), part-time employment ( β = 3.17, 95% CI [0.54, 5.87]), and greater constipation severity ( β = 2.69, 95% CI [2.24, 3.13]) were associated with poorer QoL. These associations did not differ substantially by sex. Conclusions: Functional HL was positively associated with QoL, while critical HL was negatively associated with QoL. Although females reported poorer QoL, the association between HL and QoL was consistent across the sexes, suggesting that comprehensive support, including HL interventions, may benefit female patients.

Association of health literacy with disease outcomes in inflammatory arthritis: a systematic review.

Self-reported health and health literacy, neuroplasticity and neuro-immunological markers during the first 12 months in newly diagnosed people living with HIV: An exploratory study

Objective: This study aimed to examine the relationship between health literacy and self-care agency in patients with type 2 diabetes. Materials and Methods: This descriptive and correlational study was conducted with 128 patients diagnosed with type 2 diabetes who were receiving treatment in the internal medicine clinics of a city hospital. Data were collected by the researcher between July 2021 and February 2022 using the Descriptive Characteristics Form, the Diabetes Health Literacy Scale, and the Diabetes Self-Care Agency Scale. Results: The mean total score on the Diabetes Health Literacy Scale was 34.07 ± 11.75. The subscale scores were as follows: Functional Health Literacy – 12.39 ± 4.95, Interactive Health Literacy – 7.20 ± 3.05, and Critical Health Literacy – 14.46 ± 5.82. The mean total score on the Diabetes Self-Care Agency Scale was 82.19 ± 12.97. A statistically significant, positive, moderate correlation was found between the total self-care agency score and the total score, interactive, and critical subscale scores of the health literacy scale (p

BackgroundDisordered eating behaviors, emotional eating (EE), uncontrolled eating (UE), and cognitive restraint (CR) contribute to weight dysregulation and remain public health concerns in Japan. Body image distortion (BID), or the misperception of one’s body size, has been linked to both being underweight and overweight. While health literacy (HL) and BID are individually associated with eating behaviors, the influence of higher-order HL domains—communicative and critical literacy—and their interactions with BID remain unclear. This study examined how HL and BID jointly influence multidimensional eating behaviors.MethodsIn this cross-sectional study of Japanese adults, HL was measured using the 14-item Health Literacy Scale. BID was defined as the discrepancy between the perceived (via the Figure Rating Scale) and actual body size (via BMI) and categorized as underestimation, no distortion, or overestimation. Eating behaviors (UE, EE, and CR) were assessed using the Japanese version of the 18-item Three-Factor Eating Questionnaire-R18V2. Multinomial logistic regression was used to examine the association between HL and BID, and general linear models were used to test whether BID moderated the effects of higher-order HL domains on eating behavior.ResultsAmong the participants, 13.0% were underweight, 60.2% had a normal weight, 18.7% were overweight, and 8.0% were obese. BID was categorized as overestimation (36.7%), non-distortion (53.6%), or underestimation (9.7%). HL scores were not significantly associated with overestimation or underestimation; however, a higher BMI was inversely related to overestimation. Higher functional HL was associated with lower EE, UE, and CR across all BID subgroups. However, associations for communicative HL varied by BID (interaction P = 0.002 for EE, 0.070 for CR); it was positively associated with EE and CR in the underestimated group, but inversely associated with EE in the overestimated group. Critical HL was positively associated with CR in the overestimation group (interaction, P = 0.015).ConclusionFostering functional HL may support healthier eating behaviors, regardless of BID. Communicative HL may be beneficial for individuals with overestimation-type BID, but potentially counterproductive for those with underestimation. Critical HL appears to encourage more restrictive eating, specifically among individuals with overestimated HL.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13030-025-00347-7.

Background/Objectives: This study aims to investigate the association between health literacy (HL) and stress among family caregivers of older adults with dementia. Methods: Older adults and their caregivers were recruited from the geriatric outpatient memory clinic of an Italian hospital. Caregiver stress was assessed using the General Health Questionnaire-12 items (GHQ-12). HL was measured using the Newest Vital Sign (NVS) and the Short Form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Results: A total of 170 (71% females) caregivers, including spouses and offspring, were included in the analysis. According to the NVS, 53% demonstrated adequate HL, while 83% achieved adequate scores on the S-TOFHLA. The median GHQ-12 score was 15, with 48% presenting a score above 14, indicating higher stress levels; women reported significantly higher GHQ-12 scores than men. In a multivariate linear regression analysis adjusted for sex, education, and number of care tasks provided, the S-TOFHLA score showed a borderline association with the GHQ-12 score (B = −1.45; p = 0.064). When characteristics of the care-recipient were added to the model, the S-TOFHLA score emerged as an independent predictor of the GHQ-12 score (B = −1.41; p = 0.048), along with female caregiver sex and behavioral and psychological symptoms in the care-recipients. Exploratory analysis suggested that the association between HL and stress was present among male but not female caregivers. Conclusions: HL was associated with psychological stress in caregivers of older adults with dementia, with the relationship appearing more pronounced among male caregivers.

BackgroundLimited supply has led to poor accessibility of high-priced imported human papillomavirus (HPV) vaccines, resulting in a vaccine lottery system in China. Few studies explore the inequities of vaccine lottery based on real-world environments, leaving uncertainty about whether the lottery actually achieved equal distribution in practical application. This study aims to take the HPV vaccine lottery system in China as an example to investigate the potential factors associated with participation in HPV vaccine lottery and the association between participation in HPV vaccine lottery and HPV vaccination.MethodsA cross-sectional study was conducted in a developed county that have piloted the HPV vaccine lottery system between April and June 2024. The study respondents were mothers of 7th grade students and the primary outcome variables were mothers’ participation in vaccine lottery and HPV vaccination status. Logistic regression models were used for analysis.ResultsAmong the 2436 mothers of 7th grade students, mothers with high school, bachelor’s degree or higher educational level, a monthly household income exceeding 20,000 RMB (US$2752) and better critical health literacy were more likely to have ever participated in the vaccine lottery. The above significant disparities still existed in the subgroups of medical education background, residence and functional health literacy. Mothers who used to participate in the vaccine lottery were 5.54 times more likely to have received the HPV vaccine.ConclusionsEducational attainment, household income, and health literacy are key determinants of both HPV vaccine lottery participation and vaccination. Our results suggested potential inequities generated by the vaccine lottery system, indicating that consideration should be given to further optimizing the vaccine lottery and combining it with vaccine subsidies, improving the health literacy of the population, and enhancing the accessibility and comprehensibility of vaccine-related information.Trial registrationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13690-025-01771-5.

Maternal health literacy refers to the skills mothers use to manage their own health and their family’s health in healthcare settings. Newcomer mothers face unique barriers to healthcare access, which can be reduced through health education to improve comprehension. An applied, cross-sectional design was used to recruit 20 English-speaking South Asian newcomer mothers (SANMs) and 20 English-speaking Canadian-born mothers (CANMs). This cross-sectional study utilized fuzzy-trace theory to develop an explanatory model for how mothers comprehend health information, with a focus on gist understanding. A digital survey collected data on the ability to comprehend the main idea of pregnancy health information. Additionally, three validated psychometric instruments were administered to measure differences in functional health literacy. Descriptive statistics were conducted on responses to a questionnaire, and accuracy scores were calculated using observation oriented modelling. Data analysis examined the accuracy of models in explaining patterns of observations, supplemented by a visual "eye test" using a histogram to describe observed events. Results indicate that both samples of mothers self-reported adequate numeracy abilities, but performed poorly on functional assessments. In Experiment 1, CANMs who engaged more frequently in numerical reasoning showed a meaningful, non-random pattern of comprehension regarding the chance of viral infection. In Experiment 2, SANMs who more frequently counted or read numbers demonstrated a meaningful pattern of correctly identifying medication timing. These results suggest that gist-based processing supports comprehension in both samples, but the causal patterns linking numerical engagement and comprehension differ. Numerical reasoning relates to comprehension differently across SANMs and CANMs, and therefore health education must be ethno-culturally responsive. Ultimately, this research highlights the need for ‘kind’ learning environments to help ethno-culturally diverse mothers practice and improve their comprehension in healthcare settings and recommends health numeracy education and medication literacy programs to improve numerical reasoning.

BackgroundWhile there is some research on hypertension self-management programs for individuals with profound hearing loss who use sign language as their primary mode of communication (commonly referred to as Deaf), there is no systematic program that considers their unique needs and health literacy. Given the high prevalence of hypertension among Deaf individuals and their vulnerability to limited health literacy, we developed the Hypertension Self-Management Education for the Hearing-Impaired using Sign Language (H-SMILE) program, focusing on health literacy.MethodsFollowing the Analysis, Design, Development, Implementation, and Evaluation model, this methodological study included: (1) analysis through a systematic review of health education interventions for Deaf populations, a survey of 95 Deaf individuals with hypertension, and in-depth interviews with 10 Deaf sign language users; (2) draft design of the program; and (3) program development and expert validation. A pilot test with five Deaf individuals was conducted to assess feasibility.ResultsA 12-session program was developed, covering key topics such as the definition of hypertension, dietary management, weight control, exercise, blood pressure monitoring, medication adherence, smoking and alcohol use cessation, and stress management. The program includes eight pre-recorded educational video sessions produced in Korean Sign Language (KSL) and four small-group in-person sessions for review and feedback. Expert validation of the program, including both the sign language videos and the group session materials, showed high content validity (CVI = 0.94). A pilot test with five Deaf individuals with hypertension demonstrated strong engagement, an over-80% completion rate, and satisfaction scores of 5 out of 5 across all evaluated components. The program integrates linguistic, functional, and digital health literacy to ensure a comprehensive and accessible approach for Deaf participants.ConclusionsThe H-SMILE program is designed for Deaf individuals with hypertension and may be particularly beneficial for those with limited health literacy who use sign language. The program, validated by experts and evaluated in a pilot test showing high satisfaction scores and strong feasibility, appears to be a promising intervention with the potential to enhance health literacy, promote self-management behaviors, and improve health outcomes among Deaf individuals.Trial registrationClinical Research Information Service (CRIS), South Korea (KCT0008292, registration date: March 7, 2023; https://cris.nih.go.kr/).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13726-1.

BackgroundLong-term unemployment is associated with various health risks and low health literacy. Occupational rehabilitation organizations that employ individuals with a history of long-term unemployment may be ideal settings for promoting health literacy. The purpose of this study was to develop and test an intervention to enhance health literacy in this setting.MethodsThe intervention was developed using the steps of the Intervention Mapping protocol. It focused on nutrition, physical activity, and mental health literacy, and included both problem-based learning and practical activities. The intervention was tested using a single-arm pre-post design. Health literacy was assessed at the individual level using the European Health Literacy Scale (HLS-EU-Q16) for general health literacy, the Newest Vital Sign test for functional health literacy, and domain-specific literacies for food, physical activity and mental health literacy. Additionally, structured interviews were conducted with social workers and management staff in the participating organizations to evaluate organizational readiness for change, covering domains such as knowledge of existing efforts, leadership support, implementation climate, health literacy of participants, and available resources. Changes in individual outcome parameters over time were analyzed using paired t-tests. Regression models were used to assess the association between participation in the intervention activities and changes in outcomes.ResultsA total of nine organizations participated in the study. The organizational readiness assessment revealed an increase in management support, though a slight decline in the implementation climate was noted. A total of 171 participants (65% men; mean age = 51.9 years, SD = 9.9) were included in the baseline assessment, and 110 were included in the six-month follow-up. Approximately 50% of participants took part in the intervention activities. Positive trends over time were observed for food literacy and mental health literacy, but not for other outcomes. No clear pattern emerged in the relationship between participation in the intervention activities and changes in the outcome variables.ConclusionThis study revealed small improvements in proximal outcome variables indicating feasibility and potential impact. However, more research is necessary to determine the effectiveness of this novel problem-based learning intervention.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25313-4.

Hispanic/Latino populations experience high rates of preventable conditions like heart disease and diabetes, emphasizing the importance of health literacy in promoting informed health decisions and reducing existing disparities. This systematic review aimed to identify frequently used health literacy measures used with Hispanic/Latino adults in the United States, describe the psychometric properties of these measures, and examine the medical contexts and health conditions of the included studies. A comprehensive search across four databases yielded 2,431 studies; After screening, 168 studies met inclusion criteria. Eleven health literacy measures were identified, and the Short Test of Functional Health Literacy (STOFHLA), Newest Vital Sign (NVS), and Brief Health Literacy Screener (BHLS) were the most frequently used. Study medical context and health conditions included general health (23%), diabetes (15%), cancer (14%), among others. While several health literacy measures demonstrated acceptable to good reliability and validity, gaps were identified regarding cultural appropriateness and tailoring to Hispanic/Latino communities. Enhancing health literacy measures is critical to help inform interventions and improve health outcomes in this population.

The role of older adult functional, interactive and critical health literacy in deprescribing

Unlock the Power of Cultural Competence and Functional Health Literacy (FHL) in Healthcare Practice, Education, and Research