General Health Literacy Research Articles

The Level of Health Literacy of Seniors Living in Eastern Region of Poland. Preliminary Study.

Health literacy (HL) is recognised as an important, modifiable factor in the self-management and health performance of elderly people. The aim of this preliminary study was to identify and analyse the level of health literacy among the elderly living in one of the eastern regions in Poland. The cross-sectional study was conducted among a convenience sample of 200 seniors aged 65+ after cognitive pre-screening with the use of the Montreal Cognitive Assessment (MoCA) scale. To collect data, the Polish version of the HLS-EU-Q47 was used. More than half of the elderly surveyed presented problematic levels of general HL (GEN-HL), and also problematic levels of other dimensions: health care health literacy (HC-HL), disease prevention health literacy (DP-HL), and health promotion health literacy (HP-HL). The level of seniors’ HL is dependent on the level of their education, place of living, participation in activities run by Daily Center for the Elderly, and their self-assessment of health condition (p < 0.05). These results imply the important message that there is a need to create initiatives and programs improving health literacy targeted at seniors living in rural areas, those with lower levels of education, and those with poor access to activities organised by institutions supporting seniors.

Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland.

Background. Health literacy has been separately associated with socio-economic status and worse health status and outcomes. However, the magnitude of the associations between health literacy and health status and outcomes may not be evenly distributed across society. This study aims to estimate and compare the associations between health status, health behaviours, and healthcare utilisation within different levels of social status in the Irish population. Materials and methods. Data from Ireland collected as part of the 2011 European Health Literacy Survey were analysed. General health literacy was measured on a 0–50 scale, low to high. There were four binary outcomes: long-standing health conditions, smoking, hospital visits in the last 12 months, and self-rated health status. Logistic regression analysis was conducted to estimate the likelihood of each health outcome. Health literacy was treated as the main independent variable. Marginal effects were calculated using the delta method to demonstrate the change in likelihood of each outcome associated with a 5-point increase in health literacy score. The sample was grouped into tertiles based on self-reported social status, and models were replicated and compared for each tertile. Models were adjusted for known correlates of health literacy and health: age, gender, and education. Analysis was conducted using Stata V14. Results. Higher health literacy scores were associated with a lower probability of having a limiting illness within the low social status group only. Higher health literacy scores were associated with a lower probability of three or more hospital visits in the past 12 months in the low and middle social status groups. For people in the low and middle social status groups, higher health literacy levels were associated with a lower probability of being a current smoker. The associations between health literacy and self-rated health status were similar in each social status group. Conclusions: Improvement in population health literacy may reduce the prevalence of long-term chronic health conditions, reduce smoking levels, and result in fewer hospital visits. Whilst improved health literacy should improve behaviours and outcomes in all groups, it should have a more marked impact in lower social status groups, and hence contribute to reducing the observed social disparities in these health outcomes.

Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study.

BackgroundGlobally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why.ObjectiveThis study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh.MethodsA cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices).ResultsA total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (α=.05, α is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health.ConclusionsAlthough influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study’s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care.

Determinants of caregiver satisfaction in pediatric orthopedics.

This study investigates determinants of pediatric orthopedic surgery patients' parent or guardian (caregiver) satisfaction with the physician in an outpatient office setting. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients that checked into the pediatric orthopedic clinic at the authors' institution from 1 March 2017 to 1 November 2018. Questionnaires given in clinic include the Newest Vital Sign and The Literacy in Musculoskeletal Problems survey to measure general and musculoskeletal health literacy, respectively, demographic information, expected/estimated wait time, Consultation and Relational Empathy Measure, and Consumer Assessment of Healthcare Providers and Systems Clinician and Group. After multivariate regression, only perceived physician empathy as measured by the Consultation and Relational Empathy Measure score was significantly correlated with caregiver satisfaction (P < 0.0001), accounting for 56% of the variability of caregiver satisfaction scores. The odds of a satisfaction score of at least 9 out of 10 were 21% higher for every unit increase of the Consultation and Relational Empathy Measure score [odds ratio = 1.21 (P < 0.0001)]. After logistic regression, the caregiver's gender was also correlated with patient satisfaction and the odds of a patient satisfaction score ≥9 for males was less than 1/4th that of females [odds ratio = 0.16 (P = 0.040)]. The most important determinant of caregiver satisfaction with the physician in an outpatient pediatric orthopedic setting is perceived physician empathy. This accounts for the majority of the caregiver's satisfaction. This is the first study to determine this relationship in pediatric orthopedic surgery.

Health Literacy Research in Malaysia: Health Literacy and Other Aging Challenges Among Malaysian Public Employees.

This report focuses on a study that addresses the role of health literacy in the challenges surrounding aging. The study was conducted among n=533 public employees ages 40 to 60 years old in Johor state, Malaysia. The validated Malay version of World Health Organization Quality of Life Instrument (WHOQOL-BREF) and the Short-Form Health Literacy Instrument (HLS-SF12) were used to assess perceived quality of life and general health literacy respectively. The WHOQOL-BREF comprises 26 items with six outcomes and the HLS-SF12 consists 12 items. This study provides an overview of participant quality of life, which was operationalized as a precondition of active aging. The participants' preconditions related to active aging were worrisome as 28% perceived their quality of life as poor and 34% were dissatisfied with their health. More positively, health literacy was found to be a significant determinant that may enable active aging.

P1852REGISTRATION WITH PATIENT-FACING ONLINE HEALTH RECORDS IN CHRONIC KIDNEY DISEASE IS ASSOCIATED WITH A LOWER INCIDENCE OF HYPERKALAEMIA

Abstract Background and Aims PatientView (https://patientview.org) is a web-based health record available throughout the United Kingdom which allows patients to review blood results and clinical communication from renal services. PatientView registration may differ across demographic groups and may be associated with improved clinical end points. We investigated the demographic factors associated with PatientView registration, and the association with incidence of severe hyperkalaemia. Method A retrospective analysis was performed of a prospectively-acquired database of adults with chronic kidney disease (CKD) stages 3 – 5 in a single Scottish health board attending 2006–2017. Individual start date was point of first clinic attendance; end date was date of death, commencement of renal replacement therapy or point of data extraction. Covariates included age, sex, biochemistry, socioeconomic status and co-morbidity. The Scottish Index of Multiple Deprivation (SIMD) was used as a measure of socioeconomic status, where quintile 1 is most deprived. A survival analysis of time to severe hyperkalaemia (&amp;gt;6.5mmol/L) was performed with PatientView registration as a time dependent covariate. Results Of 9935 patients, 967 (9.7%) were registered users of PatientView. The PatientView group had lower age in years (54.7 [42.7-65.6] vs 71.5 [62.1-78.4], p&amp;lt;0.001), estimated glomerular filtration rate (eGFR) (27.1 [18.6-38.8] vs 38.5 [28.3-51.8] ml/min/1.73m2, p&amp;lt;0.001), and higher SIMD (indicating lower levels of deprivation) (23 vs 13% in least deprived quintile, 25 vs 37% in most deprived quintile, p&amp;lt;0.001); fewer patients were female in the PatientView group (46 vs 51%, p&amp;lt;0.001). PatientView users had lower body mass index (29.1±7.6 vs 29.8±7.3 kg/m2, p&amp;lt;0.001), and lower prevalence of diabetes (28 vs 33%, p&amp;lt;0.001), heart failure (5 vs 7%, p&amp;lt;0.001), myocardial infarction (13 vs 22%, p&amp;lt;0.001) and stroke (3 vs 6%, p&amp;lt;0.001). On Cox regression, PatientView was associated with reduced risk of hyperkalaemia (HR 0.43, 95% CI 0.32,0.58) after adjustment for baseline eGFR, baseline serum potassium, SIMD, sex, diabetes and heart failure. Conclusion PatientView use is more prevalent amongst male, middle-aged patients with higher socioeconomic status. Registration with PatientView is associated with reduced likelihood of adverse clinical events including hyperkalaemia. Limitations include lack of ethnicity data, retrospective design and drug therapy. PatientView usage may associate with concordance to a low potassium diet, reflecting general health literacy. However, it is plausible that a causal relationship exists between Patientview usage and hyperkalaemia, by facilitating feedback on, and engagement with, lifestyle changes encouraged by healthcare providers. Whilst there remains a lack of PatientView registration in certain demographic groups, these should be targeted via quality improvement initiatives to enhance renal outcomes in underserved groups.

Health Literacy Research in Malaysia: A Scoping Review

Research on health literacy is expanding worldwide. Health literacy has been recognised as a critical determinant of health at the 2016 Shanghai Declaration. Little is known about health literacy research in Malaysia. This scoping review aims to identify and summarise published studies on health literacy in Malaysia. PubMed, Scopus and the Malaysian Medical Repository (MyMedR) databases were searched for published work by Malaysian researchers. Searches were conducted up to November 2019. The search terms used are related to ‘health literacy’ and ‘Malaysia’. Studies included were those involving Malaysian citizens and reporting on various aspects of health literacy. Studies were reviewed by two independent reviewers to determine their eligibility. Data extraction for the year of publication, name of authors, geographical location, research focus, and summary of findings from the full-text articles was carried out independently and any disagreement was resolved by consensus. A total of 29 articles were included with the earliest article published in 1985. Fifteen of the articles are on general health literacy, four on medication literacy, five on mental health literacy, three on media and e-health literacy and four on oral health literacy. Four articles are qualitative studies and the rest are quantitative studies. A few of the studies used validated health literacy tools such as Newest Vital Signs and HLS-EU-Q47. Therefore, we can conclude that there are only a limited number of articles published in the field of health literacy in Malaysia. Future work using validated international tools to allow comparison of the findings should be considered.

Health Literacy Environment of Breast and Cervical Cancer among Black African Women Globally: A Systematic Review Protocol of Mixed Methods.

Adequate health literacy is a necessity to enable effective decision making to seek, access and utilise appropriate health care service. Evidence exists indicating a low level of general health literacy among Black African women, especially those with a refugee background. Breast and cervical are the most common cancers, with Black African women or women with African ethnicity being disproportionately overrepresented. The level of health literacy specific to breast and cervical cancer among Black African women, especially those with a refugee background, has not been reviewed systematically. The present study describes a protocol for a systematic review of the available evidence on the level of health literacy specific to breast and cervical cancer among Black African women globally. We will perform a systematic review of the available quantitative and qualitative studies. The search will include studies that describe the level of health literacy specific to breast and cervical cancer among Black African women. We will conduct a preliminary search on Google scholar to build the concepts for search terms, and a full search strategy using the identified concepts and keywords across four databases namely PubMed, SCOPUS, CINAHL and Web of Sciences. We will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to schematically present the search strategy. We will use the standardized Joanna Briggs Institute quality appraisal and selection tool to recruit studies, and the data extraction tool to synthesise the information extracted from the recruited studies. We will be guided by socioecological theory and Indigenous epistemology to synthesise the non-quantifiable information thematically, and pool the quantitative information using meta-analysis, based on the availability of information.

Adapting the European Health Literacy Survey for Fourth-Grade Students in Germany: Questionnaire Development and Qualitative Pretest.

Background:Promoting health literacy in early life is regarded as an important means of sustaining health literacy and health over the life course. However, little evidence is available on children's health literacy, partly due to a scarcity of suitable measurement tools. Although there are 18 tools to measure specific items of health literacy for people younger than age 13 years, there is a lack of comparable, valid, and age-appropriate measures of generic health literacy.Objective:This study aimed to develop and qualitatively test an age-adapted version of the European Health Literacy Survey Questionnaire (HLS-EU-Q) for German-speaking children age 9 and 10 years. Although validated for adults and adolescents, the HLS-EU-Q has never been age-adapted or used with children.Methods:The content and language of HLS-EU-Q items were adapted for this age range. The literature was consulted to inform this process, and adaptations were developed and selected based on consensus among authors. From an item pool of 102 adapted items, 37 were given to 30 fourth-grade students in a cognitive pretest, which is a standard procedure in questionnaire development aiming to explore how items are interpreted. Participants (18 girls, 12 boys) were mostly age 9 or 10 years (range, 9–11 years).Key Results:Problems with misinterpretation were identified for some items and participants (e.g., items designed to assess participants' perceived difficulty in accessing and appraising health information were partly answered on the basis of knowledge and experience). A final selection of 26 well-performing items corresponded to the underlying HLS-EU-Q framework.Conclusions:This is the first age-adapted version of the HLS-EU-Q. A preliminary 26-item questionnaire was successfully developed that performed well in a cognitive pretest. However, further research needs to verify its validity and reliability. The present findings help to advance the measurement of generic self-reported health literacy in children and highlight the need for cognitive pretesting as an essential part of questionnaire development. [HLRP: Health Literacy Research and Practice. 2020;4(2):e119–e128.]Plain Language Summary:The European Health Literacy Survey Questionnaire is used for testing adults' health literacy. It was adapted for German-speaking children age 9 and 10 years. Based on a review of the original items and the literature, 26 questionnaire items were developed and tested in interviews with 30 children. Although problems with understanding could be identified, the questionnaire was mostly well understood.

Development and Psychometric Properties of a Questionnaire Assessing Self-Reported Generic Health Literacy in Adolescence.

Health literacy is a promising approach to promoting health and preventing disease among children and adolescents. Promoting health literacy in early stages of life could contribute to reducing health inequalities. However, it is difficult to identify concrete needs for action as there are few age-adjusted measures to assess generic health literacy in young people. Our aim was to develop a multidimensional measure of health literacy in German to assess generic health literacy among 14- to 17-year-old adolescents, namely, the “Measurement of Health Literacy Among Adolescents Questionnaire” (MOHLAA-Q). The development process included two stages. Stage 1 comprised the development and validation using a literature review, two rounds of cognitive interviews, two focus groups and two rounds of expert assessments by health literacy experts. Stage 2 included a standard pretest (n = 625) of the questionnaire draft to examine the psychometric properties, reliability and different validity aspects. The MOHLAA-Q consists of 29 items in four scales: (A) “Dealing with health-related information (HLS-EU-Q12-adolescents-DE)”; (B) “Communication and interaction skills”, (C) “Attitudes toward one’s own health and health information”, and (D) “Health-related knowledge”. The confirmatory factor analysis indicated a multidimensional structure of the MOHLAA-Q. The internal consistency coefficients (Cronbach’s α) of the scales varied from 0.54 to 0.77. The development of the MOHLAA-Q constitutes a significant step towards the comprehensive measurement of adolescents’ health literacy. However, further research is necessary to re-examine its structural validity and to improve the internal consistency of two scales.

Does health literacy affect fruit and vegetable consumption? An assessment of the relationship between health literacy and dietary practices among college students

Objective To explore the association between health literacy and fruit and vegetable (F&V) consumption among college students. Participants: In 2018, undergraduate students from a large, southeastern university were recruited to participate in this study. Methods: Participants (n = 436) completed an online survey assessing health literacy, F&V intake, and personal, situational, and societal and environmental determinants of health literacy. Results: There was a significant association between general health literacy, F(2, 161.54) = 6.52, p < .001; disease prevention health literacy, F(2, 214.22) = 4.788, p < .01; and health promotion health literacy, F(2, 138.35) = 5.53, p < .01 with F&V consumption. Students with excellent health literacy consumed significantly more fruits and vegetables than students with limited health literacy. Conclusions: Health literacy may play an important role in F&V consumption among college students. Future research should explore the relationship between the health literacy and dietary practice decision-making to inform intervention development among college students.

Online Survey for the Assessment of Generic Health Literacy among Adolescents in Germany (GeKoJu): Study Protocol.

The promotion of health literacy at a young age can protect, maintain and improve health across the life course. Yet to date, a sound data basis on adolescent health literacy as a requirement for the development of strategies to promote health literacy has not been given. This paper presents a study protocol for the online survey “Health Literacy Among Adolescents” (GeKoJu) that collects the first nation-wide representative data on self-reported generic health among adolescents aged 14–17 years in Germany. The objectives of the survey are (1) to assess the distribution of generic health literacy among adolescents in Germany, (2) to identify socio-demographic and social factors in regard to health literacy and (3) to assess the association of health literacy and health-related outcomes. The cross-sectional survey was conducted from September 2019 through December 2019. A two-stage stratified cluster sampling strategy was applied. Individuals invited to participate in the survey (N = 6608) were randomly selected among German-speaking adolescents aged 14–17 years, with permanent residence in Germany. Generic health literacy is measured with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Data collection also covers questions on health behavior, subjective health status, personal and social resources, socio-demographic and social factors and health services use. Results of the GeKoJu survey will provide data for the development of strategies to promote generic health literacy among families, in schools, communities and health care.

The Evidence-Based Development of an Intervention to Improve Clinical Health Literacy Practice.

Low health literacy is an issue with high prevalence in the UK and internationally. It has a social gradient with higher prevalence in lower social groups and is linked with higher rates of long-term health conditions, lower self-rated health, and greater difficulty self-managing long-term health conditions. Improved medical services and practitioner awareness of a patient’s health literacy can help to address these issues. An intervention was developed to improve General Practitioner and Practice Nurse health literacy skills and practice. A feasibility study was undertaken to examine and improve the elements of the intervention. The intervention had two parts: educating primary care doctors and nurses about identifying and enhancing health literacy (patient capacity to get hold of, understand and apply information for health) to improve their health literacy practice, and implementation of on-screen ‘pop-up’ notifications that alerted General Practitioners (GPs) and nurses when seeing a patient at risk of low health literacy. Rapid reviews of the literature were undertaken to optimise the intervention. Four General Practices were recruited, and the intervention was then applied to doctors and nurses through training followed by alerts via the practice clinical IT system. After the intervention, focus groups were held with participating practitioners and a patient and carer group to further develop the intervention. The rapid literature reviews identified (i) key elements for effectiveness of doctors and nurse training including multi-component training, role-play, learner reflection, and identification of barriers to changing practice and (ii) key elements for effectiveness of alerts on clinical computer systems including ‘stand-alone’ notification, automatically generated and prominent display of advice, linkage with practitioner education, and use of notifications within a targeted environment. The findings from the post-hoc focus groups indicated that practitioner awareness and skills had improved as a result of the training and that the clinical alerts reminded them to incorporate this into their clinical practice. Suggested improvements to the training included more information on health literacy and how the clinical alerts were generated, and more practical role playing including initiating discussions on health literacy with patients. It was suggested that the wording of the clinical alert be improved to emphasise its purpose in improving practitioner skills. The feasibility study improved the intervention, increasing its potential usefulness and acceptability in clinical practice. Future studies will explore the impact on clinical care through a pilot and a randomised controlled trial.

Relationship between health literacy and toothbrushing practice among young adults

Aims and Objectives: The aim of this study was to access the relationship between health literacy and toothbrushing practice in young adults. Materials and Methods: This cross-sectional analytical study consisted of 218 respondents: college (except dental students) and noncollege students. All respondents completed a general health literacy questionnaire using the Newest Vital Sign (NVS) and the specific health literacy (SHL) questionnaire comprising questions on access, knowledge, and attitudes on toothbrushing. Respondents’ regular toothbrushing practice was evaluated by using a video camera recording. All the analyses were performed by using the t-test, analysis of variance, Pearson correlation or Spearman rank correlation, and multiple linear regression statistical technique. Results: The mean scores of NVS and SHL were significantly different among the education groups (P < 0.001). Toothbrushing practice showed significantly (P < 0.05) correlations with gender, education, access, attitude, and SHL, but not with the NVS. The correlation of toothbrushing practice and SHL as well as access remained significant in multiple linear regression models after adjusting for gender and education (P < 0.05). Conclusion: Health literacy had a significant correlation with toothbrushing practice when measured with SHL. Access and SHL were the most influencing factors for toothbrushing practice in this study.

Critically Appraisal of Tools to Measure using the COSMIN Checklist

Purpose: Oral health literacy tools are important for assessing a population’s oral health knowledge and awareness. The objective of this study was to critically appraise the methodology used for developing all the existing oral health literacy assessment tools, by systematically reviewing the available evidence. Materials &amp; Method: Databases used for the search were Wiley, BMJ open, Pub Med/Medline and Science Direct. We identified 10 studies, published in English during 2006-2016, that focused on the development and validation of oral health literacy tools. We then assessed these studies using the COSMIN checklist, which evaluates the methodological quality of studies on measurement properties. Results: Most of the tools were adapted from the general health literacy tool. All the 10 tools had measured validity and reliability, but lacked cross-cultural validity. Conclusion: Findings from this review confirm that majority of the tools focus towards assessment of word recognition, numeracy and reading skills, rather than indicative of aspects such as health behaviors and service utilization. Developing tools that are adapted for specific populations will require further work, such as incorporating tests to ensure their acceptability and cultural competence.

VIRTUAL ONLINE COMMUNITIES FOR AGING LIFE EXPERIENCE (VOCALE) APPROACH: PILOT STUDIES

Emerging evidence suggests behavioral strategies focusing on symptom management can reduce frailty symptoms and improve quality of life. Unfortunately, these interventions are rarely scalable for implementation in geriatric care. Contemporary online technologies have tremendous potential for addressing this need. We developed and pilot tested an approach entitled Virtual Online Community for Aging Life Experience (VOCALE). The approach had two stages. In the first stage, we piloted the use of a Facebook platform to engage older adults with frailty symptoms in ten-week moderated discussions on health-related topics. In the second study, we used data from stage one to develop a prototypical persona of a person with frailty symptoms. The persona was then incorporated into an eight-week Facebook intervention informed by problem solving therapy to facilitate self-management in another group of older adults with frailty symptoms. The results from both rounds showed that it was feasible to recruit, engage, and retain persons ages 69-92 into virtual online community interventions. Attrition ranged from 25% to 33% in rounds one and two. In both rounds, we observed positive trends of change in health measures such as general health self-efficacy, disease self-efficacy, and health literacy. Throughout the studies, older adults shared multiple posts concerning their experience with age-related symptoms and described their self-management practices. These projects, which leveraged a common social media platform, demonstrated preliminary efficacy of an online intervention for frailty management. If confirmed, this approach might provide a viable model for other medically complex geriatric conditions where self-management is essential.

Significance and challenges of assessing health literacy among migrants

Abstract Background People with a migration background account for a large part of the population in many European countries. Although health literacy - knowledge, motivation, and competencies to process health information - is a key determinant of health, research on health literacy specifically among migrants in Europe is scarce. The aim is therefore to review and further develop the concept and assessment of migrant-specific health literacy for future use in a migrant health literacy survey (HLS-MIG) in Germany. Methods A literature search in Pubmed was performed in April 2019 to identify studies regarding health literacy, health outcomes and knowledge among migrant populations in Europe. A special focus was put on the conceptualization and operationalization of health literacy among migrants. Results So far, health literacy among migrants has mostly been measured using general health literacy measurement tools, that is, performance-based and self-assessment instruments as the HLS-EU-Q. Migration-specific competences, such as finding information about health in mother tongue, or outcomes of deficient HL have so far received little attention, except for e.g. the GMK-12, developed as a complement to the HLS-EU-Q16 in the Austrian context. Conclusions The use of performance-based instruments in the local language primarily provides information about existing linguistic deficits, but hardly on competencies and abilities in dealing with health information. General self-assessment tools, on the other hand, allow the identification of such competences, difficulties and challenges. However, it is necessary to take greater account of migration-specific competences, habits and obstacles in the future, in order to develop tailored interventions for individuals and organizational aspects, supporting health information processing among migrants. Furthermore, studies also need to pay attention to migrant specific health problems and prerequisites. Key messages Research focussing on migrant health literacy is scarce. More attention needs to be paid to migrant specific competencies, habits and challenges.

Health Literacy of Hearing-Impaired High School Students, Some of the Problem, and their Expectations

Abstract Purpose This study aims to determine hearing-impaired students’ levels of health literacy, problems when they receive healthcare service and their expectations. Methods This descriptive study was conducted on 88 hearing-impaired high school students over 15 years of age. The data collection tools used in the study are “Form of Problems Experienced When Receiving Healthcare Service”, “Form of Expectations from Healthcare Service”, and Turkey Health Literacy Scale (THLS-32). The researchers know sign language. The Health Sciences Faculty granted approval for the study (04.12.2017-255). The families were informed of the program through the school administration, and their consent was obtained. Results 70.5% of the students had inadequate, 19.3% had limited, 2.3% had adequate and 8% had excellent health literacy levels. Those who had communication problems with the doctor (25%), those who misused the prescribed medication (13.6%) and those who could not use the medication without help (43.2%) had low THLS scores (&amp;lt;0.05). Those who stated that they did not understand what the nurses said (43.2%) and the health education materials (56.8%) and those who reported that they were confused when they had more than one appointment (20.5%) had significantly low THLS scores (&amp;lt;0.05). 55.7% of them expected that their prescriptions or care procedures were to be given in writing, and 87.5% expected them to be told in sign language. Conclusions Most of of the participants have significantly weaker general health literacy. Students with low THLS scores have less understanding of the given information and have problems with health workers. Main messages: This can create disparities and inequalities in the use of healthcare services and in the health outcomes. Key messages This can create disparities and inequalities in the use of healthcare services. This can create disparities and in the health outcomes.

Factors associated with low health literacy among community-dwelling women in Taiwan

ABSTRACTThe present study investigated factors associated with health literacy in community-dwelling Taiwanese women, particularly focusing on those associated with prevalent unhealthy behaviors. This cross-sectional study recruited 353 community-dwelling women aged 39–89 years from February to October 2015 in urban, suburban, and rural areas. Variables investigated included physical activity, community activity, tobacco usage, alcohol consumption, and betel-nut chewing. Degree of health literacy was evaluated using the Chinese-language version of the European Health Literacy Survey Questionnaire. Most respondents had inadequate (17.6%), or problematic (49.3%), general health literacy. Multiple logistic regression analyses showed that low educational attainment was closely associated with inadequate or problematic general health literacy. Women who did not engage in regular physical activity or direct community activity were more likely to have inadequate and problematic general health literacy, respectively. Selected unhealthy behaviors (tobacco usage, alcohol consumption, betel-nut chewing) were not associated with health literacy. Low health literacy was prevalent among participants. Lower educational attainment and a lack of physical or community activity were associated with low health literacy. Health literacy should be considered during the process of delivering health information, and health education programs must enhance health literacy tailored to address individuals’ lifestyles.

Developing an Indonesia's health literacy short-form survey questionnaire (HLS-EU-SQ10-IDN) using the feature selection and genetic algorithm

Background and ObjectiveMeasuring health literacy becomes more important because its association with health status and healthcare outcomes. Studies have developed at least 133 measurement tools for health literacy. HLS-EU-Q47 is a questionnaire consisting of 12 sub-dimensions and 47 questions developed by the Europe Health Literacy Consortium. Many countries in Europe and Asia have used HLS-EU-Q47 as a tool for measuring health literacy in the general public. Indonesia has conducted general health literacy survey using HLS-EU-Q47 but finding the difficulties because of the time-consuming interview. A shorter version of HLS-EU-Q47 is needed to apply in health literacy researches in Indonesia. This paper reports the results of feature reduction to develop a short Indonesian version HLS-EU questionnaire and measures the accuracy of the model compared with other short form like HLS-EU-SQ16 or HLS-SF12. MethodThe analysis was performed on a population-based dataset from Indonesia-Semarang Health Literacy Survey for which there were specific target variables as the classification of health literacy level. All attributes were assessed as potential targets in the models derived from the full dataset and its subsets. The feature selection methods with genetic algorithm were used as the filter as well as validation (cross validation) and classification (k-NN:k-nearest neighbor). The predictive accuracy of health literacy level and the complexity of models based on the reduced datasets were compared among the methods and other short versions such as HLS-EU-SQ16, HLS-SF12. ResultThe accuracy of the existing short form models were 90.64% with the HLS-EU-SQ16 and 88.67% with the HLS-SF12. This study proposed a model with 10 features as the construct of a short Indonesian-version (proposed as the HLS-EU-SQ10-IDN) since the model was with higher accuracy than the HLS-SF12, but fewer features for measuring general health literacy index. Moreover, the short version only completed part of 12 dimensions of the full questionnare. ConclusionA data mining technique using feature selection with combination of genetic algorithm and k-NN algorithm was applied to develop a short version questionnaire and proved to have better accuracy, as compared with the short version developed by traditional statistical technique.