BACKGROUND Timely and accurate evaluation of mental disorders in adolescents using appropriate mental health literacy assessment tools is essential for improving their mental health literacy levels. AIM To develop an evaluation index system for the mental health literacy of adolescent patients with mental disorders, providing a scientific, comprehensive, and reliable tool for the monitoring and intervention of mental health literacy of such patients. METHODS From December 2022 to June 2023, the evaluation index system for mental health literacy of adolescents with mental disorders was developed through literature reviews, semi-structured interviews, expert letter consultations, and the analytic hierarchy process. Based on this index system, a self-assessment questionnaire was compiled and administered to 305 adolescents with mental disorders to test the reliability and validity of the index system. RESULTS The final evaluation index system for mental health literacy of adolescents with mental disorders included 4 first-level indicators, 10 second-level indicators, and 52 third-level indicators. The overall Cronbach’s α coefficient of the index system was 0.957, with a partial reliability of 0.826 and a content validity index of 0.975. The cumulative variance contribution rate of 10 common factors was 66.491%. The correlation coefficients between each dimension and the total questionnaire ranged from 0.672 to 0.724, while the correlation coefficients in each dimension ranged from 0.389 to 0.705. CONCLUSION The evaluation index system for mental health literacy of adolescents with mental disorders, developed in this study, demonstrated notable reliability and validity, making it a valuable tool for evaluating mental health literacy in this population.

Objectives. The EDUSTROKE project aims to (1) assess stroke-related health literacy (HL) in the general populations of Albania and Italy and identify sociodemographic and behavioral determinants of low HL, and (2) linguistically and psychometrically validate stroke-related HL questionnaires for cross-cultural use in both countries. Trial Design. This is a cross-sectional, two-phase, multicentre observational study. Phase 1 consists of a population-based survey to estimate levels and determinants of stroke-related HL. Phase 2 focuses on the linguistic, cultural, and psychometric validation of the instruments, following COSMIN and SPIRIT recommendations for measurement studies. Participants and Settings. Approximately 1,000 adults (≥18 years) will be recruited in each country using a stratified convenience sampling approach with quota targets for age, sex, geographic region, and urban–rural residence. Participants will be recruited in public settings and through an online survey. Healthcare professionals and individuals unable to provide informed consent will be excluded. Interventions. This is an observational study with no clinical intervention. Participants will complete a structured questionnaire including a sociodemographic survey, the Stroke Knowledge Test, the Awareness of Stroke Symptoms and Risk Factors Questionnaire, and the Stroke Risk Factor Knowledge and Perception Questionnaire. Questionnaires will undergo forward–backward translation, cognitive pretesting, and expert content validation. Primary and Secondary Outcomes. The primary outcome is a latent stroke-related HL score derived from confirmatory factor analysis of combined questionnaire items. Secondary outcomes include identification of HL predictors through weighted multivariable regression models and evaluation of psychometric properties (content validity, reliability, factor structure, and measurement invariance across countries). Conclusions. EDUSTROKE will provide population-level evidence on stroke-related HL in two European countries with differing healthcare contexts and deliver validated tools for cross-national HL assessment, supporting future public health education and prevention strategies.

Rural and unincorporated communities (UCs) experience persistent health disparities driven by limited healthcare infrastructure, geographic isolation, and socioeconomic inequities. Health literacy (HL), the ability to obtain, understand, and use health information, is a critical yet underexplored determinant of health outcomes in these settings. This study examined HL and barriers to healthcare and health information access among low-income adults living with chronic conditions in nine rural UCs in Southern California. A descriptive cross-sectional survey was administered in English or Spanish to 222 respondents during community food distribution events. The questionnaire included demographics, self-reported health status, chronic disease history, perceived access to care and health information, trust in information sources and HL assessment using the Newest Vital Sign (NVS). Over four-fifths (82.7%) of respondents demonstrated limited or possibly limited HL. Although Spanish-speaking respondents scored significantly lower than English speakers on the NVS, language was not a significant predictor of HL after adjusting for age, gender, education and Hispanic origin. Lower education and older age were associated with reduced HL. One in four respondents reported barriers to healthcare access, primarily due to distance and appointment availability. Over half of the respondents reported difficulty accessing or understanding health information, regardless of HL or demographic characteristics. Doctors were the most trusted source of health information, while trust in government and religious organizations was lowest. Findings reveal pervasive low HL and broad challenges accessing care and health information across rural UCs, highlighting the structural and educational inequities underlying these disparities. Addressing these gaps requires community-driven, bilingual, and culturally resonant strategies that build trust, enhance communication, and strengthen health system accessibility for residents of unincorporated rural regions.

BackgroundHealth literacy has been shown to benefit disease management, with patient activation level being important. This study aimed to assess health literacy and activation levels in hypertensive patients, investigating the relationship between literacy and activation.MethodsThe present descriptive and correlational study was conducted with 425 participants. The study was granted ethical approval by the Health Sciences Ethics Committee of a university, and institutional permission was obtained from the relevant Provincial Health Directorate. The data collection tools employed included the Socio-demographic Data Form, the Patient Activism Measure, and the European Health Literacy Scale short form.The data were collected through in-person interviews conducted in the counselling department of the family health centre.The analysis of the data involved the use of statistical methods, including number, percentage, chi-squared test, and ordinal regression analysis.ResultsThe study revealed that 46.4% of the participants exhibited insufficient health literacy, 19.1% demonstrated problematic health literacy, and 34.5% demonstrated adequate literacy. The findings further delineated that 12.4% of the participants were positioned at level 1, 11.8% at level 2, 39.8% at level 3, and 36.0% at level 4 of patient activation. The findings of this study indicate that individuals with a patient activation level 4 exhibit an adequate health literacy level greater (p = .001) in comparison to individuals with a patient activation level 1.ConclusionsThe study found a link between patient activism and health literacy among people with hypertension. It is recommended that efforts be made to improve health literacy to strengthen patient activism in managing the condition.

IntroductionThis nationwide, community-based, multicentre epidemiological survey seeks to evaluate the status, distribution and determinants of health literacy among Chinese adults aged 60 years and older. It addresses the limited representativeness of previous local studies and scarcity of data on advanced-age populations, thereby providing an evidence base for policies to improve health literacy in this demographic.Methods and analysisLed by the National Centre for Chronic and Non-communicable Disease Control and Prevention (NCNCD), this survey uses a multi-stage complex sampling design across 124 districts in all 31 provinces of China. Launched in 2022, the survey is conducted annually, recruiting 24 800 participants each year. Data collection includes demographic information, health literacy assessment (knowledge, attitudes and skills), health information channels, health behaviours and health status. Statistical analyses will assess health literacy levels, influencing factors and urban-rural/gender disparities.Ethics and disseminationEthical approval was obtained from the NCNCD Ethical Review Committee (Approval No. 202110;12 July 2021). Ongoing reviews are conducted on an annual basis, and three ethical reviews have been completed. Findings will be disseminated through peer-reviewed publications and conference presentations, ensuring participant confidentiality.

IntroductionUse of digital health technology can improve patient health outcomes; however, not all patients have the knowledge and skills to download a health app and access a patient portal. Providing digital onboarding support to hospitalized patients has potential to overcome some barriers to accessing needed education in the community, including both having the time and a location to receive education. To address this, our team developed the Jefferson Digital Onboarding Taskforce (JeffDOT), a group of staff and students who approach hospitalized patients and provide one-on-one teaching on how to sign up for and use a patient portal.Methods and materialsThis descriptive study examined the implementation and preliminary outcomes of JeffDOT. We collected patient demographics and assessed health literacy, digital health readiness, and empowerment using the patient portal after patients received individualized support with portal enrollment.ResultsWe enrolled 343 hospitalized patients from a large academic medical center in the U.S. in their patient portal. Almost half of the sample (49%) was older than 55 years, 56% were male, 34% were Black, and 19% spoke Spanish at home. After receiving individualized support from the JeffDOT team, the majority of patients (84%) reported that they felt empowered to use the portal and almost half reported that they would be very interested in additional basic computer skills training if offered by the hospital.DiscussionOur findings suggest that supporting hospitalized patients with enrollment into a health portal using a primarily student, volunteer-staffed model is feasible and acceptable to patients. Future research should focus on the impact of JeffDOT on patient outcomes and health behaviors.

Police officers are uniquely positioned in that they are often the first on scene to respond following health-related calls for help. As a result, they often encounter victims and vulnerable community members at risk for adverse outcomes and low health literacy. In response, a large urban police department in the Southwestern United States, the Phoenix Police Department, implemented a 60-minute didactic Health Literacy Training for Public Safety Professionals presentation to educate recruits in the police academy about health literacy universal precautions and how to apply them specifically to police practice. To evaluate the training’s impact, participating recruits completed pre- and post-training surveys assessing health literacy knowledge, self-efficacy, and planned use of health literacy universal precautions in victim encounters. Survey responses were then analysed using paired sample t-tests, and crosstabs analysis was performed to assess differences by participants’ age, gender, and education level. In total, six trainings were delivered to 139 police recruits, and there were significant improvements in their knowledge of health literacy, self-efficacy, and intended frequency of use of communication techniques (p < 0.001). There was no significant association between recruits’ age, gender, and education level on post-training survey responses. Following the health literacy training, the improved knowledge, self-efficacy, and planned behaviour across age, gender, and education history supports the benefit of health literacy training for all policerecruits. Moreover, findings support the notion that evidence-based and standardized health literacy trainings should be widely incorporated into the education of public safety professionals.

After decades of relative stability, syphilis rates among reproductive-age women in the United States have sharply increased, with maternal cases tripling between 2016 and 2022. This surge has also contributed to a concerning rise in congenital syphilis. Gaps in healthcare access and stigma surrounding sexually transmitted infections have compounded the problem. Focused public health initiatives are needed to strengthen prevention, screening, and treatment efforts. We conducted a national survey to assess health literacy and syphilis knowledge among 643 women aged 18 to 49. Participants completed validated measures, including the Brief Health Literacy Screener and a syphilis knowledge assessment. Recruitment was conducted online to achieve geographic diversity across 48 states, with intentional oversampling of Michigan participants to support future region-specific analyses. Overall, 120 (18.7%) screened positive for inadequate health literacy and 523 (81.3%) did not. Among those who screened positive, 72.5% (87/120) were syphilis-knowledgeable versus 89.1% (466/523) among those who did not screen positive. In logistic regression, syphilis knowledge was associated with nearly three times the odds of not screening positive for inadequate health literacy (AOR = 2.99, 95% CI: 1.71-5.22; p < .001). Education was not associated with health literacy (p = .802). Age and race were significant predictors of health literacy, but neither age nor race predicted syphilis knowledge in adjusted models. This study highlights the connection between health literacy and syphilis knowledge. It emphasizes the need for integrated health education that targets knowledge and literacy, especially among younger and marginalized groups. Incorporating health literacy and syphilis education into sexual health strategies could improve prevention and reduce disparities in syphilis rates among women of reproductive age and racially marginalized populations.

Background/Objectives: Health literacy (HL) plays a fundamental role in maternal and neonatal outcomes by influencing women’s ability to access, understand, and apply health information during pregnancy. However, evidence regarding the determinants of HL among pregnant women remains limited, particularly within the Spanish context. This study aimed to assess HL levels among pregnant women and to examine their association with personal, socioeconomic, and health-related factors. Methods: A cross-sectional study was conducted between January 2023 and February 2024 across nine primary care centres within the Vigo Health Area (Spain), including 182 pregnant women receiving prenatal care. HL was measured using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Sociodemographic, obstetric, and health-related variables were collected through structured interviews. Descriptive and inferential analyses were performed to explore associations between HL and the selected variables. Results: Limited HL was observed in 35.7% of participants. A significant association was found between HL and family income (p = 0.037), with limited HL being more frequent among women with a monthly family income below €2000. No associations were identified with other sociodemographic or health-related variables. Thirty-nine per cent of participants visited hospital emergency services on two or more occasions, mostly without admission. The main source of information was healthcare professionals, although Internet use was also relevant. Conclusions: The prevalence of limited HL was lower than that reported in other national studies, although inequalities related to family income persisted. These findings highlight the need to incorporate systematic, HL-tailored strategies into prenatal care, based on prior HL assessment, to promote informed decision-making and improve maternal and neonatal outcomes.

Health misinformation on social media disproportionately impacts individuals with mental illness, increasing health care avoidance and stigma. The current integrative review aimed to identify effective, evidence-based interventions to improve mental health literacy and counter misinformation in clinical settings. A systematic search of PubMed, Embase, and CINAHL was conducted using terms related to health literacy, mental illness, and patient education. Inclusion criteria focused on adult populations and articles published from 2015 to 2025. Thirteen studies were included and appraised using the Johns Hopkins Nursing Evidence-Based Practices Evidence Rating Scale. Key components of effective interventions included audiovisual education tools, integration into routine appointments, and use of health literacy assessments. Most studies reported improvements in health literacy, anxiety, and depression. However, heterogeneity in tools and lack of theoretical frameworks limited generalizability. Brief, accessible audiovisual interventions embedded in standard care improve patient understanding and emotional outcomes. Future research should focus on theory-based design, validated tools, and mental health-specific outcomes.

Chronic obstructive pulmonary disease (COPD) is a progressive, largely irreversible respiratory condition that has a significant impact on the UK healthcare system. Despite effective treatments, optimal COPD management requires a holistic, patient-centred approach, with self-management playing a crucial role. This article explores self-management interventions, including tailored education, medication adherence support, symptom monitoring and written action plans. Nurses are well positioned to assess health literacy and address barriers to adherence through personalised, non-judgemental strategies. Interventions also encompass lifestyle modification, such as smoking cessation, physical activity, nutrition and psychological support. Emerging digital tools offer new opportunities for enhancing patient engagement. Recognising the heterogenous nature of COPD, interventions must be individualised to each patient's experience. Nurses' ongoing contact with patients enables them to deliver meaningful, tailored support, ultimately improving self-efficacy and health outcomes while reducing healthcare burden.

Background: The public harbors adverse perceptions of individuals with mental illness. The global prevalence of mental health illnesses has consistently risen. Untreated mental illness in high school adolescents can result in social, behavioral, and academic problems. Methods: A respondent-driven sample of 716 high school teachers working in Najran city was surveyed. The participants completed questionnaires assessing their mental health knowledge and Perceived Devaluation and Discrimination. Results: Almost two-thirds of participants had adequate knowledge. The highest knowledge scores were found in the items related to the effectiveness of medication and psychotherapy. Schizophrenia was the most recognized mental health condition, followed by bipolar disorder and depression (mean scores 4.3, 4.0, 3.9, respectively). Almost two-thirds of the study participants (73.6%) had high perceived stigma in the total score of the PDD scale. The highest scores of perceived stigma were found in the scale items related to hiring a qualified person with severe mental illness (86.3%) and being close friends with a person with severe mental illness (85.6%). Participants with adequate knowledge had more perceived social stigma than those with inadequate knowledge (77% versus 66%). There were statistically significant associations between Stigma-related mental health knowledge and socio-demographic characteristics of the study participants (p &lt; 0.05). Conclusions: This study found that, despite the foundational level of knowledge, particularly regarding treatment effectiveness, gaps exist in understanding help-seeking behaviors. Socio-demographic factors play a role in shaping mental health literacy among high school teachers in Najran city.

ABSTRACTBackground and AimMultiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, often leading to cognitive and physical impairments. Medication adherence is crucial for managing MS, yet nonadherence remains a significant issue, influenced by factors such as health literacy (HL) and beliefs about medication. This study aimed to evaluate HL, medication adherence, and the association between them among patients with MS in Jordan.DesignA cross‐sectional study was conducted.MethodsA total of 307 patients with MS from Al‐Bashir Hospital in Amman, Jordan, participated in this study. Patients completed questionnaires assessing HL (HLS‐Q12), medication beliefs (BMQ‐Specific), the Communication and Language Assessment for Multiple Sclerosis (CALMS), and Medication Adherence Report Scale (MARS‐5). Hierarchical logistic regression was conducted to evaluate associations between HL, medication beliefs, and adherence. The study was reported in accordance with the STROBE guidelines for cross‐sectional studies.ResultsThe median MARS‐5 score was 25 (IQR: 21–25), indicating high adherence, with 77.5% of participants reporting never skipping doses. Higher HLS‐Q12 scores were significantly associated with better adherence. Receiving medications with less frequent dosing (i.e., monthly or annually administered injectables) was associated with higher adherence compared to daily dosing regimens (i.e., oral medications). Medication necessity beliefs scores were positively associated with medication adherence.ConclusionHL, dosage regimen and medication beliefs are significantly associated with adherence among patients with MS in Jordan. Tailored interventions to enhance HL, and promote positive beliefs about medication are important for supporting adherence and health outcomes in this population.

Abstract OP 13: Research Methods, B304 (FCSH), September 3, 2025, 17:00 - 18:00 Aims The Health Literacy Questionnaire (HLQ) is a widely used tool for assessing health literacy across diverse populations, translated into 47 languages and used in over 80 countries. HLQ translation uses the Translation Integrity Protocol for linguistic and cultural adaptation to maximise construct equivalence. This study reviews HLQ validity evidence and explores key considerations for its use in migrant populations. Methods A PRISMA systematic review (registered on PROSPERO) identified 257 studies on psychometric properties, with 22 articles across 15 countries/languages included in the analysis. Studies used factor analysis (n = 18), Rasch modelling (n = 3), and reported reliability indices, mainly Cronbach’s alpha (range: 0.57 to 0.95). Additional insights were drawn from translation and cognitive interview studies focusing on construct equivalence. Results Most studies reported strong psychometric properties of the HLQ, though some required modifications (e.g., correlated residuals or item refinements) to achieve model fit. Professional interpreters often focused on linguistic adaptation and accuracy rather than ensuring construct equivalence in the new cultural and health system context. A main issue that requires careful consideration for migrant populations is the challenge of navigating foreign healthcare systems, not just language barriers. The findings recommend that effective linguistic and cultural adaptation strategies need to include (1) engaging clinicians who are familiar with local health systems, (2) prioritising commonly used language and terminology to ensure accessibility, and (3) involving migrants with lived experience of health issues. Conclusions The HLQ demonstrates strong psychometric robustness across languages and cultures. We know it is being used in migrant populations in Europe, Africa, Asia and Australia. However, for migrant populations, translation alone may not be sufficient. Cognitive interviews need to extend beyond language comprehension to assess how migrants interpret health literacy constructs. Future adaptations should emphasise cultural and systemic navigation challenges to ensure meaningful health literacy assessment for intervention development.

BackgroundIndividuals living in poverty may experience premature cognitive impairment and premature aging, which are associated with biological deterioration, and may lead to early onset of dementia.MethodAdults experiencing homelessness (N = 60) for at least 12 months and non‐homeless (N = 45) participated in this study. Validated assessment tools along with biomedical analyses were utilized to provide a thorough evaluation of the targeted groups’ cognitive health, health literacy, and biological and physical health. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), the Comprehensive Trail Making Test, and the Hopkins Verbal Learning Test. Cognitive load was evaluated through pupil diameter captured with the Tobii Pro Nano eye tracking device, while grip strength was measured with a handheld dynamometer, and biological health was assessed through telomere length analysis.ResultIndividuals from the homeless group scored significantly lower in the HVLT and the C‐TMT; similarly, the mean MoCA score was higher in the non‐homeless group than in the homeless group (26.4 ± 2.07 and 20.1 ± 2.86, p = 0.000) with evidence of higher increase in cognitive load during a health literacy test in the homeless group. On average, the homeless group spent significantly longer time completing the health literacy assessment and the cognitive tests, suggesting correlations with processing speed, executive functioning and memory. The homeless group's MoCA and Hopkins Verbal Learning test scores were consistent with weaker grip strength (M = 31.3kg ±11.6 kg vs 40kg ±7.8kg), pointing to a correlation between cognitive weakening and frailty.ConclusionThis pilot study focuses on the association between psychosocial stress and accelerated aging, particularly in the homeless person. The results suggest that individuals exposed to chronic stressors may experience premature aging and premature cognitive decline, which may impact cognitive function.

Factors Associated With Sedentary Behavior Reduction in Older Adults Based on the Capability, Opportunity, Motivation, and Behavior Model: A Multicenter Cross-Sectional Study.

Measuring health literacy in the Indian population: A psychometric review.

ObjectiveTo translate and validate the HLS-Child-Q15, a relatively short questionnaire for assessing health literacy in children originally validated in German, into English to make it accessible to a large population of English-speaking children.DesignWe translated the HLS-Child-Q15 into English following established methods, including forward and backward translation, using multiple translators. We incorporated clinician and consumer input into the translation process. We conducted a qualitative pre-test to assess comprehension and a validation to assess psychometric properties and test-retest reliability.SettingPerth Children’s Hospital, Perth, Western AustraliaPatientsWe recruited English-speaking children aged 8 to 15 years.Main outcome measuresQualitative analysis of pre-test interviews, Cronbach’s α coefficient for internal consistency and intraclass correlation coefficient for test-retest reliability.ResultsThe translation process yielded an acceptable translation. A qualitative pre-test conducted with 10 children demonstrated good comprehension of questionnaire items and resulted in small changes to increase item clarity. Validation with 207 participants demonstrated that questionnaire output score increased with age, school year, self-efficacy score, parental educational level and home literacy environment score. Internal consistency was assessed, with a Cronbach’s α coefficient of 0.854 (95% CI 0.812 to 0.887). Test-retest reliability was moderate, with an intraclass correlation coefficient of 0.612 (95% CI 0.402 to 0.761).ConclusionsThe translated HLS-Child-Q15 was well understood by children. Validation of the translated questionnaire demonstrated adequate psychometric properties, consistent with the original German questionnaire. The translated HLS-Child-Q15 is suitable for use with English-speaking children.Data availability statementData are available on reasonable request and in compliance with institutional ethics and governance requirements.Trial registration numberACTRN12622001499774

To evaluate quality of life (QoL) and health literacy (HL) in Brazilian individuals with Diabetes Mellitus type 2 (DM2) and diabetes-related foot ulcers (DFU). An observational, cross-sectional study was conducted at a tertiary outpatient clinic in Southeastern Brazil. A total of 100 adult study participants, aged ≥ 18 years, who were diagnosed with type 2 DM and presented with at least one DFU were included. Instruments included a sociodemographic and clinical questionnaire, the Diabetic Foot Ulcer Scale-Short Form (DFS-SF), and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18). DFUs were classified using the Wound, Ischemia, and foot Infection (WIfI) system. Statistical analyses included comparison, correlation, and multiple linear regression tests. Based on the present study, the level of diabetes HL among the study participants was inadequate. Taking into consideration the sample size, exploratory regression analyses suggest that hypertension and a moderate-to-high amputation risk (WIfI classification) were both significantly associated with poorer QoL, with respect to leisure activities and a greater perceived dependency during daily activities, respectively. Participants expressed considerable concern regarding their foot health and the challenges associated with foot ulcer management. A connection between neuropathy and increased anxiety regarding foot conditions was also found. Older age, longer disease duration, hypertension, and neuropathy were associated with poorer QoL in DM patients with DFU. Although no overall association was found between HL and the DFS-SF domains, adequate HL was associated with higher scores in the "Bothered by ulcer care" domain. These findings highlight the multi-faceted impact of clinical and demographic factors on QoL in this population, and warrant further investigation using larger, longitudinal cohorts.

The primary objective of this study was to assess the health orientation and health literacy of individuals seeking assistance at a provincial hospital in Greece. A cross-sectional study design was employed to collect data over a four-month period, from July to October 2022. The study was conducted in the outpatient clinics and Emergency Department of the Argolis General Hospital. The study was carried out in the healthcare facilities of the Argolis General Hospital, including outpatient clinics and Emergency Department. This hospital is in the provincial region of Argos in Greece. A total of 223 individuals participated in this study. The participants were individuals who sought medical assistance at the Argolis General Hospital during the specified four-month period, encompassing a diverse range of sociodemographic and medical backgrounds. The study involved participants with an average age of approximately 41years, where the majority were females (63.2%). Most were nonsmokers (65.2%), infrequent exercisers (56.8%), and did not have chronic diseases (80.7%). A significant proportion had been both vaccinated (78.5%) and infected with COVID-19 (67.7%). The average health literacy score was 13.15%, with 69.7% having adequate health literacy, 18.5% showing problematic health literacy, and 11.8% demonstrating insufficient health literacy. Education played a role, with primary school graduates scoring lower and master's degree holders performing better in internal health control. Age correlated with various health aspects, and health literacy was positively associated with factors like private health consciousness, health esteem-confidence, and motivation for healthiness. Higher health literacy is linked to positive health attitudes and behaviors, including confidence in health, motivation for healthiness, and control over health decisions. In clinical practice, healthcare professionals should routinely assess health literacy and orientation to identify individuals who may need targeted interventions to improve health literacy and promote positive health behaviors.