Health Literacy Competencies Research Articles

Opening doors to clinical trial participation among Hispanics: Lessons learned from the Spanish translation of ResearchMatch.

Clinical trial participation among US Hispanics remains low, despite a significant effort by research institutions nationwide. ResearchMatch, a national online platform, has matched 113,372 individuals interested in participating in research with studies conducted by 8778 researchers. To increase accessibility to Spanish speakers, we translated the ResearchMatch platform into Spanish by implementing tenets of health literacy and respecting linguistic and cultural diversity across the US Hispanic population. We describe this multiphase process, preliminary results, and lessons learned. Translation of the ResearchMatch site consisted of several activities including: (1) improving the English language site's reading level, removing jargon, and using plain language; (2) obtaining a professional Spanish translation of the site and incorporating iterative revisions by a panel of bilingual community members from diverse Hispanic backgrounds; (3) technical development and launch; and (4) initial promotion. The Spanish language version was launched in August 2018, after 11 months of development. Community input improved the initial translation, and early registration and use by researchers demonstrate the utility of Spanish ResearchMatch in engaging Hispanics. Over 12,500 volunteers in ResearchMatch self-identify as Hispanic (8.5%). From August 2018 to March 2020, 162 volunteers registered through the Spanish language version of ResearchMatch, and over 500 new and existing volunteers have registered a preference to receive messages about studies in Spanish. By applying the principles of health literacy and cultural competence, we developed a Spanish language translation of ResearchMatch. Our multiphase approach to translation included key principles of community engagement that should prove informative to other multilingual web-based platforms.

WHO Working Group on Health Literacy in Schools

Abstract Background Addressing children`s and adolescents` health literacy is a bedrock for personal and societal growth, health and wellbeing over the life-course, and sustainable development in the WHO European Region and beyond. Promoting health literacy competencies should already be addressed in schools. To outline a strategy for the national education sectors, WHO Europe has launched a working group on health literacy in schools, which aims to develop a conceptual framework for decision makers within the educational and health sector to advocate for health literacy, facilitate the implementation process, and support the uptake on the national level. Methods Based on expert workshops and meetings, literature and document analyses and discussions, this working group has developed a concept note on health literacy addressing the education sector of the WHO member states. Results This work is linking health literacy in schools with the wider WHO health literacy strategy. Emphasis is placed on the critical role of the education sector and the necessary resources to implement action in schools. In addition, this report provides curriculum examples from Member States and key health literacy learning objectives. This includes an action agenda in order to implement monitoring and surveillance of health literacy in schools. The concept paper acknowledges the large variation in the level and organizational structure of the school health services among the 53 regional Member States. Conclusions This report highlights the reason why health literacy of children and adolescents should be addressed as early as in schools. It outlines the available evidence on children and adolescent`s health literacy and the challenges the Member States might face when they aim at addressing health literacy in the education sector and schools. The report should help policy and decision makers to implement health literacy in their countries taking into consideration the importance of adapting to local contexts.

Health Literacy of Rural Population of Kazakhstan.

Background:To date, there is no data available of health literacy of the population in Kazakhstan. This study was aimed to assess the health literacy of the rural population for the development of the targeted health education programs.Methods:The adapted HLS-EU-Q47 survey was carried out among 1650 respondents aged 18–76 from rural settlements in Almaty region of Kazakhstan in 2013. The health literacy competences to assess, understand, appraise and apply health information on healthcare, disease prevention and health promotion were measured. The associations between the health literacy competencies and demographic and socio-economic characteristics were shown through a multiple linear regression analysis.Results:The overall health literacy rate of the rural population of Almaty region was problematic and inadequate. With regards to their age, sex, social and economic characteristics, the health literacy competencies differ according to health literacy domain. Respondents with low education level or perceived social status had respectively low health literacy scores, especially in appraising and applying information of disease prevention.Conclusion:Low educated people and with lower income have lower health literacy in comparison to respondents with higher education level and higher income. Respondents with higher health literacy have higher rate of self-assessed health.

Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review

The objectives of this review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes. Health literacy is defined as a person's competence in accessing, understanding, appraising and applying health information in order to make sound health decisions. A high level of health literacy is positively related to better health outcomes. However, nearly half of the American and European populations have low health literacy levels. Socioeconomically disadvantaged groups in particular present with the weakest health literacy levels, suggesting that differences in health literacy levels contribute to health disparities. Therefore, there is a need to understand the conditions under which health literacy interventions aiming at improving health-related outcomes among socioeconomically disadvantaged people can be implemented. This review considered studies on socioeconomically disadvantaged adults living in the community identified using the socially stratifying PROGRESS factors (Place of residence, Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital).This review considered studies evaluating the following interventions: i) targeting health literacy based on either a clinical and/or a public health approach, ii) delivered at the individual, interpersonal, community or societal level, iii) delivered by any healthcare/social work professional, and iv) using a single or multicomponent strategy. The comparator was no treatment, standard care or a variation of the intervention. All randomized and non-randomized controlled trials as well as quasi-experimental designs were included. Outcomes considered were: i) health-related quality of life and health-related outcomes, ii) health behavior outcomes, and iii) outcomes related to the access and use of healthcare services. A three-step strategy was conducted for primary research published up to May 2018 across seven databases without any language restriction. A search for gray literature was also conducted. Titles and abstracts were screened for assessment against the inclusion criteria. Studies that met the inclusion criteria were retrieved in full and then assessed in detail against the inclusion criteria. Critical appraisal was undertaken using the standardized critical appraisal instruments from JBI. Data were extracted from included studies using standardized data extraction tools from JBI. A meta-analysis was not possible; findings have been presented in a narrative form. Twenty-one studies were included in the review. Three studies addressed the health literacy competency of understanding health information, and 18 addressed the competency of applying health information. Thirteen studies were found as effective based on a variety of health-related outcomes (mainly clinical outcomes), preventive health practices and behaviors, and health-promoting behaviors. Results enabled identification of some effective intervention operational components, including cultural appropriateness, tailoring, skills building, goal setting and active discussions. Multi-faceted interventions, combining both an information transfer medium and contact with an interventionist, appear to be more effective than single modality interventions. The use of an appropriate theoretical foundation is also an important factor for successful interventions. To improve health-related outcomes among socioeconomically disadvantaged people, health literacy interventions are more likely to be successful if they are theory-based, are multi-faceted and use person-centered operational components such as cultural appropriateness, tailoring, skills building, goal setting and active discussions.

Integrated Measures of Health Literacy, Language Access, and Cultural Competency Would Improve Health Care Quality and Value.

Improving health care quality and value requires increased attention to patient and family-centeredness as well as care equity. Although health literacy, language access, and cultural competency have been perceived as separate constructs. each represents a dimension of patient and family-centeredness and care equity. Developing and using integrated measures of health literacy, language access, and cultural competency could provide a viable strategy to improve patient and family-centeredness and equity in health care. While there are challenges to the development and use of integrated measures, some responsive strategies include: using more patient, family and caregiver-reported information; utilizing patient demographic data from electronic health records; and incorporating the latter elements within measures of patient experience. Integrated quality measures also create opportunities for collaborative and interdisciplinary research, and for health care delivery innovation.

Abstract A009: Validation of an instrument to measure health professionals' health literacy competence

Abstract Introduction: Health literacy (HL) has been identified as a significant predictor of outcomes across the health continuum, including cancer care. As a result it is recommended that all health professionals receive health literacy training. Some institutions have begun integrating health literacy into training programs, but there is a dearth of reliable assessment tools to measure learners' knowledge. Only one validated instrument (Health Literacy Knowledge and Experience Scale (HL-KES)) exists that specifically assess health professionals' health literacy competence, but it was validated for use among nurses. The purpose of this study was to evaluate the reliability and validity of the HL-KES as a suitable measure for assessing the HL knowledge and experience of health promotion professionals. Methods: Advanced (junior and senior) students (n=250) enrolled in bachelor-level health promotion programs in three large public universities in Texas completed the 29-item HL-KES. Exploratory and confirmatory factor analyses were conducted to test the factor structure. Reliability estimates of the overall scale and subscales were assessed using the item covariance method with coefficient alpha (α). Results: The analyses identified three factors that accounted for 62% of the total variance. Twelve items loaded on factor 1 (Knowledge of HL challenges), four items loaded on factor 2 (knowledge of HL assessment strategies), and three items loaded on factor 3 (knowledge of HL principles for written healthcare materials). Results from the test of internal consistency indicated the HL-KES had acceptable reliability for the overall knowledge scale (Cronbach's alpha = 0.77). The sub-scales had Cronbach's alphas ranging from .31 to .52. Conclusion: The results suggest the HLKES is a reliable instrument for assessing health promotion professionals' health literacy knowledge. As a whole, the Cronbach's alpha for the instrument falls within the acceptable range (.65 - .90). The subscales, however, have low reliability coefficients. Cronbach's alpha is a function of test length and inter-item correlation and a couple of subscales had just a few items. Reduction in the number of items no doubt attenuated the internal consistency. Citation Format: Lenna Dawkins-Moultin, Lisako McKyer. Validation of an instrument to measure health professionals' health literacy competence [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A009.

Evaluation of individual health literacy among inpatients of different types of hospitals in Istanbul

Objective: The objective of our study is to evaluate the individual health literacy level among patients who received health servicesfrom different types of hospitals in Istanbul.Materials and Methods: This cross-sectional study was conducted among inpatients of a public, private and university hospital inIstanbul. Data were collected by the application of a questionnaire to 1500 adult inpatients who were discharged between February-July2017. The study questionnaire included questions to determine the health literacy competency and sociodemographic characteristicsof patients. Rapid Estimate of Adult Literacy in Medicine (REALM) scale was used to measure the health literacy level.Results: The mean REALM score was higher among females than males (p<0.013). Health literacy mean score was lowest amongpublic hospital inpatients and highest among university hospital inpatients (p<0.001). Primary-school graduate patients hadsignificantly lower scores (p<0.001) than the other groups. The findings of the REALM test were in agreement with the health literacycompetencies.Conclusion: Males, patients older than 35 years old, primary-school graduates, and public hospital inpatients had lower levels ofhealth literacy.

Health literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study

BackgroundThe increasing number of people living with one or more chronic conditions imposes a growing demand on healthcare providers. One way to handle this challenge is by re-orientating the way care is provided, empower people and increase their ability to manage their condition. This requires, amongst other factors, sufficient level of health literacy (HL) and digital competences among both patients and the healthcare providers, who serve them. The focus of this study is the level of HL, digital literacy (DL), and eHealth literacy (eHL) in nursing students in Denmark.The objective was to examine the level of these three literacies in entry- and graduate-level nursing students and examine sociodemographic characteristics and self-rated health (SRH) associations.MethodsA cross sectional study was conducted among 227 students at entry-level and 139 students at graduate-level from a nursing program. The survey consisted of the health literacy questionnaire (HLQ (nine scales)), the eHealth Literacy Assessment toolkit (eHLA (seven scales)), the eHealth Literacy Questionnaire (eHLQ (seven scales)), questions soliciting sociodemographic data, and a single item assessing the students’ SRH. Pearson’s chi-square test and the Mann-Whitney test were used to examine the differences in HL, DL, and eHL and between groups, and Kendall’s tau-b test to examine correlations between SRH and HL, DL, and eHL.ResultsThe level of HL, DL and eHL tended to be higher among graduate-level students than in entry-level students and was satisfactory. Age, sex, country of origin, and parents’ educational level and occupational background influenced students’ HL levels. SRH was higher in students at the graduate level. Amongst entry-level students, SRH was positively associated to seven HLQ, four EHLA and four eHLQ, amongst graduate-level students, SRH was positively associated to seven HLQ and six eHLQ.ConclusionsEducators must be aware of how sociodemographic factors affects students’ literacies and increase learning opportunities by mixing students when planning activities. Considering the higher SRH in graduate-level students, HL, DL, and eHL levels indicate that current curricula and study activities are appropriate, but there is still room for improvement.

Health literacy and education level correlates of participation and outcome in a remotely delivered epilepsy self-management program

SignificanceHealth literacy, the ability to understand necessary health information to make proper health decisions, has been linked to greater frequency of hospitalizations. However, there is limited literature on the associations between health literacy and outcomes in patients with epilepsy, and thus, this secondary analysis investigates the associations between health literacy and outcomes in patients with epilepsy enrolled in the self-management intervention “Self-management for people with epilepsy and a history of negative events” (SMART). We examined the associations between higher health literacy and higher education level and outcomes of the SMART trial. MethodsThis is a secondary analysis of data from the SMART self-management intervention, where individuals were randomized to the SMART intervention or a 6-month waitlist (WL) control. Health literacy was assessed at baseline before randomization using the Rapid Estimate of Adult Literacy in Medicine (REALM-R). Education level was self-reported by participants at baseline. Pearson correlations between REALM-R scores and continuous demographic and clinical variables were conducted. Point-biserial Pearson correlations were computed for REALM-R and dichotomous variables. The effect of education on change in negative health events (NHEs) counts from baseline to six months was conducted using a linear regression. A logistic regression with health literacy and randomization arm as predictors and improvement in NHE (1 = improvement, 0 = no change or increased NHEs at 6 months) as the outcome was conducted. ResultsLower education and lower income were significantly correlated with lower health literacy (p < 0.001 and p = 0.03). Higher education level was associated with a greater improvement in 6-month seizure counts (rs(105) = 0.29, p = 0.002), and a greater improvement in total 6-month NHEs (rs(95) = 0.20, p = 0.045). Health literacy was not associated with change in NHEs or with study retention. ConclusionsThe SMART intervention appears effective for individuals regardless of health literacy competency. Nevertheless, individuals with higher levels of education have fewer epilepsy complications, and thus, those with limited education may still require additional support while participating in epilepsy self-management programs.

Cost health literacy as a physician skill-set: the relationship between oncologist reported knowledge and engagement with patients on financial toxicity.

Oncologists are increasingly encouraged to communicate with patients about cost; however, they may lack the cost health literacy required to effectively perform this task. We conducted a pilot survey of oncologists in an academic medical center to assess potential factors that may influence provider attitudes and practices related to financial toxicity. We assessed perceived provider knowledge of treatment costs, insurance coverage and co-pays, and financially focused resources. We then evaluated the relationship between perceived knowledge and reported engagement with issues of financial toxicity. Of 45 respondents (85% response rate), 58% had changed treatment within the past year as a result of patient financial burden. On self-report, 36% discussed out-of-pocket costs with patients, 42% assessed patient financial distress, but only 20% felt they could intervene upon financial toxicity. Self-perceived awareness of cost health literacy concepts were low; only 16% reporting high out-of-pocket cost knowledge, 31-33% high insurance knowledge, and 8% high awareness of financial resources. Report of cost discussion was associated with greater perceived awareness of both out-of-pocket costs and insurance design. However, reported financial distress assessment was only associated with perceived insurance awareness, not perceived cost knowledge. Cost health literacy was not associated with an increased sense of being able to impact on financial toxicity. Oncologists acknowledge deficits in knowledge and skills that may play a role in the discussion and management of financial toxicity. Some cost health literacy competencies appear to correlate with physician involvement with financial toxicity, suggesting that education on this topic may facilitate physician engagement.

Developing mental health literacy and cultural competence in elite sport

Mental health symptoms and disorders amongst elite athletes have attracted a great deal of discussion recently. Current epidemiological evidence illustrates that mental health symptoms and disorders in elite athletes are prevalent and a concern for athletes, coaches, and sport organizations. Recently, seven consensus, expert, or position statements have been written on the topic of mental health in elite sport. A strategy suggested by each of the seven statements – aimed at preventing and treating mental health symptoms and disorders in elite athletes, both individually and systemically – is to employ education interventions, specifically those based on increasing mental health literacy. Mental health literacy has come to include concepts related to knowledge of effective self-management strategies, challenging mental disorder stigma, awareness and use of mental health first-aid to assist others, and the facilitation of help seeking behaviors. In elite sport, questions remain about how mental health literacy can address the unique needs of the individual athlete, but also factor in their culture and their environment to identify how to prevent and treat mental health symptoms and disorders. The purpose of this commentary is twofold: 1) to explore the evolving concept of mental health literacy within elite sport which addresses individuals, their culture, and their environment, and 2) to propose strategies for best practice and research in mental health literacy within elite sport relying on collaboration between sports psychiatry, sport psychology, and clinical psychology. Lay summary: Expert statements on mental health in elite sport have suggested the use of educational strategies to address poor mental health in elite athletes. This commentary explores the concept of mental health literacy within elite sport which addresses individuals, their culture, and their environment, and proposes strategies for best practice. Implications for Practice Mental health literacy interventions should be based on detailed knowledge of developmental, cultural, and social issues related to sport participation and systemic issues within sport settings and organizations. Mental health literacy interventions should be designed in a manner which takes due account of cultural issues and contexts, where sport organizational goals are considered while helping organizations recognize and address mental health symptoms and disorders and also create sport environments where individuals can thrive. Mental health literacy interventions should have measurable impact on both organizations and individuals.

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students: A Randomized Controlled Trial.

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient’s autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students’ competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations.

Influence of oral health literacy on dissatisfaction with oral health among older people.

To investigate the influence of oral health literacy (OHL) and associated factors on dissatisfaction with oral health (DOH) among older people. Oral health literacy is a recent field of research that has been considered an important mediator between socioeconomic variables and oral health outcomes. However, there are few studies with older people. A cross-sectional study was conducted with 535 non-institutionalised older people aged 60-100years from Brazil. Individuals completed a questionnaire on general health, sociodemographic information and usual reason for dental visit. OHL was assessed using the Health Literacy in Dentistry questionnaire (HeLD-14), validated in Brazil. DOH was the outcome of interest. Poisson regression with robust standard errors was applied as a statistical model to estimate bivariate and multivariable relationships of DOH with OHL after adjusting for sex, age, social characteristics and general health using the P-value of≤.05. The overall prevalence of DOH was 21.1%. Multivariable regression analysis showed that older people with low OHL (HeLD-14 score ≤35) had 1.28 times the odds of having DOH than those with high OHL (HeLD14 score >46), after adjusting for sociodemographic, economic and health outcomes. Dissatisfaction with oral health in older people is a complex issue associated with OHL, social and behavioural factors. Health services should give greater attention to developing health literacy competences in older adults in order to empower them to achieve optimal oral health.

Health Literacy Profile and educational intervention as a prevention action for Type2 Diabetes

Abstract Diabetes Type 2 is being categorized as a health crisis in Mauritius where 22.8% of the population suffers from it coupled with a 19.5% who are pre-diabetic. Government is already spending a huge proportion of the national budget in care of diabetic patients. Since one of the known means to better control diabetes is structured diabetes education, we tested the “learning nests” as a prevention measure for Type2 Diabetes. The “learning nests” is a structured health education programme which takes into account both biomedical and psychosocial dimensions which has already proved its effectiveness in other countries and it is theoretically based on socio-constructivism, social contextualization, empowerment and action planning. Health literacy refers to the capacity to access, understand and use health related information to make appropriate health decisions. A concept which is highly correlated to the health outcomes of a population since it addresses necessary competencies to maintain oneself in good health. The objectives of the educational sessions were to educate people on the risk factors of diabetes and at the same time these people can disseminate the knowledge acquired in their social environment. Six educational sessions were organized for 30 participants whereby the main eligibility criteria was age &amp;gt; =18 years. A qualitative study was conducted with the participants to analyse the learning process as well as their health literacy competencies in terms of access, comprehension and evaluation of health information. The study was conducted before and after three structured educational sessions based on cardiovascular risks, Physical Activities and managing fat intake. The findings show that these learning situations when contextualized can prove to be promising, in terms of health actions being undertaken by participants and improvement in health literacy competences in a middle-income country like Mauritius. Key messages Improvement of Health Literacy level can decrease the prevalence of Diabetes. Structured Health Education can help in improving health literacy.

Health literacy level and influencing factors in university students.

Health literacy (HL) competencies vary across different health domains, and so the youth HL level plays an important role in access to healthcare. The aim of this study was to determine HL levels, the factors that affect it and health-promoting lifestyle behaviours of university students. This cross-sectional study was conducted with 905 students in nursing, law and Islamic sciences departments. An introductory information form, European Health Literacy Scale and Health Promoting Lifestyle Behaviors Scale were used to collect research data. The results showed that 45% of the students had a problematic HL level. Each subscale of the HL scale exhibited a significant positive correlation with the subscales of the Health Promoting Lifestyle Behaviors scale. Logistic regression showed that gender and health education were significantly associated with the HL level. We recommend increasing awareness regarding health liability and integrating HL notions into the higher education curriculum.

Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries: A Multi-centre Pre-post Intervention Study.

Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address health literacy related problems and support the development of people’s autonomy and self-management abilities after training and 6–12 weeks later, (2) professionals were satisfied with the training, (3) outcomes differed for the three participating European countries. Health professionals (N = 106) participated in a multicentre pre-post intervention study in Italy, the Netherlands and Northern Ireland. The 8-hour training-intervention involved health literacy knowledge, the practice of comprehensible communication skills, shared decision-making, and enhancing self-management. Self-rated health literacy competencies and training satisfaction were assessed at baseline, immediately after training and 6-12 weeks later, and analysed by multi-level analysis. Professionals’ self-rated health literacy competencies significantly improved following training in all three countries; this increase persisted at 6-12 weeks follow-up. The strongest increase regarded professional’s skills to enhance shared-decision making and enabling self-management after training and follow-up respectively. Professionals perceived the training as relevant for practice. Competency increases seemed to be consistent across countries. In three countries, professionals’ self-rated health literacy competencies increased following this comprehensive training. These promising findings should be confirmed in a further full effect study. Implementation of this training in European education and health care may improve person-centred communication by professionals and might help to tackle health literacy related problems and to strengthen people’s abilities in achieving better health outcomes.

86. EARLY IMPACT OF A HEALTH EQUITY, DIVERSITY, AND INCLUSION CURRICULA ON RESIDENT KNOWLEDGE, ATTITUDES AND SKILL IN CROSS-CULTURAL CARE

Background GME programs that provide targeted training on the care of disadvantaged populations may result in improved cross-cultural care and decreased health disparities and patient discrimination. In 2018, the ACGME highlighted lack of formal education on knowledge and strategies to address health disparities as a national priority need. Currently, many residents do not receive training on structural competencies and biases that contribute to poor health, nor are they equipped with skills to advocate for patients who disproportionately experience inequity from structural and social determinants of health (SDOH). Design The HEDI curriculum at Cohen Children's Medical Center expands resident training to include sessions on: implicit bias, use of interpreters, health literacy, health disparities, community engagement, LGBTQ health, mistrust, racism, SDOH, cultural and structural competency. Prior to curriculum initiation, residents completed the validated Cross-Cultural Care Survey (CCCS). Trainees engage in monthly, interactive workshops and case-based simulations. Pre and post surveys assess resident knowledge, skill, and attitudes related to each session. Descriptive analyses and Fisher's Exact Test assess bivariate associations. Results Of the 49 residents who completed the CCCS, 67% felt unprepared to deliver cross-cultural care. 18% identified lack of experience and 30% reported inadequate training as barriers to delivering cross-cultural care. Attendance of at least 1 HEDI session was associated with a decrease in residents personal feeling of helplessness when caring for patients of different cultures (p Conclusion Early results from the HEDI curriculum show residents' improvement in preparedness and attitudes in providing cross-cultural care. Further research is warranted to examine whether curricular elements provide a long-term, sustained impact on resident knowledge, skills, and attitudes, which are necessary to combat and eliminate health disparities.

Health Literacy: Knowledge and Experience Among Senior Students in A Nursing College

Introduction: Training and education on health literacy must start in the undergraduate nursing program. While nursing schools include health education courses and provide opportunities for nursing students to give healthcare information to individuals in various healthcare settings, there is a dearth of empirical evidence on health literacy in the Philippines. The purpose of this study was to examine the health literacy knowledge and experience of senior nursing students in a College of Nursing in Iloilo City, Philippines. Methods: This study utilized a descriptive cross-sectional research design with 160 senior nursing students as participants. Data were gathered using Cormier's (2006) Health Literacy Knowledge and Experience Survey (HL-KES) questionnaire. Descriptive statistical tools, t-test, ANOVA and Pearson’s r were used to analyze the data. Results: Results revealed that majority of senior nursing students had limited health literacy knowledge (M=13.19) and had moderate health literacy experience (M=2.50). No significant differences were found in the knowledge and experience according to sex (p &gt; .05) as well in grade in Health Education course (p &gt; .05). Knowledge of health literacy was not significantly related to health literacy experience (p &gt; .05). Conclusions: Health literacy must be given greater emphasis in the undergraduate nursing curriculum. Nursing schools must pay more attention to devising measures in improving nursing students' health literacy competencies.

Magnetic Resonance Imaging: A Personalized Approach to Understanding Fatty Liver Disease.

To assess information retention by parents/caretakers regarding nonalcoholic fatty liver disease (NAFLD) utilizing the actual image of their child's affected liver. In this pilot study, parents/caretakers of children with newly diagnosed NAFLD were presented with an magnetic resonance (MR) image of their child's fatty liver. An adjacent image of a normal-appearing liver was used to highlight the degree of fat accumulation present in their child's liver. The appearance of the fatty liver was used as an adjunct to patient education as provided by a nurse clinician. The efficacy of this approach was determined by a set of image- and disease-specific queries. Health literacy was assessed concurrently by the Newest Vital Sign (NVS) instrument. The image- and disease-specific queries were then repeated by telephone follow-up 2 to 4 weeks after initial clinic visit. Parents/caretakers initially gave 100% correct responses regarding the variation of appearance of normal liver (pink) and their child's fatty liver (yellow). They also all correctly stated the fat content initially. At follow-up, their recall was 95% for the appearance of normal liver and 81% for fatty liver; recall was only 52% for fat content at follow-up. Nonvisualized elements of nonalcoholic steatohepatitis (NASH) and cirrhosis were not identified or recalled as well. Results may have been influenced by parent/caretaker health literacy competence. Personalized images of fatty liver were effective visualization tools for parents/caretakers to comprehend NAFLD and comprehension was not compromised by health literacy. Clear visual instruments may improve parent/caretaker comprehension of these conditions and may help to address deficiencies in health literacy.

Examining health literacy on cholera in an endemic community in Accra, Ghana: a cross-sectional study

BackgroundThe periodic and seasonal outbreaks of cholera in Ghana make the disease a vital health concern. The country is cholera endemic with several communities within cholera hotspots. This study, therefore, assesses health literacy on cholera and the association between health literacy competency and health outcome.MethodsThe study adopted a health literacy framework that theorized the pathways between health literacy and health outcomes controlling for confounding factors. A survey questionnaire was administered to a representative sample of 401 individual household heads in James Town, Accra, Ghana. Reliability analysis was undertaken to ascertain the internal consistency of the instrument. Bivariate methods of analyses used were chi-square tests, ANOVA, Mann–Whitney U test, and Kruskal–Wallis test. Binary logistic regression models were run to examine the relative effects of health literacy competency on health outcome (having not had cholera).ResultsThere are substantial knowledge gaps about environmental risk factors for cholera like the presence of the cholera germ in coastal water, as well as the likelihood of contracting cholera due to overcrowded spaces. However, better knowledge on cholera risk factors was found to be associated with better health literacy competency (food safety and personal hygiene practices). An increase in health literacy competency score was associated with lower likelihood of having had cholera, after controlling for intermediate factors.ConclusionFurthering health literacy on cholera environmental risk factors as well as a deliberate and targeted effort in encouraging consistency in the translation of disease knowledge into healthier practices may improve the well-being of the people.