Health Literacy Competencies Research Articles

Patient-Centered, Integrated Health Care Quality Measures Could Improve Health Literacy, Language Access, and Cultural Competence

The authors of this paper recommend the integration of health care quality improvement measures for health literacy, language access, and cultural competence. The paper also notes the importance of patient-centered and equity-based institutional performance assessments or monitoring systems. The authors support the continued use of specific measures such as assessing organizational system responses to health literacy or the actual availability of needed language access services such as qualified interpreters as part of overall efforts to maintain quality and accountability. Moreover, this paper is informed by previous recommendations from a commissioned paper provided by the National Committee for Quality Assurance (NCQA) to the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine. In the commissioned paper, NCQA explained that health literacy, language access, and cultural competence measures are siloed and need to generate results that enhance patient care improvements. The authors suggest that the integration of health literacy, language access, and cultural competence measures will provide for institutional assessment across multiple dimensions of patient vulnerabilities. With such integration, health care organizations and providers will be able to cultivate the tools needed to identify opportunities for quality improvement as well as adapt care to meet diverse patients’ complex needs. Similarly, this paper reinforces the importance of providing more “measures that matter” within clinical settings.

Challenges and opportunities in building critical health literacy.

Critical health literacy is the least explored domain of health literacy and is addressed by few projects seeking to build health literacy. Lack of research means there is little evidence upon which to design effective interventions. Yet critical health literacy offers potential for individuals and communities to make important contributions to their own and society's health. This paper reports on an evaluation of a community project designed to develop critical health literacy. The evaluation explored, (a) processes used to build critical health literacy and (b) the impact on the critical health literacy of participants. A mixed methods approach was used combining a pre-and post-intervention assessment of 14 of the 24 participants using the All Aspects of Health Literacy Scale, with participant focus groups and facilitator interviews. Strategies used to build critical health literacy included informal and participatory learning, supported and independent assessment of the problem, appraising information, familiarisation of health systems and services, and social support. Common to these was learning within the context of participants' lives. Fewer strategies encouraged empowerment and political action. The evaluation showed slight improvements in some critical health literacy competencies: the ability to critically appraise health information and apply it to the context of their own lives and being able to critically question health professionals based on an individual's own research. However, there was no change in participants' ability to understand the determinants of health or involvement in activities for social and political change. Informal, participatory community projects can successfully build many characteristics of critical health literacy. However, the political action element of critical health literacy remains the least well understood and faces particular challenges in its implementation.

Health literacy assessment and patient satisfaction in surgical practice.

BackgroundLimited health literacy has been associated with poorer health outcomes and increased morbidity and mortality. Though caring for surgical patients requires communication about complex topics, there is limited literature on health literacy competency in this population. The objective of this study was to assess health literacy in an adult surgical outpatient clinic population, to explore potential determinants of adequate health literacy, and to assess patient satisfaction with physician-patient communication.Materials and methodsA prospective cross-sectional study was performed and anonymous data including health literacy, demographics, and patient satisfaction with provider communication were collected. The study population included adult patients who visited an outpatient surgical practice over a one-month period. Health literacy was assessed using the Newest Vital Sign while the satisfaction questions came from the Outpatient Satisfaction Survey (Press-Ganey Associates, Chicago, IL).Results148 patients participated in the study. The mean age was 49 years, 41% of those who gender identified were male, and 76% were White/Caucasian. 34 (27%) of those who answered the question had received a four-year undergraduate/university degree. 55 (37%) of the patients were identified as having low health literacy. More years of education was significantly associated with adequate health literacy and those patients who were more educated and had adequate health literacy were more satisfied with provider communication.ConclusionPatients on average were highly satisfied with provider communication in this outpatient surgical clinic. Higher education levels were associated with better health literacy and patients with both characteristics were more satisfied with provider communication.

Building and Maintaining a Citizen Science Network With Fishermen and Fishing Communities Post Deepwater Horizon Oil Disaster Using a CBPR Approach

When the Deepwater Horizon oil rig blew out in 2010, the immediate threats to productive deep water and estuarial fisheries and the region's fishing and energy economies were obvious. Less immediately obvious, but equally unsettling, were risks to human health posed by potential damage to the regional food web. This paper describes grassroots and regional efforts by the Gulf Coast Health Alliance: health risks related to the Macondo Spill Fishermen's Citizen Science Network project. Using a community-based participatory research approach and a citizen science structure, the multiyear project measured exposure to petrogenic polycyclic aromatic hydrocarbons, researched the toxicity of these polycyclic aromatic hydrocarbon compounds, and communicated project findings and seafood consumption guidelines throughout the region (coastal Louisiana, Mississippi, and Alabama). Description/analysis focuses primarily on the process of building a network of working fishermen and developing group environmental health literacy competencies.

Health Literacy Competence of Health Education Students in Three Universities

Introduction. Limited health literacy challenges health care and perpetuates health disparities. Health agencies, such as the U.S. Department of Health and Human Services and the World Health Organization, have recommended health literacy training for all health professionals, but little is known about the health literacy competence of health education professionals. The purpose of this study was to assess the health literacy knowledge and experience of advanced health education students. Method. We used a cross-sectional design to collect data from a sample of 250 juniors and seniors enrolled in health education programs who self-reported an intention to take the certified health education specialists examination. Descriptive and bivariate analyses were conducted. Findings. Results showed most students (84%) scored below 70% on the knowledge component of the test, even though majority of them (94%) reported health literacy training was included in their health educator preparation curriculum. A correlation analysis found health literacy knowledge was not associated with students’ reports of health literacy in their health education curriculum. Prior academic degree was negatively correlated with health literacy knowledge (ρ = −.211, p < .05), and there was a negative correlation between health literacy knowledge and health literacy experience (ρ = −.189, p < .05). Discussion. The study identified weaknesses and gaps in the health literacy knowledge and skills of students, most of who were in the final phase of their professional preparation. The findings have implications for research, practice, and credentialing.

Validation of the European Health Literacy Survey Questionnaire in Women With Breast Cancer.

Health literacy enables effective communication, participation, and cooperation with clinicians of patients with breast cancer in healthcare processes. The European Health Literacy Survey Questionnaire (HLS-EU-Q) comprehensively assesses multiple conceptual domains of health literacy in a diverse range of health contexts. However, the HLS-EU-Q has not been validated in women with breast cancer. We examined the psychometric properties, particularly the factorial validity, of the HLS-EU-Q in women with breast cancer. We performed a first-order confirmatory factor analysis (CFA) to verify the 12-subdomain model of the 47-item HLS-EU-Q. A second-order CFA was conducted to investigate whether the 12 subdomains reflected the 3 domains of healthcare, disease prevention, and health promotion correspondingly. A total of 475 women with breast cancer participated in this study. The first-order CFA fitted with the HLS-EU-Q containing 47 items. However, item 29, with a low factor loading (-0.05), was deleted. The modified first-order CFA adequately fitted the data of the HLS-EU-Q with 46 items. The second-order CFA model acceptably fitted with the data, but the 3 domains with high correlations (0.92-1.00) were merged into a single domain, health literacy. Our results supported the factorial validity of the 12-subdomain HLS-EU-Q with 46 items in women with breast cancer. It is recommended that the 12 subdomain scores be summed up to represent overall health literacy. The HLS-EU-Q with 46 items is recommended for use in capturing the diverse health literacy competencies of women with breast cancer in different health contexts.

TEACHER HEALTH LITERACY: WHY DOES IT MATTER?

It is obvious, that education is one of the main social factors having influence on health. Health education is most effective at school, because it reaches a man at his most receptive period of life - childhood and adolescence. A demand to live a healthy life is formed not only by family, but also by school. Teachers’ role in health education process is very significant, therefore, their health literacy and health competence are the main components realising health education at school. During the studies at university pre-service teachers in one way or another develop health competence, however hopefully not enough attention is paid to this, and study process poorly contributes to health literacy improvement, health competence formation.

Health literacy and current CD4 cell count in a multiethnic U.S. sample of adults living with HIV infection.

Hispanic and Black adults are disproportionately affected by HIV and experience poorer HIV-related health outcomes relative to non-Hispanic White adults. The current study adopted Sørensen's integrated model to test the hypothesis that lower functional and critical health literacy competencies contribute to poorer HIV-related health and CD4 cell count for Hispanic and Black individuals. Eighty-one non-Hispanic White, Hispanic, and Black HIV seropositive individuals from a large, Southwestern metropolitan area were administered measures of health literacy, including the Expanded Numeracy Scale, Newest Vital Sign, Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy (TOHFLA)-numeracy, and TOHFLA-reading. Hispanic and Black individuals demonstrated less HIV knowledge than non-Hispanic White individuals. Black participants demonstrated fewer health literacy appraisal skills. Importantly, lower levels of health literacy were linked to poorer CD4 cell count (an index of immune functioning) for Hispanic and Black individuals and not for non-Hispanic White individuals. These findings suggest race group differences for health literacy on current CD4 cell count such as very specific dimensions of low health literacy (e.g. poorer judgment of health-related information), but not other presumed deficits (e.g. motivation, access), play an important role in clinical health outcomes in HIV.

Assessing dentists’ human papillomavirus–related health literacy for oropharyngeal cancer prevention

BackgroundOropharyngeal cancers related to human papillomavirus (HPV) are on the rise. Dentists may be the next group of providers participating in the prevention of HPV. The aim of this study was to assess dentists’ health literacy regarding the connection of HPV and oropharyngeal cancer. MethodsThe authors conducted 4 focus groups with dentists (N = 33) during a regional dental conference in 2016. Guided by the health literacy competencies (that is, access, understand, appraise, and apply), the authors used constant comparison methods for data analysis. ResultsDentists mentioned a variety of informational sources (for example, dental journals and colleagues). Knowledge about the link between HPV and oropharyngeal cancer varied among participants. Participants appraised multiple patient and practice factors when deciding to have the discussion with patients. Some dentists discussed the HPV and oropharyngeal cancer connection with patients, and most conducted secondary screenings. ConclusionsFindings indicate areas for intervention, including creating awareness of trusted informational sources, as well as increasing HPV knowledge and understanding the multiple patient (for example, age) and practice (for example, open operatories) appraisal factors. Moreover, enhancing the communication skills of dentists with patients is needed to improve HPV-related cancer prevention education. Practical ImplicationsAddressing dentists’ HPV-related health literacy has the potential to improve dentists’ HPV-related prevention practices, including expanding patient education about this topic and increasing HPV vaccination knowledge, ultimately contributing to the reduction of oropharyngeal cancers.

Health Literacy Competencies for European Health Care Personnel.

Background:Health literacy as a concept is gaining importance in European countries, although it is still not adequately addressed among health personnel. Health literacy supports the self-management of patients in maintaining and improving health, which could decrease the burden on health systems in Europe. However, health professionals lack adequate knowledge about health literacy and the skills to promote health literacy among their patients.Objective:The Health Literacy Practices and Educational Competencies for Health Professionals (a health literacy training curriculum for health professionals) was recently developed in the United States, and the study presented here aimed to refine that assessment for health personnel in European settings.Methods:The modified Delphi method was used and data collected online via electronic communication to achieve consensus among an expert panel. The participants were a group of 20 health literacy and health care experts from 10 professional fields representing 13 European countries. The participants rated health literacy competencies on a four-point Likert scale and provided written feedback and recommendations. If a predetermined threshold of 70% or more of the participants agreed on the competency, the consensus was defined (similar to the criteria in the Health Literacy Practices and Educational Competencies for Health Professionals intervention).Key Results:After three rounds of ratings and modifications, consensus agreement was reached on 56 health literacy competencies (20 knowledge items, 25 skills items, 11 attitude items) and 38 practices. Eight items were removed from the original list and eight new items were added to the final list.Conclusions:This study is the first known attempt to develop a measurable list of health literacy competencies for health personnel in Europe. Further work is needed to develop educational curricula, standard national and regional guidelines, and questionnaires for the process of implementation to maximize health literacy responsiveness in health care organizations. [Health Literacy Research and Practice. 2017;1(4):e247–e256.]Plain Language Summary:The Health Literacy Practices and Educational Competencies for Health Professionals was recently developed in the United States. This study aimed to refine that assessment for health care professionals in Europe. The modified Delphi method was used and data collected online via electronic communication, and in the end, 56 health literacy competencies were included.

A Rohingya refugee’s journey in Australia and the barriers to accessing healthcare

Australia’s processing of some asylum seekers on offshore detention centres has recently been brought to light by human rights organisation. While the internal politics of resettling refugees may be complex,...

Chemotherapy safety standards: A pediatric perspective.

Chemotherapy safety standards: A pediatric perspective.

Validation of the instrument of health literacy competencies for Chinese-speaking health professionals.

The study aimed to illustrate the constructs and test the psychometric properties of an instrument of health literacy competencies (IOHLC) for health professionals. A multi-phase questionnaire development method was used to develop the scale. The categorization of the knowledge and practice domains achieved consensus through a modified Delphi process. To reduce the number of items, the 92-item IOHLC was psychometrically evaluated through internal consistency, Rasch modeling, and two-stage factor analysis. In total, 736 practitioners, including nurses, nurse practitioners, health educators, case managers, and dieticians completed the 92-item IOHLC online from May 2012 to January 2013. The final version of the IOHLC covered 9 knowledge items and 40 skill items containing 9 dimensions, with good model fit, and explaining 72% of total variance. All domains had acceptable internal consistency and discriminant validity. The tool in this study is the first to verify health literacy competencies rigorously. Moreover, through psychometric testing, the 49-item IOHLC demonstrates adequate reliability and validity. The IOHLC may serve as a reference for the theoretical and in-service training of Chinese-speaking individuals’ health literacy competencies.

Is Health Education at University Associated with Students' Health Literacy? Evidence from Cross-Sectional Study Applying HLS-EU-Q.

Background Despite the large number of studies assessing health literacy, little research has been conducted with young adults. Since health literacy is related to the setting in which health information is provided, our study aim was to measure health literacy competencies in a sample of university students and to evaluate the relationships between these competencies and their university health education. Methods A total of 912 university students (aged 18–24 years) completed the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Results Perceived difficulties with health information were related to gender, with male students reporting significantly lower health literacy scores. Studying more health education-related subjects was associated with a higher health literacy competency, due to these students' higher rates of accessing and understanding health information in the health promotion domain. Conclusion Health literacy among young adult university students is insufficient. The subjects they study are related to their university health education; in particular, the number of health-related subjects they study is positively related to students' health promotion domain-based competencies.

Building Health Literacy and Cultural Competency Through Video Recording Exercises

Video creation skills would allow pharmacists to create content tailored to their patients’ needs and include relevant aspects of cultural competency to achieve the goal of improved health literacy. Video recording exercises can provide students with an opportunity to build their drug knowledge and health literacy skills.
 Conflict of Interest
 None
 
 Type: Commentary

Health Literacy Competencies for Registered Nurses: An e-Delphi Study.

The Institute of Medicine's landmark report, Health Literacy: A Prescription to End Confusion, recommends that health professionals be trained to effectively communicate with patients with limited health literacy. Nurse-specific competencies that explicitly address the needs of patients with low health literacy are lacking. A national group of nurse health literacy experts (N = 41) participated in a three-round e-Delphi study to identify essential health literacy competencies for RNs in any work setting. Based on partial replication of prior work by Coleman, Hudson, and Maine, a final list of 50 nursing health literacy core competencies were identified in round two and prioritized in round three. The final list of prioritized competencies generated in this study have been provided as a starting point for health literacy education efforts in practice. J Contin Educ Nurs. 2016;47(12):558-565.

The Fall Season: A Time of Home, Holidays, and Health Literacy!

Health literacy is a priority issue, as the majority of American adults lack the skills needed to manage their health. Health literacy education and competencies should be incorporated throughout all nursing curricula, as nurses are uniquely positioned to enhance effective communication that is essential to patient safety and patient outcomes. J Contin Educ Nurs. 2016;47(10):440-442.

Health Literacy pada Mahasiswa Kesehatan, Sebuah Indikator Kompetensi Kesehatan yang Penting

Health literacy Competency is important for health students since they will be a role model for people to do healthy behavior and provide health services to the community. Previous research results in 2014 on students of Faculty of Health Sciences Dian Nuswantoro University showed 31.9% of respondents had low level of health literacy (inadequate and problematic).This research aims to design a program for intervening student health literacy. Data was collected by filling questionnaire, focused group discussion and developing SMS Gateway program. Population was second semester students of Undergraduate Program of Public Health, however the number of students who participated in this study was 82 student from three classes.The results showed low health literacy was experienced by 40.2% of respondents; it was higher than previous study because the number of respondents was bigger. In addition, there were 95.9% of respondents could not answer correctly questions of nutritional fact in NVS measurement. FGD results showed that respondents prefer to use social media and SMS Gateway to receive health messages. Health messages that they need were: reproductive health, nutrition, smoking, drugs, cosmetics, and diet. The recommendation is using social media such as Blackberry Messengers, Line, Instagram, Twitter to broadcast health messages besides SMS Gateway that has been developed. Keywords: health literacy, health student.

Complementary Medicine Health Literacy among a Population of Older Australians Living in Retirement Villages: A Mixed Methods Study.

Background. Older Australians are consumers of high levels of complementary medicines. The aim of this study was to examine health literacy in a population of older Australians related to their use of complementary medicine. Methods. A two-phase sequential mixed method design incorporating quantitative and qualitative methods was used in this study. The first phase consisted of a cross-sectional survey using a validated health literacy questionnaire and follow-up interviews with 11 residents of retirement villages. Interviews explored low scoring domains on the health literacy questionnaire. Results. Health literacy competencies scored higher for the domains of having sufficient information to manage their health; felt understood and supported by health care providers; actively managed their health; and having social support for health. Three health literacy domains scored low including appraisal of health information; ability to find good information; and navigating the health care system. The findings suggest that participants had different experiences navigating the health care system to access information and services relating to complementary medicines. Two themes of “trust” and “try and see” provide insight into how this group of older Australians appraised health information in relation to complementary medicines. Conclusions. With a focus on self-care there is a need for improved health literacy skills.

Developing a Method to Derive Indicative Health Literacy from Routine Socio-Demographic Data

Context: Low health literacy (HL) is a public health issue, with impacts on population health and illness, however there are few tools for collecting health literacy data in large populations. Objective: To develop a method of deriving indicative functional HL levels from routinely collected socio-demographic data. Method: We investigated which socio-demographic variables would best depict whether an individual is above or below a constructed HL competency threshold. Weighted logistic regression was used to estimate Odd Ratios for being below the threshold. Weighted Receiver Operating Characteristic (ROC) analysis examined which variables best predicted low HL. Specificity, sensitivity and area under (AU) the ROC were descriptors for ability to predict risk. Results: Three models were developed; one using all nine variables; a pragmatic model using the four most predictive variables (Qualification (whether the individual had achieved the level expected by age 16 years), Ethnicity, Home ownership, and Area Deprivation); and one using only “Qualification” (the single most predictive variable). All models showed good prediction of low HL (AUROC 0.73 (95% CI 0.71; 0.74) to 0.78 (95% CI 0.76; 0.79)), with predictive power increasing with more complex models. Conclusion: The most important predictor of low HL is achievement of the qualification level expected by age 16 years, with additional variables adding more predictive power. The developed formulae can be used to estimate functional HL levels in populations from routinely collected socio-demographic data, and hence facilitate effective development and targeting of public health communications. The method to derive the formulae will be applicable in other industrialized countries.