Health Literacy In Adults Research Articles

Evaluating the impact of loneliness and social isolation on health literacy and health-related factors in young adults.

In current study, we aim to extend previous research by investigating the unique impact of loneliness on health literacy and health-related factors of young adults, after controlling for social isolation, depressive symptomology, and social anxiety, as well as evaluate how social isolation and loneliness differ in their impact on health literacy, and health-related factors among young adults, after accounting for abovementioned concomitant variables. Using a cross-sectional study design, 521 young adults completed an online survey in 2020, where they self-reported their loneliness, social isolation, health-related factors, and health literacy data. Increased loneliness was associated with decrease in several health literacy domains (e.g., poorer social support for health, lower appraisal of health information, among others) and increase in some health-related factors (e.g., higher perceived stress, higher negative affect), among young adults, even after controlling for social anxiety, depressive symptomology, and social isolation. Contrastingly, increase in social isolation was associated with changes in some health-related factors - more somatic health complaints, higher alcohol use, poorer cognitive and physical functioning, and lower scores for only one health literacy domain (i.e., social support for health) among young adults, after adjusting for the influence of social anxiety, depressive symptomology, and loneliness. Even after accounting for the influence of several co-occurring social and mental health symptoms, higher loneliness was associated poorer health literacy and health-related factors in young adults. We also found loneliness and social isolation may differ in the mechanisms through which they impact health literacy and health-related factors in young adults.

Oral Health Literacy and Health Seeking Behavior of Older Adults in Rural Community

Objectives: This community-based cross-sectional study aimed to examine health information seeking behavior regarding oral health and oral health literacy and their relationship in older adults. Methods: The research was conducted with 432 participants from the rural area of, Noen Maprang District, Phitsanulok province, Northern Thailand. To measure oral health literacy, modified Short Test of Functional Health Literacy in Dentistry for Older Adults was used. The adapted questionnaire was used to collect health information seeking behavior in the past 3 months. Results: Only 12.3% demonstrated adequate oral health literacy. Some 27.1% presented active health information seeking behavior, 57.3% presented passive health information seeking behavior and 15.6% had never obtained or sought any oral health information. The association between health information seeking behavior and oral health literacy could not be observed. Television, health personnel, family members/relatives and village health volunteers were the most popular information sources. Conclusions: By adding oral health information and improving skills of oral health information for village health volunteers, it is possible to develop oral health literacy in older adults in rural areas.

The Multidimensionality of Low Health Literacy in Older Adults: A Scoping Review of International Studies.

This scoping review aims to map the dimensions encompassing the low health literacy (HL) of older adults, describing their respective causes and consequences. A three-step search strategy was conducted using 16 databases from nine portals and reference lists. Of the 4,259 identified studies, 2,845 were screened and 29 (1%) were included. Studies were published between 1999 and 2021, most of them in English (86.2%), from the American continent (48.3%) and with observational design (86.2%). Four dimensions encompassing the low HL of older adults were mapped: (1) patient dimension, (2) healthcare system dimension, (3) social/economic dimension, and (4) health condition dimension. This review highlights specific dimensions encompassing the low literacy in older adults with evidence about its causes and consequences. These results can guide future research and evidence-based practice involving HL of older adults.

Energy drinks consumption among construction workers in Indonesia and associated factors

Younger and adults tend to consume energy drinks due to the benefit received as promoted by the manufacturer. This retrospective, cross-sectional study aimed to investigate factors associated with energy-drink consumption in a group of construction workers in Indonesia. Literate construction workers who have consumed any brand of energy drink at least once per week were recruited. Demographic data and health literacy were self-reported. The short version of the test functional health literacy for adults (S-TOFHLA) tool was used to examine health literacy. Kidney function was determined by an estimated glomerulus filtration rate (EGFR). An average EGFR of 83.76 mL/min/1.73 m2 was retrieved from 114 participants. Health literacy (p=.016), pre-existing disease (p=.001), and intensity (p=.029) showed a significant difference with decreased kidney function. Age of the first-time experiencing energy drinks (r=-0.260) and pre-existing disease (r=-0.282) showed negative significance correlations (p=<.001) with kidney function. A family history of comorbidity (ß=-0.213), (p=.023), 95% CI (-6.697－-1.286), was a predictor of lowering kidney function among construction workers with extended ingestion of energy drinks. This study emphasizes the importance of elevating public awareness of possible dangers caused by extending the ingestion of energy drinks on the kidney.

Health literacy and health behaviors of Guinean university students residing in Brazil.

To evaluate the health literacy and health behaviors of Guinean university students residing in Brazil. A cross-sectional, analytical study conducted with 51 Guinean university students residing in Brazil. A health behavior questionnaire and the Test of Functional Health Literacy in Adults - Short version were applied. Spearman correlation coefficient, U of Mann-Whitney and Kruskal-Wallis were calculated. Health literacy was adequate (median=79; IQR=24). Reading comprehension (median=70; IQR=16) of health information was better than numerical comprehension (median=14; IQR=14). Better health literacy performance was found in those with daily screen time of 3 to 5 hours (p=0.004) and who consumed fatty meat (p=0.002). Adequate health literacy of Guinean university students was associated with mostly healthy behaviors, except for screen time and consumption of fatty meat.

Health Literacy predicts incident foot ulcers after 4 years – the SHELLED cohort study

Aims/hypothesisTo determine whether health literacy is associated with an index diabetes-related foot ulcer (DFU).MethodsThe SHELLED Study is a 4-year prospective study of people with diabetes aged over 40 with no history of DFU. The primary outcome was development of a first foot ulcer. Health Literacy was measured using the short form Test of Functional Health Literacy in Adults (s-TOFHLA) and nine domains of the Health Literacy Questionnaire (HLQ).ResultsOf 222 participants, 191 (86.0%) completed the study, of whom 13 (5.9%) developed an incident ulcer. In multivariable models, every unit increase in S-TOFHLA was associated with a reduced odds of foot ulcer development by 6% (OR 0.94, 95% CI 0.88 to 0.99). Better scores on two HLQ domains reduced the odds of foot ulcer (actively managing my health (OR 0.23, 95% CI 0.08 to 0.65) and understanding health information well enough to know what to do (OR 0.39, 95% CI 0.19 to 0.78). This was independent of baseline risk for foot disease.Conclusions/interpretationThese data provide novel evidence that health literacy is an important clinical risk factor for index foot ulceration. This is an area of potential focus for research and development of educational programs or policy aimed at reducing development of incident foot ulceration.

Evaluation of Health Literacy Levels and Associated Factors Among Patients with Acute Coronary Syndrome and Heart Failure in Qatar.

To determine the prevalence of inadequate health literacy and its associated risk factors among patients with acute coronary syndrome (ACS) and/or heart failure (HF) in Qatar. This cross-sectional observational study was conducted among patients with ACS and/or HF attending the national Heart Hospital in Qatar. Health literacy was assessed using the abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Three-item Brief Health Literacy Screen (3-item BHLS). Three hundred patients with ACS and/or HF, majority male (88%) and non-Qatari (94%), participated in the study. The median (IQR) age of the participants was 55 (11) years. The prevalence of inadequate to marginal health literacy ranged between 36% and 54%. There were statistically significant differences in health literacy level between patients based on their marital status (p=0.010), education (p≤0.001), ability to speak any of Arabic, English, Hindi, Urdu, Malayalam, or other languages (p-values ≤0.001 to 0.035), country of origin (p≤0.001), occupation (p≤0.001), and receiving information from a pharmacist (p=0.008), a physiotherapist (p≤0.001), or a nurse (p=0.004). Inadequate health literacy is common among patients with ACS and/or HF. This study suggests a need for developing strategies to assist healthcare professionals in improving health literacy skills among patients with ACS and HF. A combination of interventions may be needed to improve patients' understanding of their disease and medications, and ultimately overall health outcomes.

Associations between health literacy, digital skill, and eHealth literacy among older Chinese adults: A cross-sectional study.

Digital divide in health-related technology use is a prominent issue for older adults. Improving eHealth literacy may be an important solution to this problem. This study aimed to explore the associations between health literacy, digital skills, and eHealth literacy among older Chinese adults. A total of 2,144 older adults (mean age, 72.01 ± 6.96 years) from Jinan City, China participated in this study. The eHealth Literacy Scale was used to measure eHealth literacy in older adults. A linear regression model was used to analyze the associations among health literacy, digital skills, and eHealth literacy in older Chinese adults. The mean eHealth literacy score of the older adults was 17.56 ± 9.61. After adjusting for sociodemographic characteristics and experience of Internet usage, the results of the linear regression showed that health literacy (B = 0.258, 95% confidence interval (CI) = 0.215-0.302, P< 0.001) and digital skills (B = 0.654, 95% CI = 0.587-0.720, P < 0.001) were positively associated with eHealth literacy. Sensitivity analyses revealed that this association remained robust. The level of eHealth literacy in older Chinese adults is low. Health literacy and digital skills are associated with eHealth literacy in older adults. In the future, eHealth literacy intervention research should be considered from the perspective of health literacy and digital skills.

The Relationships Among Health Literacy, Patient Activation, and Self-Care Behaviors in Adults With Heart Failure: A Cross Sectional Study

Despite current efforts, adherence to heart failure (HF) selfcare remains suboptimal. There is a need to identify modifiable factors that promote self-care adherence. Evidence suggests that patient activation and health literacy (HL) are modifiable and may be useful for improving HF self-care. However, more research is needed to understand the influences of these variables on HF self-care. The aim of this study was to examine the relationships between patient activation, health literacy, and self-care adherence in a diverse group of adults with HF. This study used a correlational, cross-sectional design. Correlation and regression tests were used to analyze associations among variables. Stratified random sampling was applied to attain a study sample that was 50% persons of color (POC). Of the 174 participants, 51% were female and 48.5% were POC with a mean age of 62 years. There was no significant relationship between HL and HF self-care adherence. There was a small, positive correlation between HL and dichotomized high/low activation levels ( r = .163; p &lt; .05). There was a small, positive correlation between patient activation and HF self-care behaviors ( r = .151; p &lt; .05). However, regression tests showed patient activation was not a predictor of selfcare ( B = 0.173, p = .064). Persons with HF may perform self-care activities when highly activated, regardless of HL status. Patient activation was not a reliable predictor of self-care adherence. More research is needed to elucidate the influence of patient activation and HL on HF self-care behaviors.

Exploring Older Adult Health Literacy in the Day-to-Day Management of Polypharmacy and Making Decisions About Deprescribing: A Mixed Methods Study.

Polypharmacy use in older adults is increasing and sometimes leads to poor health outcomes. The influence of health literacy in managing polypharmacy and making decisions about stopping medication has received limited attention. A mixed methods design was used to measure and investigate the influence of health literacy in the management of polypharmacy and decisions about deprescribing. Phase 1 involved two cross-sectional surveys, one with older adults using five or more medications and the other with general practitioners (GPs). Older adult health literacy was measured using the All Aspects of Health Literacy Scale. Phase 2 employed individual interviews with both older adults and GPs and further explored the reported use of health literacy in practice. SPSS version 24 was used to conduct descriptive statistical analysis of the Phase 1 survey responses and Phase 2 interviews were analyzed using thematic analysis with the assistance of NVivo 12. Phase 1 survey responses were received from 85 GPs and 137 older adults. Phase 2 interviews were conducted with 16 GPs and 25 older adults. Phase 1 results indicated that self-reported older adult health literacy was high, and that GPs believed older patients could engage in decisions about deprescribing. Phase 2 findings showed that older adults developed and employed complex health literacy practices to manage medications between consultations; however, few reported using their health literacy skills in consultations with their GPs. GPs noted that older adult involvement in decision-making varied and generally thought that older adults had low health literacy. Older adults reported using health literacy practices in the management of their sometimes-complex medication regimens. However, the role of health literacy in deprescribing decision-making was limited. The mixed methods approach allowed greater insight into older adult and GP practices that influence the acquisition and use of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(1):e14-e25.] Plain Language Summary: This report explores health literacy in the use of multiple medications and decisions to stop using medication/s in older age. Older adults reported good heath literacy and practiced many health literacy skills in the management of their medications. However, they did not always report the use of their health literacy skills when discussing their medications with their family doctor.

Parental oral health literacy influences preschool children's utilization of dental services.

Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

The association between Electronic Health Literacy and Self-care Management in Adults with Type-2 Diabetes

Purpose: E-health illiteracy has disadvantages including misevaluation of medical information displayed on the internet. Both effective self care management and e-health literacy are important terms in order to control of the chronic diseases. The aim of this study is to determine the relationship between e-health literacy and the self-care management of patients with Type-2 diabetes. Materials and Methods: The type of the study is descriptive. A questionnaire was applied to individuals who have been diagnosed with Type-2 diabetes in the endocrine policlinic of the internal medicine clinic of a tertiary state hospital in Istanbul, Turkey. The sample size was calculated as 384 by accepting the adequate e-health literacy rate among Type-2 diabetes patients as 50%, the margin of error 5%, and the confidence level as 95%. In addition to sociodemographical questions; our questionnaire contains two scales: Self-Care Management Protection scale and the E-health Literacy Scale. Number (n) and percentage (%) values were used in the expression of descriptive data. Mean, standard deviation, median and minimum, maximum values were given. For data comparison; Mann-Whitney U test was used for non-normally distributed variables. The Spearman correlation used to measure the linear relation between two numeric variables. Significance level has been accepted as p&lt;0.05. Results: Totally 330 patients were included our study by a participation rate of 85.9 %. The mean age of the participants was 57.74±13.83 and 52.4% were female. A positive correlation was observed between scores of e-health literacy scale and self-care management scale (r=0.235, p&lt;0.001) and self- protection subscale of self-care management scale (r= 0.345, p&lt;0.001). A negative correlation exists between age and e-health literacy (r= -0.419, p&lt;0.001). Conclusions: The results support the claim that individuals with a higher e-health literacy can better able to control their disease through self- management.

The development and validation of Chinese Health Literacy Scale (CHLS) for older people

ObjectivesWe tried to develop a more concise health literacy scale for Chinese older adults. MethodsA draft scale based on the Health Literacy Questionnaire (HLQ) was developed, and revised by experts. We conducted a pilot study to test the readability and establish a standard inquiry method within 10 residents. We tested the validity and internal consistency using a field test with 3,739 participants. ResultsOverall standardized Cronbach's α of Chinese Health Literacy Scale (CHLS) was 0.86 and that of each dimension ranged from 0.69 to 0.81. Nearly all dimensions had satisfactory factor loadings (0.33-0.98). The correlation coefficient between the score of each item and its dimension ranged from 0.59 to 0.92. ConclusionsThe performance of CHLS was almost the same as the HLQ but more concise. It might play a role in reflecting the health literacy of older adults in China and further promoting their health.

EXPLORING HEALTHCARE WORKERS' GERIATRIC EDUCATION AND SUBSEQUENT COMMUNICATION WITH OLDER ADULTS

Abstract Research shows that older adults are living longer than ever, are the fastest growing population, and can have increasingly complex health-related issues. However, the health knowledge and literacy of older adults can be limited, and these adults may have difficulty understanding the terminology that healthcare workers use to communicate with them about their health. For impoverished older adults especially, this can contribute to poor health decisions and decreased care. Given this, educating healthcare practitioners to communicate effectively with older adults becomes essential to older patients’ quality of care. Using predominantly North American studies of healthcare workers’ practices, education, and their interactions with older adults (aged 65-85, primarily), this review paper finds that: i) older adults are responsible for their communication with healthcare workers, but practitioners, because of their implied authority, control the narrative, and therefore it is necessary for them to become more educated in communicating with older adults; ii) some current communication practices by healthcare workers (with older adults) are not reflective of sufficient care; and iii) new gerontology education can foster increased empathy and shared communication practices among healthcare workers, and this can aid patients to better control and have confidence in their healthcare decisions. Social and cultural factors that may explain the health literacy divide in older adults are discussed, as are recommendations and best practices for healthcare workers working with older adults.

Investigating the structural validity and reliability of the sexual health literacy for adults (SHELA) questionnaire among a sample of women in Qazvin, Iran

BackgroundThe correct measurement of sexual health literacy requires an instrument with desirable psychometric properties and fitness to the sociocultural context. Despite acceptable psychometric properties of the sexual health literacy for adults questionnaire in the mixed population of men and women, the validity and reliability of this questionnaire in the female population were not determined. Therefore, considering differences in the study population, this study aimed to determine the structural validity and reliability of the questionnaire among women.MethodsThe present study was a methodological and psychometric study of instruments conducted among 310 women referring to healthcare centers in Qazvin, Iran in 2020. Sampling was done using a one-step cluster method. We used Cronbach's alpha coefficient, Pearson correlation coefficient, and confirmatory and exploratory factor analyses to determine the reliability, convergence validity, and construct validity of the questionnaire respectively. Also, the Sexual Quality of Life-Female questionnaire (SQOL-F) and the Female Sexual Function Index (FSFI) were used to evaluate the convergence validity. Data were analyzed using SPSS 20, and STATA 13.ResultsExploratory factor analysis identified three factors including, “reading and understanding”, “evaluation and application of information”, and “skills of access” which together accounted for 70.85% of the whole variance. Based on the results of confirmatory factor analysis, this questionnaire had overall goodness of fit too. (RMSEA = 0.071, CFI = 0.928, TLI = 0.919, SRMR = 0.041, X2/df = 2.501). Convergent validity of the questionnaire showed a correlation of 0.121–0.243 between the questionnaire's dimensions with the FSFI and the SQOL-F questionnaires respectively. Also, the results showed that the questionnaire had proper internal consistency (Cronbach’s alpha was 0.981) for measuring sexual health literacy in women.ConclusionsThe 39-item sexual health literacy assessment questionnaire consisting of 3 factors in the present study was endowed with sufficient validity and reliability, and it can be used for precisely assessing women’s sexual health literacy.

Insight into global research on health literacy and heart diseases: A bibliometric analysis.

Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.

The Nutrition Literacy Assessment Instrument for Brazilians, NLit-Br: An Exploratory Cross-Cultural Validity Study.

This study aimed to test the validity of the cross-cultural adapted Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). An observational cross-sectional study was performed in chronic disease clinics from the Brazilian Public Health System in two phases: (1) linguistic and cultural adaptation and (2) validity testing. Six registered dietitians and thirty adult patients diagnosed with at least one chronic disease participated in the study using the nutrition literacy assessment instrument (NLit-Br) and the short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18). Sample descriptive variables: age, sex, race, income, education, and occupation. To adapt the instrument to the Brazilian Portuguese and Brazilian culture, we tested cognitive interviewing and the Scale Content Validity Index (S-CVI) with a group of dietitians and patients. To test the tool's validity, health literacy (SAHLPA-18) was used as a construct that presents similarities and differences with nutrition literacy (NLit-Br). The correlation of NLit-Br and the SAHLPA-18 was tested (Spearman's Rho). Internal consistency was measured by Kuder-Richardson Formula 20 (KR-20). The NLit-Br content validity (S-CVI = 0.85) and internal consistency (KR-20 = 0.868) were confirmed. Additionally, NLit-Br presented a significant and robust correlation with SAHLPA-18 (r = 0.665, p &lt; 0.001). Therefore, the NLit-Br was considered a linguistic, cultural, and valid instrument to measure Brazilian's nutrition literacy.

Association between ecological footprint awareness and health literacy in adults: a population-based study from Turkey

ABSTRACT This study aimed to determine the relationship between health literacy and ecological footprint which is an indicator of sustainability and environmental impact and to examine the factors that may affect them. It was found that 20.3% of individuals have inadequate, 43.7% problematic, 26.1% sufficient and 10.0% excellent health literacy levels. There were differences in age, education level and BMI classification according to Ecological Footprint Awareness Scale score quartiles and health literacy levels (p < 0.05). It was determined that age and Turkey Health Literacy Scale score had effect on ecological footprint awareness. Individuals with a high level of health literacy have a high awareness of their ecological footprint. The increase in people’s health literacy levels and ecological footprint awareness with age can be interpreted as the increase in people’s education and knowledge levels and their awareness levels against the protection of nature and the environment.

Association between Level of Parental Oral Health Literacy and the Rational Use of Fluoride for Children from 0 to 4 Years of Age after Instruction: An Intervention Trial

An inadequate level of oral health literacy (OHL) can hinder the understanding of dental information, which can have a negative impact on health promotion actions, such as the rational use of fluoride. The aims of the present study were (1) to look for association between parents/guardians’ OHL and the amount of fluoride toothpaste used for children from zero to four years of age; (2) to compare the effect of different modes of educational interventions on the amount of fluoride toothpaste used for children from zero to four years of age; and (3) to assess the ability of parents/guardians to choose a toothpaste with adequate fluoride concentration, after the educational intervention. A randomized intervention study was conducted with parents/guardians of children from zero to four years of age (n = 145). The participants answered the Oral Health Literacy Adults Questionnaire and a questionnaire addressing sociodemographic characteristics. The participants were allocated to four intervention groups based on type of counseling (written, oral, written + photograph, and oral + photograph), with randomization stratified by level of OHL. The participants were instructed to place the adequate amount of toothpaste on a toothbrush for children from zero to four years of age (smear of 0.125 mg) before and after the intervention. The correct choice of toothpaste was also evaluated by the interpretation of the labels of four toothpastes of different brands and with different concentrations of fluoride. Associations between variables were tested using the Student’s t test and one-way ANOVA. Level of OHL was associated with the amount of fluoride toothpaste deposited prior to the educational intervention (p = 0.021) and the percentage of approximation to the appropriate amount of fluoride toothpaste (p < 0.05). The choice of toothpaste was associated with schooling (p = 0.031). In conclusion, parents/guardians with adequate OHL better quantified fluoride toothpaste before and after the educational intervention and also came closer to the appropriate amount of toothpaste after the educational intervention. No significant differences in the final amount of toothpaste placed on the toothbrush were found among the intervention groups. The choice of the correct toothpaste was associated with a higher level of schooling.

Association between health literacy and medication adherence in chronic diseases: a recent systematic review.

Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.