Individual Health Literacy Research Articles

The Role of Health Literacy in Multiple Sclerosis: A Systematic Review

Introduction: Health literacy is an essential indicator of health care habits and consequences. Health literacy and having the right information is effective in better managing symptoms and problems and improving the overall quality of life. This systematic review aimed to analyze previous studies and collect information on multiple sclerosis patients' health literacy.Material and Methods: The PRISMA guidelines were used to define the systematic review methods. PubMed, Cochrane, Web of Science, Scopus, ScienceDirect Journal, ProQuest, Wiley Online Library, SID, and Magiran databases were searched on 14 January 2022, without restrictions in publication time. We also searched Google Scholar and Research Proposal Information System. Two independent reviewers reviewed the papers' eligibility and extract data into a spreadsheet using a structured form.Results: Of the 165 articles retrieved, 14 were eventually included in the study. All of the studies’ audiences and targets were MS patients and their families or caregivers. Four studies examined the level of health literacy of individuals. Other objectives included determining variables affecting the relationship between patients' health literacy and behaviors, comparing the effects of lecture-based teaching and peer group experience on improving patients' health literacy, and determining psychometric characteristics of the MS patient’s health literacy questionnaire. Studies assessing people's health literacy revealed that most people have an adequate or acceptable health literacy level.Conclusion: Improving the level of health literacy is one of the fundamental ways to improve the physical and mental health of MS patients to increase compliance and self-care and medication adherence. Accordingly, policymakers need to work on designing effective programs to develop health literacy and overcome the challenges associated with it.

The Effects of Financial Attitudes, Financial Literacy and Health Literacy on Sustainable Financial Retirement Planning: The Moderating Role of the Financial Advisor

Financial planning for retirement is essential to ensure that people have enough money to live the lifestyle they desire when they retire. Self-employed business owners in developed countries widely do financial retirement planning. However, in Malaysia, the percentage of self-employed individuals concerned about financial retirement planning is lower than in other countries. This study aims to identify the relationship between the financial attitude, financial literacy and health literacy of self-employed individuals toward sustainable financial retirement planning in Malaysia and find out the moderating effect of the role of financial advisors. The study utilized structural equation modelling. Data were collected through a survey questionnaire and analyzed using SMART PLS 3.3. The total sample size was 416 self-employed individuals from the northern Malaysian region. The findings revealed that financial attitude and financial literacy significantly impact retirement planning. Moreover, the role of financial advisors moderates the relationship between financial attitude–financial retirement planning and financial literacy–financial retirement planning. The result of the study will fulfil the needs of self-employed individuals to plan their retirement by including the financial planning determinants needed for a well-planned retirement.

Planetary health literacy: A conceptual model.

Education for planetary health could be one of the key levers of the much-needed civilizational turn toward a sustainable and healthy future. Education goes beyond information provision and passing on of knowledge and includes competencies to transfer knowledge from one decision situation to another. There are a range of different literacy concepts from various research perspectives that aim to improve such competencies. While many contain aspects highly relevant for planetary health, there is still no comprehensive and integrative planetary health approach. To fill this research gap, we present a conceptual model of planetary health literacy. By zooming into the model, further details on the necessary core competencies of accessing, understanding, appraising, and applying information in order to make judgements and take decisions regarding planetary health can be found. Zooming out of the model allows a holistic planetary health perspective and shows the potential and opportunities of planetary health literacy for the health of humans and ecosystems. Planetary health literacy encompasses both a life-course and a transgenerational approach, at the individual, societal, and global level. Future educational programs focusing on planetary health could integrate the conceptual model to increase planetary health literacy of individuals, including relevant health literacy agents, and of societies.

Health Literacy in Children and Adolescents: A Review of the State of the Art

Health literacy has been defined as the ability of people to access quality health information and apply it, making appropriate decisions in the process of health and a correct use of health services. Despite the large body of literature produced since the first studies of this topic on the adult population, there is less scientific documentation regarding children and adolescents. The research team conducted a literature review of health literacy in children and adolescents; as well as the role of digital health literacy and other divides in the health status of this specific group of the population. The results of the literature review showed that health literacy is crucial to obtain a good physical, emotional and cognitive development. It is also related with the acquisition of healthy behaviors and lifestyles. The level of health literacy depends on many factors such as personal health status, the existence of health problems or diseases; as well as socio-economic status, cultural, social, and demographic determinants of health, among other variables. These aspects at the family level, friends, and school life, moreover, influence children and adolescents. In this group of the population, health status and healthy lifestyles are not only influenced by the level of individual (or parental) health literacy, but also by the social context in which the child or youth is immersed. In addition, these variables related to socio-economic and cultural factors are associated with the existence of gaps or divides in certain groups. In this scenario, an adequate conceptualization of health literacy during childhood and adolescence is necessary when designing appropriate interventions and policies for this group of the population. In order to achieve this, it is necessary to define what we mean by health literacy and how we are going to measure it. In summary, it is important not to focus only on an individual perspective; on the contrary, it is necessary to understand health literacy in the context where children and youth live and develop, as well as their interactions with the health, educational and social system. Further research is needed to explore more in depth the importance of health literacy in children and adolescence.

The Relationship between Health Literacy and COVID-19 Vaccination Prevalence during a Rapidly Evolving Pandemic and Infodemic.

The gap between how health information is communicated and what people understand and can use to make informed health decisions is called health literacy. This gap was exacerbated by the rapidly changing and excessive volume of information, misinformation, and disinformation during the COVID-19 pandemic. People with lower health literacy may not have understood the importance of COVID-19 vaccination for themselves or for their communities. Our aim was to understand health literacy levels within Fulton County, Georgia, and their relationship to vaccine prevalence. Fulton county residents ages 18 and over (n = 425) completed an on-line Health Literacy Questionnaire. Individual, organizational, functional, interactive, and critical health literacy scales were created. Vaccination prevalence data were collected from the Georgia Vaccine Distribution Dashboard. All data were divided into one of three county areas. There were statistically significant variations in vaccine prevalence χ2(3) = 29.325, p < 0.001 among the three county areas. All levels of health literacy predicted overall county vaccination prevalence F (4,420) = 85.941, p < 0.001, There were significant differences in health literacy levels among two of the three county area pairs; the lowest resourced county area had the lowest vaccination prevalence and health literacy rates. This is the first example of relating direct health literacy measures across a major metropolitan US county with vaccine prevalence data.

The Digital Transformation in Healthcare

A digital transformation is taking place in healthcare, especially since the Covid-19-pandemic which stands for the intersectoral networking and empowerment of people. E‑health, meaning the use of digital technologies in healthcare, induces many benefits such as increased individual health literacy. However, they are confronted with various challenges such as the risk of violating personal rights. This basic article is dedicated to the term e‑health and introduces the relevant actors of the healthcare system. Further it discusses selected benefits as well as challenges and presents relevant technical prerequisites for the implementation and use of e‑health technologies. A conclusion ends the article.

Do Patients Understand Radiation Therapy? Radiation Oncology Knowledge Assessment and Health Literacy among Culturally Diverse Breast Cancer Patients at a Safety-Net Hospital

<h3>Purpose/Objective(s)</h3> Comprehensive understanding of oncologic treatment is essential for shared decision-making and has been shown to improve health outcomes and quality of life in patients with breast cancer. However, comprehension and retention of information in radiation oncology consults is poorly understood, particularly among Spanish-speaking patients at safety net hospitals. The purpose of this study was to examine post-consultation radiation oncology knowledge and health literacy among culturally diverse breast cancer patients. <h3>Materials/Methods</h3> After consultation for curative breast radiotherapy (cT1-4N1-3M0), the Radiation Oncology Knowledge Assessment Survey (ROKAS) was administered to Spanish- and English-speaking patients ≥ 18 years old, from January 2021 to January 2022 at a safety-net hospital. Radiation knowledge was assessed using the ROKAS and included items involving the site and purpose of treatment, logistics of simulation, number of fractions, and short and long-term side effects. Additional independent variables included validated questionnaires related to health literacy, health numeracy (numerical medical concepts), acculturation (assimilation to the dominant culture), and socioeconomic factors. Items regarding satisfaction with consultation, language interpretation, and understanding treatment were also included in the survey. Bivariate Pearson correlations were conducted to examine the relationship between the independent variables and post-consultation radiation knowledge. <h3>Results</h3> Fifty ROKAS were obtained from 25 Spanish- and 25 English-speaking breast cancer patients (median age 57 [IQR 49.75-62.25]). While 92% of Spanish-speaking and 96% of English-speaking patients agreed or strongly agreed with satisfaction with consultation, language interpretation, and understanding treatment (p=0.60), radiation knowledge questions were frequently missed. The most missed radiation knowledge items included the long-term side effects of arm swelling (n=40); skin (n=30), heart (n=19), and lung (n=13) toxicities; fractionation number (n=14); and the location of where radiation kills cancer cells (n=13). Post-consultation radiation knowledge was positively correlated with higher health literacy (p=0.048), acculturation (p=0.014), and health numeracy (p=0.027), as well as English-language preference (p=0.024) and a higher education level (p=0.023). <h3>Conclusion</h3> Post-consult radiation knowledge was significantly associated with health literacy, health numeracy, and acculturation among breast cancer patients. As such, providing patients with comprehensible medical information while accounting for individual health literacy, is crucial to improve shared decision making between patients and providers in a culturally diverse population.

Measurement and Decomposition of the Health Poverty of Rural Residents in China.

Narrowing the health gap and promoting health equality is the key to effectively blocking the intergenerational transmission of rural poverty. Previous studies have mainly focused on the relationship between health and poverty, but assessments of health poverty are lacking, especially with regard to the health poverty of rural residents. Based on China’s large sample household survey data, this study uses the Alkire–Foster (AF) method to measure and decompose the health poverty of rural residents. The results show that the health poverty of Chinese rural residents greatly improved from 2016 to 2018. However, significant regional differences exist with regard to the level of health poverty. The marginal contribution of economic poverty alleviation is diminishing; the equalization of health services and security has shifted to a policy focus. Community environmental management has also become an important aspect of health poverty governance, and individual health literacy and behavior have played an important role in endogenous poverty alleviation. Ultimately, this paper offers some insightful policy implications. This study extends the multidimensional poverty measurement system and reveals the relationship between health poverty and regional economic and social development. The findings also enhance the understanding of the health poverty of rural residents in developing countries.

How to co-design a health literacy-informed intervention based on a needs assessment study in chronic obstructive pulmonary disease

ObjectiveTo develop a co-designed health literacy (HL)-informed intervention for people with chronic obstructive pulmonary disease (COPD) that enables them to find, understand, remember, use and communicate the health information needed...

Coronavirus-19 phobia and health literacy in adults: A descriptive-correlational study

Aim: The aim of this study was to determine the levels of health literacy (HL) and COVID-19 Phobia (C19P-S) in adult individuals and was to evaluate the relationship between health literacy and coronavirus-19 phobia among adults. Materials and methods: The sample of this descriptive and correlational study consisted of 545 people living in Kahramanmaras city center and meeting the study criteria. Study data were collected through google forms using personal information form, Health Literacy Scale and Coronavirus-19 Phobia Scale (C19P-S). Results: The mean C19P-S score of the participants was 30±16.33. A statistically significant difference was determined between the mean C19P-S scores of women and men (p<0.05). It was determined that those with a middle income level, those who reported that they took adequate precautions to protect against coronavirus and those who did not receive health education had higher C19P-S score averages. According to the correlation analysis, there is no relationship between the health literacy total score and C19P-S [r(545)=-0.054; p>0.05]. There was a weak negative statistically significant correlation between the somatic sub-dimension of C19P-S and health literacy total score, access, understanding, and appraisal sub-dimensions (p<0.05). Conclusion: HL adult population was generally high and the coronavirus phobia was moderate. Addressing HL as a variable may be beneficial in the management of coronavirus phobia.

Turkish Sign Language Adaptation of the Turkish Health Literacy Scale-32.

Sign language speakers are at a disadvantage in terms of health literacy due to the lack of health education materials in sign languages. Deaf and hard of hearing (DHH) individuals are excluded from health literacy research due to the lack of measurement tools in their language of excellent fluency. This study aims to provide the literature with a tool that allows the measurement of health literacy among DHH individuals. The Turkish Health Literacy Scale (THLS)-32 was translated into Turkish Sign Language (TSL). After the THLS-32 was translated into TSL in video format, it was tested for validity and reliability. The translated version of the scale was administered to participants from a DHH association in Turkey who are fluent in TSL. Subsequently, a study was conducted with 207 DHH individuals. The study group was assessed in terms of their mean index scores and evaluated to have "limited health literacy" according to the THLS-32 classification. We conclude that the THLS-32 in TSL is suitable to measure health literacy in DHH individuals and to assess the impact of the health education system.

Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis

ObjectiveTo investigate gender differences of health literacy in individuals with a migration background.DesignSystematic review and meta-analysis. OVID/MEDLINE, PsycINFO and CINAHL were searched in March 2018 and July 2020.SettingStudies had to...

Tools zur Stärkung der organisationalen Gesundheitskompetenz in Einrichtungen der Gesundheitsversorgung

BackgroundThe National Action Plan to Improve Health Literacy calls for user-friendly and health-competent development of health care at all levels. After the first years of focusing on individual health literacy, the focus is increasingly on organizational health literacy. Organizational health literacy addresses different standards (e. g., management, communication, staff, users or patients) and levels in the organization (i.e., organizational, staff and user level). Numerous tools already exist to strengthen health literacy in hospitals. However, previous studies have rarely focused on a differentiated overview of tools to strengthen organizational health literacy by health literacy standards and differentiated by level of organization, staff and users. The article has two goals, one of which is to search for and review existing tools to strengthen organizational health literacy in health care institutions. In addition, selected tools for strengthening organizational health literacy for health care institutions, differentiated according to the eight fields of action and the three organizational levels (i.e., institution, staff, users), will be presented. MethodA search was carried out to identify tools on strengthening health literacy in facilities of health care. All the tools identified were reviewed, selected according to previously defined inclusion and exclusion criteria and assigned to the level (institution, employees or patients/clients and their relatives) as well as the eight fields of action of organizational health literacy. ResultsWe found a total of N=191 tools for health care facilities. After taking into account the inclusion and exclusion criteria, a total of n=60 tools were selected and differentiated according to the level and standard of organizational health literacy. Some of these tools could be assigned to more than one field of action. Most tools (n=37) were found for Standard 5 “Health-competent communication users”, while the lowest number of tools were identified for Standard 7 “Promoting the health literacy of employees” (n=4). Differentiation by level (i. e., organizational, staff, patients or clients) shows that there is a smaller number of tools for employees (n=43) compared to the level of the organization (n=76) or users (n=65). DiscussionOverall, the study shows that numerous tools already exist to strengthen organizational health literacy for hospitals, in particular, and for health care settings, in general. In the future, however, it will be necessary to develop and test tools for individual standards of health literate organizations in health care facilities. Further, internationally provided and tested tools have to be adapted and piloted for the German-speaking countries and health care settings in order to address the health literacy of staff, users and their relatives in a sustainable manner. ConclusionThe development of health literate settings requires effort from health care organizations. Thus, tools for strengthening organizational health literacy should be provided and implemented by also focusing on the level of organization, staff and users so that the individual health literacy of users can be addressed and improved in the long-run.

Cognition, educational attainment and diabetes distress predict poor health literacy in diabetes: A cross-sectional analysis of the SHELLED study.

ObjectivesTo identify factors that predict poor health literacy amongst people with diabetes.DesignCross-sectional analysis of baseline data from a prospective study of diabetic foot disease.SettingPatients attending a tertiary hospital diabetes outpatient clinic in Tasmania, Australia.Participants222 people with diabetes mellitus, aged >40 years, with no history of foot ulceration, psychotic disorders or dementia.Outcome measuresHealth literacy was measured using the short form Test of Functional Health Literacy in Adults (functional health literacy), and the Health Literacy Questionnaire (HLQ), which measures nine domains of health literacy. Predictors included demographic characteristics, cognition, diabetes distress, depression, and educational attainment.ResultsIn multivariable analysis, greater educational attainment (OR 0.88, 95% CI 0.76, 0.99) and poorer cognition (OR 0.71, 95% CI 0.63, 0.79) were associated with poorer functional health literacy. Age was negatively associated with domains of appraisal of health information and ability to find good health information (both beta = -0.01). Educational attainment was positively associated with four domains, namely having sufficient information to manage my health, actively managing my health, appraisal of and ability to find good health information (beta ranging from +0.03 to 0.04). Diabetes distress was negatively associated with five domains: having sufficient information to manage my health, social support for health, ability to actively engage with healthcare providers, navigating the healthcare system and ability to find good health information (beta ranging from -0.14 to -0.18).ConclusionPoorer cognition and poorer educational attainment may be detrimental for an individual’s functional health literacy, and education, diabetes distress and older age detrimental across multiple health literacy domains. Clinicians and policy makers should be attuned to these factors when communicating with people with diabetes and in designing healthcare systems to be more health-literacy friendly in order to improve diabetes outcomes.

Organizational Health Literacy in the Context of Employee Health: An Expert-Panel-Guided Scoping Review Protocol.

Health literacy (HL) is an interplay of individual and organizational health literacy (OHL). While individual HL has been intensively studied, the importance of OHL has become a greater focus of research attention. The National Action Plan Health Literacy in Germany emphasizes the promotion of HL in all areas of everyday life, including occupation and the workplace. The proposed scoping review aims at identifying and evaluating definitions, empirical studies and instruments on OHL targeting employee recipients. The search will be conducted in two consecutive steps and guided by expert-panel discussions in accordance to the method of Consensus Development Panels. The search will be conducted in Web of Science, PubMed and Google Scholar according to the methodological framework of Arksey and O’Malley and supplemented by the snowball principle and a hand search. All records will be included that were published until the final search date. To define eligibility criteria, the PCC framework of the Joanna Briggs Institute is used. The scoping review will critically discuss whether a new definition of OHL in the context of employee health is of purpose for future research and practice. Nonetheless, it will provide orientation in the context of employee health, also facing the consequences of SARS-CoV-2.

The Effect of Mobile Health Applications on the Health Literacy of Individuals

Purpose: The study aims to determine the effect of mobile health applications on the health literacy of individuals. Methods: The study is a prospective, cross-sectional survey using a quantitative method. A questionnaire form consisting of a socio-demographic part of 15 questions and a part of the "Health Literacy Index" with 25 statements was used in the research. The study population consists of a total of 450,496 people between the ages of 18-40 living in Samsun. The number of samples for the study was determined as 384, and it was conducted online on a total of 431 people using the convenience sampling method between 22.09.2021 and 20.10.2021. Results: There are significant differences between E-Nabız application usage status and access to information sub-dimension, appraisal sub-dimension, and general health literacy level. There is a significant difference between the participants' use of HES application and access to information sub-dimension, understanding information sub-dimension, appraisal sub-dimension, application sub-dimension, and general health literacy levels. There is a significant difference between gender status and access to information sub-dimension, understanding information sub-dimension, appraisal sub-dimension, practice sub-dimension, and general health literacy levels. Conclusion: Women have a higher level of health literacy than men, and individuals aged 26-40 have more increased access to information than individuals aged 18-25. In addition, individuals who actively use the E-Nabız application and HES application have a higher level of health literacy than those who do not actively use it. Keywords: E-Nabız, health literacy, HES, mobile health applications.

Relationship Between Health Anxiety and Compliance Preventive Behaviors with Health Literacy in the COVID-19 Process

Objective: Health literacy levels of individuals are very important during epidemic periods such as COVID-19. The aim of this study is to evaluate the relationship between adaptation to preventive behavior and health anxiety with health literacy level in the COVID-19 process. &#x0D; Material and Methods: This study is a descriptive and cross-sectional study. The data were collected between January and April 2021 via Google Drive Form. The study involved 428 people who met the inclusion criteria working in a Provincial Municipality in north-west Turkey. The data were collected using Socio-demographic and compliance to preventive behavior data form, “Turkey Health Literacy Scale” and “Health Anxiety Scale”.&#x0D; Results: Participants in the study were found to have adequate health literacy (35.51 ± 7.13). It was observed that the level of adequate health literacy of individuals during the COVID-19 process were effective complying with preventive behavior. It was found that there was a significant negative correlation between the health literacy score averages and the health anxiety score averages (r= -0.459, p=0.000).&#x0D; Conclusion: Health literacy education and counseling services especially by those working in the field of primary health care and public health, can reduce health anxiety by increasing the adaptation of individuals to preventive behaviors during the COVID-19 period.

An Evaluation of the Health Literacy of Patients Visiting Family Medicine Clinics and The Related Factors

Aim: This study aimed to determine the level of health literacy among individuals visiting the Family Medicine Clinic in Tepecik Hospital and to reveal the relationship between health literacy and independent variables. Methods: This study has a cross-sectional analytical design. A sample size of 141 was found to produce a two-sided 95% confidence interval and an estimated standard deviation of 6141 people who met the inclusion criteria participated in the study. The dependent variable in the study was the health literacy level determined by using the Turkish Health Literacy Scale. Student’s t-test, ANOVA, Pearson correlation analysis, and linear regression analysis were used to analyze the relationship between the dependent and independent variables. Results: The mean Turkish Health Literacy Scale score was 28.95±5.86; 60.28% of the participants had problematic-limited health literacy, while 20.57% had insufficient, 17.02% had sufficient, and 2.13% had excellent health literacy. The health literacy score of females was 3.204 points lower than that of males. For each unit increase in household disposable income, the Turkish Health Literacy Scale score increased by 0.001 points. The Turkish Health Literacy Scale score was 1.771 points higher for those who have not been hospitalized in the last ten years. The Turkish Health Literacy Scale score increased by 1.306 points for a percent increase in the frequency of obtaining health-related information from the Internet, while it increased by 1.686 points for a percent increase in the frequency of obtaining health-related information from brochures, posters, or books. Conclusion: This study demonstrated that health literacy was quite limited and insufficient among the participants. Determining the factors influencing health literacy, planning with these factors in mind, developing policies to improve health literacy, and increasing the health literacy of individuals and society may be critical for the improvement of public health. Keywords: health literacy, health care, information, primary health care

Association Between Health Literacy and Work Ability in Employees With Health-Related Risk Factors: A Structural Model.

IntroductionIn workplace health promotion (WHP), health literacy and work ability are considered as outcomes of high interest. Therefore, the question arises as to what extent individual health literacy skills have an impact on work ability alongside sociodemographic influences.ObjectivesThis study aimed to examine the associations between a structural model of health literacy as well as sociodemographic context factors and the work ability among employees with health-related risk factors.Materials and MethodsThe study was based on baseline data of a workplace-related intervention (158 employees with health-related risk factors, 53.8% women, 48 ± 10 years). Health literacy skills were assessed with Lenartz's Questionnaire (measuring “self-perception”, “proactive approach to health”, “dealing with health information”, “self-control”, “self-regulation”, and “communication and cooperation”). Work ability was measured by the German Short Form of the Work Ability Index (WAI). As sociodemographic context factors, sex, age, and educational level were assessed. The associations were examined using structural equation modeling with partial least squares (SmartPLS 2.0.M3). Common quality criteria were applied and significance level was set at α = 5%.ResultsModel's reliability, validity, and structure could be validated. Regarding the impact on work ability, “self-regulation” showed a statistically significant direct effect (ß = 0.32, t(∞) = 4.00, p < 0.01, f2 = 0.09) and “self-perception” had a significant indirect effect (ß = 0.13, t(∞) = 2.53, p < 0.05). The only additional association with work ability was found for age (ß = −0.25, t(∞) = 3.82, p < 0.01, f2 = 0.04). The WAI score variance was explained to 17.5% by the health literacy skills and to 27.5% considering the additional sociodemographic context factors.ConclusionAccording to the structural model of health literacy, in employees with health-related risk factors, a target group-specific WHP approach could be the encouragement of self-regulation and self-perception. However, additional resources and conditions influencing work ability should be considered.

Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic.

Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.