Personal Health Literacy Research Articles

Enhancing Healthcare Provider Feedback and Personal Health Literacy: Dual Use of a Decision Quality Measure.

In this protocol for a pilot study we seek to establish the feasibility of using a web-based survey to simultaneously supply healthcare organisations and agencies with feedback on a key aspect of the care experience they provide and increase the generic health decision literacy of the individuals responding. The focus is on the person's involvement in decision making, an aspect of care which is seriously under-represented in current surveys if one adopts the perspective of person-centred care. By engaging with an instrument to assess decision quality the person can, in the one action, provide a retrospective evaluation of a past decision making experience in a specific provider context and enhance their competency in future decision making in any setting. We see this as an exercise in context-sensitive educational health informatics.

Health Literacy Among People with Serious Mental Illness.

People diagnosed with a mental illness are at higher risk of developing preventable chronic diseases; thus, health literacy improvements may have great potential to impact health outcomes for this typically underserved population. However, there is a dearth of research on health literacy of persons with severe mental illness. The purpose of this research was to investigate aspects of health literacy and identify factors associated with low literacy among adults with severe mental illness using three literacy assessment tools. Seventy-one adults with serious mental illness were assessed and a high proportion had limited literacy levels: 42% with the Single Item Literacy Screener, 50% with the Rapid Estimate of Adult Literacy in Medicine-Short Form, and 67% with the Newest Vital Sign. Findings suggest that individuals with certain mental illnesses and lower functioning may have more difficulty understanding health information and have limited numerical literacy.

Why should and how can hospitals improve their organizational health literacy?

In late modern "multi-option" and "health" societies, health literacy (HL), understood as a specific competence, is considered necessary to successfully deal with the multitude of health relevant decisions and tasks to be taken every day. The concept has been used in the US, primarily in healthcare, to research the consequences of HL on the outcome of treatment specifically in patients with limited HL. In this context, it became evident that HL has to be understood as a relational or contextual concept. That is, the adequacy of HL does not only depend on personal HL, but equally on the demands organizations put on their users. This understanding of HL opened the road to measure not only individual HL, but also the HL sensitivity of organizations, i.e. organizational HL, and to use targeted measures to improve it. The ten attributes of a health-literate healthcare organization, as defined by the US Institute of Medicine, are a first systematic attempt to use this strategy in healthcare. In the meantime, the strategy has been used in other settings as well. Using experiences from health-promoting hospitals and the quality movement in healthcare, the authors develop this approach further into the comprehensive Vienna concept of the health-literate hospital, which considers all stakeholders and tasks of the hospital which are relevant for HL. A self-assessment tool was developed and tested as a basic instrument for developing a health-literate hospital. By doing so, hospitals are empowered to make a contribution to the promotion of HL as an important societal task.

Health literacy association with health behaviors and health care utilization in multiple sclerosis: a cross-sectional study.

BackgroundLow health literacy is generally associated with poor health outcomes; however, health literacy has received little attention in multiple sclerosis (MS).ObjectiveThe aim of this study was to investigate the health literacy of persons with MS using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry.MethodsIn 2012, we conducted a cross-sectional study of health literacy among NARCOMS participants. Respondents completed the Medical Term Recognition Test (METER) which assesses the ability to distinguish medical and nonmedical words, and the Newest Vital Sign (NVS) instrument which evaluates reading, interpretation, and numeracy skills. Respondents reported their sociodemographic characteristics, health behaviors, comorbidities, visits to the emergency room (ER), and hospitalizations in the last 6 months. We used logistic regression to evaluate the characteristics associated with functional literacy, and the association between functional literacy and health care utilization.ResultsOf 13,020 eligible participants, 8934 (68.6%) completed the questionnaire and were US residents. Most of them performed well on the instruments with 81.04% (7066/8719) having functional literacy on the METER and 74.62% (6666/8933) having adequate literacy on the NVS. Low literacy on the METER or the NVS was associated with smoking, being overweight or obese (all P<.001). After adjustment, low literacy on the METER was associated with ER visits (OR 1.28, 95% CI 1.10-1.48) and hospitalizations (OR 1.19, 95% CI 0.98-1.44). Findings were similar for the NVS.ConclusionsIn the NARCOMS cohort, functional health literacy is high. However, lower levels of health literacy are associated with adverse health behaviors and greater health care utilization.

Gender differences in mental health literacy of family caregivers of persons with mental illness: an Indian perspective

Research on mental health literacy in India is limited despite increasing growing evidence of mental illness among general population. Therefore, this study aimed to investigate gender differences in mental health literacy of family caregivers of persons with mental illness. A cross-sectional descriptive survey was carried out among 161 randomly selected caregivers of persons with mental illness at outpatient department of a tertiary care centre. Data were collected through face-to-face interview using a structured questionnaire. This study supports the previous research that gender differences exist in mental health literacy of persons with mental illness. Men were less literate than women regarding knowledge of people with mental illness as well women hold better positive attitudes towards persons with mental illness. Hence, gender differences need to be considered in developing mental health literacy programmes for family caregivers of mentally ill and general population.

Baseline medication adherence and response to an electronically delivered health literacy intervention targeting adherence

Medication adherence in persons treated for human immunodeficiency virus (HIV) continues to be an important focus for intervention. While high levels of adherence are required for good clinical outcomes, research shows many patients do not achieve these levels. Despite multiple interventions to improve adherence, most require multiple sessions delivered by trained clinicians. Cost and lack of trained personnel limit the availability of these interventions. Alternatives to clinician-delivered interventions are interventions provided via electronic devices (eg, personal/tablet computers and smartphones). Modern technology allows devices to provide tailoring of content to patient characteristics and learning needs, and to be excellent platforms to deliver multimedia teaching content. The intervention reported drew on research on health literacy in persons with HIV and the relation of health literacy to medication adherence in persons treated for HIV to develop an electronically delivered application. Using the Information-Motivation-Behavioral Skills model as a conceptual framework for understanding patients' information needs, a computer-delivered intervention was developed, its usability and acceptability was assessed, and medication adherence in 118 patients for 1 month before and after they completed the intervention was evaluated. Changes in participant adherence were evaluated in sequential models with progressively lower levels of baseline medication adherence. Results show that although changes in adherence in the entire sample only approached statistical significance, individuals with adherence less than 95% showed significant increases in adherence over time. Participants' self-reported knowledge and behavioral skills increased over the course of the study. Their change in information predicted their post-intervention adherence, suggesting a link between the intervention's effects and outcomes. A computer-delivered intervention targeting HIV-related health literacy may thus be a useful strategy for improving patient adherence.

Assessing the capacity of New Zealand health promoters to develop programs that meet the health literacy needs of both consumers and government

Since 2008 a conservative government in New Zealand has emphasised the importance of individual responsibility for health, with the implication that health promotion, including health literacy, would be of low priority. This paper discusses this in the context of research that aims to assess (i) the views of disadvantaged consumers on nutrition information and (ii) health promoter competence in health literacy practice, and argues that aspects of health literacy principles may indeed be of interest to conservative governments. First, four focus groups of consumers drawn from disadvantaged neighbourhoods discussed nutrition information. Second, a self-completed questionnaire to health promoters in six non-government agencies assessed health promotion competencies and understanding of health literacy. Consumers confirmed the need for personal responsibility for food choices, were critical of confusing information and sought simple messages on which they could act. They also acknowledged environmental constraints on their actions. Survey respondents (n=56; 53% response rate) reported technical competence in health promotion but less competence in strategic and leadership areas. More than one-third of respondents were assessed as having a good understanding of health literacy. Consumer acceptance of individual responsibility and workforce capability in technical aspects of health literacy suggest that health promotion organisations can align themselves with government goals and seek to improve personal health literacy.

Health literacy in pharmacy

The U.S. National Literacy Act of 1991 defines literacy as “an individual’s ability to read, write, and speak English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals and to develop one’s knowledge and potential.”1 Health literacy goes beyond this definition to include the ability to use these skills to read and understand health-related information, such as medication labels and insurance forms.2 These skills are vital for patients to receive the highest quality of care; however, 90 million people (nearly half of all Americans) have limited health literacy skills.3 This number is based on the 2003 National Assessment of Adult Literacy (NAAL), which for the first time included a component designed to specifically test adults’ ability to read and understand health-related information. The U.S. Department of Health and Human Services uses the NAAL to evaluate progress toward the Healthy People 2010 goal “to improve the health literacy of persons with inadequate or marginal literacy skills.”4 Raising awareness about this issue is important, since the NAAL showed no change in the average overall literacy score between the most recent assessment in 2003 and the prior assessment conducted a decade earlier.5

Advancing health literacy: a global challenge for the 21st century

The most recent United States health objectives for the nation published in Healthy People 2010 contain for the first time an objective to improve health literacy. This objective forms part of an entirely new chapter on Health Communication in the report. The objective is very general-- to improve the health literacy of persons with inadequate or marginal literacy skills--and it is presented as a developmental objective on the basis that there is no established measure of health literacy which could be used to monitor progress in relation to this target. This is not the first time that a government has targeted improvements in health literacy. For example in 1993 a Report to the Australian Government Goals and Targets for Australias Health in the Year 2000 and Beyond recommended three goals for health literacy. These concerned improving general language skills and literacy levels in the population; improving knowledge and health literacy to enable people to make informed choices about health; and improving knowledge and health literacy in ways that enable people to take an active role in bringing about change in environments which influence their health. (excerpt)

Nutrition behaviors of North-African people living in the Paris area. Contribution to an improvement of nutritional education of North-African patients with metabolic disorder

A Healthy People 2010 objective is to improve the health literacy of persons with inadequate or marginal literacy skills. We designed a nutrition education module for dietetics students that allowed learning about health literacy while teaching this information to interested practitioners. Students designed a workshop for nutritionists by conducting a learning needs assessment and then developing learning objectives, content/methods, and process/outcome objectives. Students presented interactive sessions on using literacy assessment tools and developing low-literacy education materials. Handout packets included a list of relevant literacy Web sites. Evaluations unanimously rated the workshop as excellent or good. By helping teach others, students' learning experience was enhanced. J Am Diet Assoc. 2003;103:878-880.

Haida Gwaii Diabetes Project: developing culturally-sensitive interventions in Aboriginal communities

A Healthy People 2010 objective is to improve the health literacy of persons with inadequate or marginal literacy skills. We designed a nutrition education module for dietetics students that allowed learning about health literacy while teaching this information to interested practitioners. Students designed a workshop for nutritionists by conducting a learning needs assessment and then developing learning objectives, content/methods, and process/outcome objectives. Students presented interactive sessions on using literacy assessment tools and developing low-literacy education materials. Handout packets included a list of relevant literacy Web sites. Evaluations unanimously rated the workshop as excellent or good. By helping teach others, students' learning experience was enhanced. J Am Diet Assoc. 2003;103:878-880.