Health Literacy In Population Research Articles

Addressing Low Health Literacy in Surgical Populations

AbstractHealth literacy is defined as the ability to obtain, engage, understand, and act upon health information to make decisions about health care. Health literacy is a key determinant of health outcomes and disparities including those in surgery. Over one-third of surgical patients suffer from low health literacy, with disproportionately higher rates among older, rural, and black patients. Low health literacy has been associated with poor adherence to preoperative and discharge instructions, longer lengths-of-stay, higher readmission rates, and higher health care costs. However, health literacy is modifiable, and therefore it is uniquely positioned for meaningful interventions at the patient, provider, and system level. These interventions include using more visual aids with patients and families (patient level), communicating in more understandable ways (provider level), and improving the organizational health literacy of hospitals (system level). Through high-quality research and multilevel interventions, significant opportunities exist to address low health literacy and improve outcomes, eliminate disparities, and reduce costs for this disparity population.

Measuring General Health Literacy in Chinese adults: validation of the HLS19-Q12 instrument.

Health literacy measurement lays a solid foundation to identify associations with health outcomes and monitor population health literacy levels over time. In mainland China, most existing health literacy instruments are either knowledge-based or practice-based, making health literacy results incomparable between China and other countries. This study aimed to examine the reliability and validity of the 12-item Health Literacy Population Survey (HLS19-Q12) in a general population of Chinese adults. A cross-sectional study was conducted to recruit primary carers of students from 11 schools in Zhengzhou, Henan Province, using convenience cluster sampling. Participants completed an online self-administered survey that collected information on key sociodemographics, health literacy (HLS19-Q12 and a comparison tool: Health Literacy Questionnaire (HLQ)), and health-related outcomes. Using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist as a guideline, we tested internal consistency, test-retest reliability, content validity, structural validity, concurrent predictive validity, and convergent validity of the HLS19-Q12. Overall, 14,184 participants completed the full survey. The HLS19-Q12 showed excellent internal consistency (Cronbach's α = 0.93), moderate test-retest reliability (intra-class correlation coefficient = 0.54), satisfactory content validity (based on the 12-matrix health literacy model), and strong structural validity (comparative fit index = 0.94, Tucker and Lewis's index of fit = 0.93, root mean square error of approximation = 0.095). Concurrent predictive validity results showed health literacy was associated with both health determinants and health-related outcomes. The HLS19-Q12 had weak to strong correlations (coefficients = 0.24 to 0.42) with the nine scales of the HLQ. Respondents had an average score of 81.6 (± 23.0) when using the HLS19-Q12, with 35.0% and 7.5% having problematic and inadequate levels of health literacy, respectively. The HLS19-Q12 is a reliable and valid instrument to measure health literacy in our sample. Further validation is needed with a more nationally representative sample of Chinese adults. The HLS19-Q12 could be used as a comprehensive, skills-based, and easy-to-administer health literacy assessment tool integrated into population surveys and intervention evaluations.

Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review.

Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions. Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes. We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective. Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.

Exploring Mental Health Literacy and Its Associated Factors: A National Cross-Sectional Study in Saudi Arabia, 2023.

The aim of this study is to examine, for the first time, the mental health literacy of the Saudi general population. Additionally, we aim to identify demographic factors associated with elevated mental health literacy scores. A cross-sectional study using a phone interview survey with quota sampling was conducted for equal distribution of sexes, age and administrative regions. Mental health literacy was assessed by the previously validated mental health literacy scale (MHLS). The MHLS ranges from 35 to 160, and a higher score indicates greater level of mental health literacy. In this study, 4,547 (70.2%) agreed to complete the interview. The sample was equally distributed across Saudi Arabia's 13 administrative regions with 50.1% female and mean age 35.9 (SD: ±12.8). In terms of education, 55.1% have a bachelor's degree or above. The nationally weighted score on the original MHLS was 110.75. the MHLS Saudi validation score was influenced by various variables including: marital status, healthcare-related job, sex, education level, and proximity to individuals with mental health issues. The study offers data for the first time on Saudi Arabian mental health literacy status. The high MHLS score reflects good societal awareness and understanding of mental health related concepts and issues in the Saudi population. The results of this study set the baseline for mental health literacy in Saudi Arabia. Future research may focus on utilizing the validated MHLS and the method used in this study to explore the effect of other social and individual factors on mental health literacy.

The Impact of the Ecosystem on Health Literacy Among Rural Communities in Protected Areas: Protocol for a Mixed Methods Study.

Protected areas are crucial for the maintenance of human health and well-being. They aim to preserve biodiversity and natural resources to secure various ecosystem services that are beneficial to human health. Their ecological characteristics can influence local health literacy. Typically, communities surrounding protected areas have limited economic opportunities due to restriction policies to protect the ecosystem, resulting in socioeconomic disparities. The local community faces obstacles in gaining access to health care facilities and health information due to these limitations. It is difficult for them to locate, comprehend, and apply information and services to make better health-related decisions for themselves and others. This study protocol examines the impact of the ecosystem on health literacy among rural communities in protected areas. This study comprises 5 phases. In phase 1, we conduct a systematic review to identify the issue of health literacy in protected areas. In phase 2, we will collect data from stakeholders in a protected area of Pahang National Park and analyze the results using Net-Map analysis. In phase 3, we will conduct a survey among the adult community in Pahang National Park related to health literacy, socioeconomic status, health expenditure, and quality of life. In phase 4, informed by the results of the survey, we will determine suitable intervention programs to improve health literacy through a focus group discussion. Finally, in phase 5, we will conduct a costing analysis to analyze which intervention program is the most cost-effective. This study was funded by Universiti Sains Islam Malaysia (USIM) and strategic research partnership grants, and enrollment is ongoing. The first results are expected to be submitted for publication in 2024. This is one of the first studies to explore health literacy among rural communities in protected areas and will provide the first insights into the overall level of health literacy in the protected community, potential determinants, and a suitable intervention program with expected cost analysis. The results can be used to promote health literacy in other protected areas and populations. International Standard Randomized Controlled Trial Number Registry ISRCTN40626062; http://tinyurl.com/4kjxuwk5. PRR1-10.2196/51851.

Prevalence and factors associated with limited hypertensive health literacy among Myanmar migrant workers in Northeastern Thailand

Background: Regarding hypertension, limited health literacy was considerably high worldwide. Although hypertensive health literacy in general population was explored by some studies, there was no study specific for it among Myanmar migrant workers in Thailand. Objectives: Aimed to explore the prevalence of limited hypertensive health literacy and identify the associated factors among Myanmar migrant workers in Northeastern Thailand. Method: A cross-sectional analytical study was conducted among Myanmar migrant workers with the age between completed 18 years to 59 years old in Khon Kaen Province, Northeastern Thailand from June 2023 to August 2023. Multistage random sampling procedure was applied to select 406 sample. A validated and reliable structured questionnaire was used to collect the data. Descriptive statistics and multiple logistic regression were used. The association between limited hypertensive health literacy and each statistically significant factor (p-value < 0.05) after controlling other covariates were described by adjusted odds ratio (AOR), 95% Confidence Interval (95% CI). Results: Of 406 participants, the overall prevalence of limited hypertensive health literacy was 54% (95% CI: 49.20-59.11). Among the participants, 56% were male and 68% of them were married. Factors associated with limited hypertensive health literacy were pre-hypertension (AOR=1.83, 95% CI: 1.12-3.01), primary and below level of education (AOR=2.26, 95% CI: 1.36-3.74), ≤48 months duration of stay in Thailand (AOR=2.24, 95% CI: 1.44-3.48), poor and fair level of knowledge (AOR=2.02, 95%CI: 1.20-3.42) and poor and fair level of attitude (AOR=2.61, 95%CI: 1.68-4.07). Conclusion: More than half of the study population was limited in hypertensive health literacy. Educational status, duration of stay in Thailand, blood pressure, knowledge and attitude towards hypertension were associated with health literacy among Myanmar migrant population. Thus, creating user-friendly resources and health programs for newcomers is essential to close health literacy disparities. Using multidisciplinary approach could be effective in promoting health literacy.

Exploring health literacy categories among an Iranian adult sample: a latent class analysis

General and electronic health literacy are important factors engaging in healthy behaviors and maintaining good health. The present study explored demographic factors associated with general and electronic health literacy in the Iranian adult population. Via stratified cluster sampling, trained interviewers visited adult residents in Qazvin Province, Iran between January, and April 2022. The participants (N = 9775; mean age = 36.44 years; 6576 [67.3%] females) completed the Health Literacy Instrument for Adults (HELIA) assessing health literacy and the eHealth Literacy Scale (eHEALS) assessing electronic health literacy. Demographic data, including age, gender, educational level, marital status, and living location (city or rural), were collected. Latent class analysis (LCA) was used to classify the participants into different health literacy/electronic health literacy levels. The relationships between health literacy/electronic health literacy levels and demographic factors were examined using χ2 or analysis of variance. The LCA used HELIA scores to suggest five classes of health literacy and eHEALS scores to suggest three classes of electronic health literacy. For general and electronic health literacy, similar relationships were with demographic factors: females as compared with males had better general/electronic health literacy; younger people as compared with older people had better general/electronic health literacy; higher educational level was associated with better general/electronic health literacy; and city residents as compared with rural residents had better general/electronic health literacy. In conclusion, Iranian governmental agencies may wish to target on males, older adults, people with low educational level, and rural residents to improve their health literacy.

Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French.

Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate. The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge. This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F. A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p < 0.001). Participants with an education level lower than the baccalaureate, and those who never visit the dentist or only in case of pain, had significantly lower OHLI-F scores. Internal consistency was excellent (Cronbach's alpha = 0.881-0.914). Test-retest reliability was very high (intraclass correlation = 0.985 to 0.996). The OHLI-F has demonstrated adequate psychometric properties and can therefore be used to measure oral health literacy in French-speaking populations.

Validation and psychometric testing of the Arabic version of the mental health literacy scale among the Saudi Arabian general population

ObjectiveThis study aimed to validate the Arabic Version of the Mental Health Literacy Scale (Arabic-MHLS) among the Saudi Arabian general population, assessing its internal consistency, test-retest reliability, and structural validity.MethodsA total of 700 Arabic-speaking Saudi adults were randomly selected to complete the electronic questionnaire in May 2023, which generated 544 participants. Data were coded and stored in the ZdataCloud research data collection system database. Test-retest reliability was assessed using a subsample of 48 participants who completed the questionnaire twice, with a one-week interval. Structural validity was examined using confirmatory factor analysis (CFA) and Exploratory Factor Analysis (EFA).ResultsThe Arabic-MHLS demonstrated good internal consistency (Cronbach’s alpha = 0.87) and test-retest reliability (intraclass correlation coefficient = 0.89). EFA revealed a four-factor model closely resembling the model identified in the Slovenian validation of MHLS, with factor loadings ranging from 0.40 to 0.85. The four factors included knowledge of mental health disorders, knowledge of help-seeking, knowledge of self-help strategies, and knowledge of professional help also showed good internal consistency.ConclusionThe Arabic-MHLS is a valid and reliable tool for assessing mental health literacy in the Saudi Arabian general population. However, further research is needed to refine the measurement tool and understand the complex relationships between mental health literacy and other mental health-related concepts. This will contribute to the development of targeted interventions and policies aimed at improving mental health literacy and promoting mental well-being in the Saudi Arabian population and beyond.

Analyzing an immunization resource website: User browsing trends

PurposeAccess to internet-based resources may help to improve population health awareness and literacy surrounding immunization related topics. The primary aim of this study was to evaluate and analyze trends for a single immunization resource website, the Melbourne Vaccine Education Centre (MVEC). Principal resultsOver a four-year period from 2019 to 2022, the website had over 2 million visitors from 236 countries. Users were predominantly female, in the 25 to 44 year age bracket and accessed resources using a mobile device.There was significant interest in specific vaccine related topics, particularly during the COVID-19 pandemic, that corresponded with key vaccine related recommendations and updates from a national level. Usage patterns saw spikes in interest around topics including COVID-19 vaccine administration techniques and adverse events following immunization. Major conclusionsUse of online platforms including websites such as MVEC may reflect trends and behaviors towards immunization related information. Analysis of usage patterns have provided user insights into key domains of interest including areas such as vaccine administration, policies and programs, vaccine safety and barriers to vaccine uptake.

Enhancing bowel preparation quality and tolerability in a low health literacy population in Western China: a multicenter randomized trial

Enhancing bowel preparation quality and tolerability in a low health literacy population in Western China: a multicenter randomized trial

Health Literacy, lifestyles, and socio-economic factors in the Italian population: a national survey

Abstract Introduction Health literacy (HL) entails people's knowledge and abilities to find, understand and use health information to make health-related decisions. This study aims to evaluate HL association with lifestyles in the Italian adult population. Methods In 2021, in the framework of the Italian participation in the WHO network Measuring Population and Organizational Health Literacy M-POHL, a survey was conducted on a representative sample of the Italian population aged 18+ years (n = 3,500). A validated 47-item questionnaire was used to collect core HL information, plus 31 items for correlate information, including lifestyles. For each HL-item, a 4-point Likert scale was applied: very easy/easy/difficult/very difficult. The HL index (percentage of very easy/easy), was stratified in Inadequate (0%−50%), Problematic (51%−66%), Sufficient (67%−80%), Excellent (81%−100%). Inadequate/Problematic were merged into “Limiting”, Sufficient/Excellent in “Not limiting”. Multivariate logistic regression analysis was implemented to assess the association between dichotomous HL and obesity (BMI &amp;gt; =30 Kg/m2), physical activity-PA (intense (5-7 days a week)/not intense (0-4 days a week)), fruit and vegetable diet-FVD (daily/not daily), smoking habit (yes/no), adjusted by sex, age, region, education-ED, financial deprivation-FD. Results Prevalence of Limiting HL is 64.6%. In Limiting HL, obesity is significantly higher than in Not limiting HL (14.6% vs 12.0%), similarly not intense PA (82.3% vs 75.7%), not daily FVD (54.0% vs 47.7%), low ED (22.3% vs 18.0%), severe FD (20.8% vs 9.1%); the opposite for smokers (30.2% vs 34.7%). Significant association with Limiting HL was found for not intense PA (Odds Ratio-OR=1.48), not daily FVD (OR = 1.24), low ED (OR = 1.39), severe FD (OR = 3.33). Conclusions Results show that persons with not intense PA and those with not daily FVD need targeted support to improve HL, as well as those with a lower level of education and problematic financial situation. Key messages • This study aims to evaluate Health literacy association with lifestyles and socio-economic factors in the Italian adult population. • Intense physical activity and a regular fruit and vegetable diet lifestyles are associated with ‘Not limiting’ Health Literacy, as well as high educational level and low financial deprivation.

Measuring Digital Health Literacy in Europe – Scope, determinants and consequences

Abstract Background Increasing access to health-related digital information/resources of varied quality warrants sufficient Digital Health Literacy (DHL) in the population. Public health researchers, practitioners, and policy makers need to consider DHL for improving people's ability to use digital resources. The M-POHL HLS19 study objectives were to construct and validate a DHL measure, and identify its determinants and consequences. Methods A scale was constructed with 8 items on dealing with digital health resources. Two additional items examined interactive use of resources. The scale was applied among a sample of 29,060 respondents in 13 countries using CAPI, CATI, CAWI, PAPI and mixed methods. A standardized score was calculated for DHL, range: 0-100. Results Appraising the reliability of digital resources was perceived particularly difficult. The scale showed acceptable reliability (Cronbach's α 0.7-0.87/country). A confirmatory factor model loading onto a single latent variable indicated an acceptable fit for all countries. The DHL scale was sufficiently unidimensional based on principal component analysis of Rasch model residuals combined with dependent t-tests. Linear regression models with 5 DHL predictors showed a social gradient with explained variance of 6% (2-23%/country). The highest predictor was financial deprivation: ß=−0.15 (0.08--0.27), then age: ß=−0.13 (0.15--0.26); self-assessed social status: ß=0.08 (0.05-0.13). General health literacy was a strong predictor: ß=0.51 (0.43-0.67). In linear regressions to explain variance in self-assessed health, the DHL coefficient was significantly different from zero in 9 countries (ß=−0.05-0.10). Conclusions The new DHL scale had acceptable psychometric properties. The relevance of DHL is reflected in the high proportions with lower DHL, a social gradient, and health consequences in most countries. The study offers an evidence base for tailoring DHL intervention strategies and organizational health literacy policy. Key messages • Digital Health Literacy of populations in Europe was estimated through a validated measure with associations that predict public health and healthcare consequences in most countries. • Public health practitioners and policy makers should be aware of populations with lower Digital Health Literacy (DHL), and both promote DHL while also adjusting interventions/services to DHL needs.

Health literacy: association with socioeconomic determinants and the use of health services in Spain.

Health literacy (HL) is the set of social and cognitive skills that determine person's level of motivation and the ability to access, understand and use information to promote and maintain good health. The aim of this study is to assess the level of health literacy, and to analyze its relationship with sociodemographic variables, state of health, and use of health services in the population aged 15 and over in the Valencian Community (Spain). Cross-sectional study based on a sample of 5,485 subjects participating in the Health Survey of the Valencia Community. The HLS-EU-Q16 was used. As outcome variables we considered HL categorized into 2 levels: Inadequate or Problematic HL and Sufficient HL and the standardized literacy index. Prevalence rates and HL means were estimated and OR were calculated to analyze the association between variables. A total of 12.8% of the subjects surveyed presented an inadequate or problematic degree of HL. This percentage was higher in people >85 years (63.1%), with a low level of education (46.5%), in retired people (27.4%) or in other work situations (25.0%), in foreigners (18.1%), in low-income people (16.2%), with a perception of poor health status (26.9%), chronic disease (18.5%) or with activity limitations (56.4% severe, 19.7% not severe). Significant differences were found. With the exception of chronic disease, all the variables analyzed were associated with HL. Low HL was associated with a lower consumption of medicines, a greater use of health services, general medical consultations, poorer knowledge of new health technologies and fewer preventive health visits. The percentage of inadequate or problematic HL was globally not very high, but certain population subgroups notably presented a high degree of inadequate or problematic HL. Raising the HL level of such groups should be regarded as a priority. HL was shown to be associated with the service use and new health technology use. Enhancing the population's HL should lead to the following: a greater probability of adopting preventive practices; improving the use of the health system; and boosting people's abilities to manage and to improve their own health.

A Qualitative Study on the Effects of Health Literacy in Population with Hypertension at Blossom Health Care Center, Kabul City, Afghanistan

A Qualitative Study on the Effects of Health Literacy in Population with Hypertension at Blossom Health Care Center, Kabul City, Afghanistan

O.4.5-11 The association between health literacy and objectively measured physical activity in Norwegian young adult students

Abstract Background Insufficient physical activity (PA) is a significant public health challenge, with a drastic decline in activity levels observed in young adulthood likely contributing to increases in cardiometabolic risk factors with age. Recent research suggests that health literacy (HL) may be an important modifiable factor associated with reduced physical activity levels and poor health outcomes in elderly and disease-prone populations. However, limited research has focused on young adulthood when the drastic decline in PA is observed. Moreover, most previous studies have only assessed self-reported PA, which has limited accuracy. Therefore, the purpose of this study was to assess the relationship between HL and objectively measured PA levels in healthy young adults. Method 28 young adult (18-25 years) college students participated in the study (men: n = 7, women: n = 21). PA was measured objectively and subjectively using an accelerometer (Actigraph GT3X+) and the IPAQ questionnaire, respectively. The HLS19 instrument was used to assess HL, which was developed within “HLS19 – the International Health Literacy Population Survey 2019-2021” of M-POHL. Participants were categorized as having low or high health literacy based on the classification defined in the Norwegian HLS-19 report (2021). Additionally, each response was assigned a value (1-4) to calculate a summative health literacy point score, with a higher summative value indicating greater health literacy. Results In our cohort, 60% (n = 17) of the participants were categorized as having low and 39% (n = 11) as having high health literacy. There was no group difference in objective and subjective PA levels between those with low and high HL (all comparisons: p &amp;gt; 0.05). However, we observed a significant positive correlation between health literacy (point score) and objectively measured moderate to high-intensity PA (r = 0.52, p = 0.002). Likewise, there was a significant correlation between health literacy (point score) and self-reported total PA (r = 0.34, p = 0.03). Conclusion This is the first study to show a positive relationship between HL and PA in healthy young adult students, highlighting the potential role of HL in modulating PA in this population. Thus, further research is needed to determine whether targeting HL could effectively increase PA levels in young adults.

Disparities in public understanding, attitudes, and intentions during the Covid-19 pandemic: The role of health literacy

The Covid-19 pandemic has highlighted the need to address health literacy as a critical priority for public health. Health literacy is crucial during a pandemic for understanding and following health advice and for navigating vast amounts of information and misinformation. However, public health communication globally has inadequately met the needs of low literacy and culturally and linguistically diverse groups. This review examines the role of health literacy and how it is related to Covid-19 related outcomes, as well as how public health communication has routinely failed to follow basic health literacy principles. Lessons from the pandemic about health communication and recommendations for how health literacy needs can be addressed in the future are discussed. Improving public health communication requires an immediate short-term response and longer-term investment to build the health literacy responsiveness of public health units, health organisations, and government departments to meet health literacy population needs.

Investigation of the relationship of general and digital health literacy with various health-related outcomes.

Despite the growing number of health literacy surveys, we know little about the combined effect of the different dimensions of health literacy on various health-related outcomes. Thus, our study aimed to examine the impacts of general and digital health literacy on health behaviour, confidence in vaccination, self-perceived health, and health care utilization. Our research was part of the Health Literacy Population Survey 2019-2021, which was an international, multicentre, cross-sectional study. The data were collected via computer-assisted telephone interview in December 2020 in Hungary. Multiple multinomial logistic and multivariate linear regression models were used to analyse the separately effects of general and digital health literacy on the studied outcomes. Moreover, the combined effect of general and digital health literacy was also analysed via sensitivity analyses. In the last step, the interactions between general and digital health literacy were examined using the Johnson-Neyman procedure. The results did not reveal any associations between health literacy and health behaviour. Health care use was only affected by digital health literacy; however, this effect was inconsistent. Both dimensions of health literacy were positively associated with self-perceived health and vaccination confidence. Our results suggest that increasing health literacy could promote health and vaccination confidence, while the potential effect of higher digital health literacy on more conscious use of the health care system should be investigated further.

#4102 THE IMPACT OF MOBILE HEALTH ON HOME BLOOD PRESSURE AND HEALTH LITERACY IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Mobile health (mHealth) management is an emerging therapeutic strategy for chronic diseases. mHealth has been considered to improve self-care management and assist in detecting a worsening health status early. However, the effect of mHealth management on the blood pressure (BP) of patients with chronic kidney disease (CKD) has not been well-studied. This study aimed to access the association between mHealth management and BP control in CKD. We also investigated the association between mHealth and health literacy(HL) in CKD. Method Kaohsiung Medical University Hospital designed and developed a new healthcare mobile application called iCKD. The application has several major features, including BP monitoring, alarms, and a warning system. We randomly assigned 122 CKD patients stages 1-5 to utilize iCKD or paper records (control group) for BP management. The primary outcome was the portion of reaching the target goal, defined as office BP less than 130/80 mmHg, during the 6-month study. Trained nurses interviewed CKD patients using structured questionnaires to evaluate HL. Results Baseline kidney function and BP were not significantly different between iCKD and control groups. During the study period, 11 participants had withdrawal.42.3% of the iCKD group (22/52) had the BP control reaching the target goal, while only 22.4% (11/49) in the control group(p = 0.03). Regarding HL, CKD patients with BP reaching the target goal had higher total scores than those without. The score for iCKD group, ranging from 29.29 to 32.85, were higher than the control group, ranging from 28.94 to 31.03. (p = 0.01). Conclusion The iCKD group had a higher proportion of reaching the BP target goal and better HL score than the control group. This study demonstrates that mHealth can improve the CKD population's health literacy and BP management.

Psychometric Properties of a Brief Health Literacy Instrument (HL-8) Among 18-65-Year-Old Iranians: A Scale Developed for Online Surveys

Background: A short, valid, and reliable instrument is required for the easy assessment of health literacy in online surveys. Objectives: In this study, we investigated the validity and reliability of the Persian version of the 8-item Health Literacy Questionnaire as a brief online survey tool in 18-65-year-old Iranians. Methods: This was a cross-sectional study undertaken in thirty-one provinces of Iran. A total of 2374 Iranian people with age 18 - 65 years participated in this study. To ensure the quality of English-to-Persian translation, the process of forward-backward translation was conducted. The scale’s factor structure was assessed using a series of exploratory factor analyses (EFA) and confirmatory factor analyses (CFA). In order to assess reliability, Cronbach’s alpha estimation, test-retest reliability, and Spearman correlation coefficients were applied. Results: Most of the participants were male (1610, 67.8%), married (1610, 67.8%), and 31 - 59 years old (1672, 70.4%). Cronbach’s alpha coefficients for the factors of finding &amp; evaluating, understanding, decision making, interaction, and the questionnaire as a whole were 0.76, 0.46, 0.75, 0.82, and 0.59, respectively. Test-retest correlation coefficients for these factors and the questionnaire as a whole were 0.85, 0.94, 0.75, 0.82, and 0.86, respectively. Based on CFA, the four-factor structure of the 8-item health literacy (HL) fitted the data well. Conclusions: The validity and reliability of the online version of the Persian 8-item Health Literacy Questionnaire to measure the HL of the public were approved. This short online tool can be helpful for future online survey studies on the health literacy of Persian-language populations at a large scale.