Health Literacy In Population Research Articles

Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey.

BackgroundLower health literacy is a public health issue that follows a social gradient, potentially reinforcing existing health inequalities. However, levels of health literacy in particular populations can be unclear and are a key to identifying effective public health interventions. This research examined health literacy levels in Stoke‐on‐Trent, where 31.2% of the population live in areas classified amongst the 10% most deprived in England.MethodsA cross‐sectional survey using the Newest Vital Sign examined associations with demographic factors, lifestyle behaviours, Internet use and self‐rated health. The sample (n = 1046) took account of variance in levels of health literacy by age, educational attainment and deprivation. Bivariate logistic regression and multivariate logistic regression were used to estimate associations with health literacy when adjusted for other demographic factors and lifestyle behaviours.ResultsNine hundred and seventy‐two respondents completed the health literacy measure (93%): 277 (28.5%) scored low, 228 (23.5%) scored marginal and 467 (48.0%) scored adequate. Associations with higher rates of limited health literacy included older age, lower educational level, lower income, perceived poor health and lack of access to the Internet.ConclusionsGiven the complexity of factors influencing health literacy interdisciplinary approaches across health and social care and the voluntary sector are essential in identifying and developing appropriate interventions.

Don't assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy.

Low health literacy populations have difficulty understanding health information and making appropriate health decisions. Pharmacists need to ensure patients have a basic understanding of how to take their medications and understand the risks and benefits of their prescriptions. To explore the major challenges low health literate adults face when trying to understand their medication therapy. One-on-one semi-structured interviews were used to gather data on the major challenges low health literate adults face regarding their medication. Each interview began with a verbal health literacy assessment, followed by open-ended questions focused on medication information. After each interview was complete, a written health literacy assessment was given in English, which was later used to compare self-assessed health literacy to written health literacy scores. All interviews were audio-recorded, transcribed and analyzed using thematic analysis. The population sample had an average age of 67 years old and 90% had been education outside of North America. Low health literacy levels were found in 75% of participants based on the S-TOFHLA and demonstrated a generally over estimated self-assessed health literacy levels. After thematic analysis, a flow chart that describes the low health literate population's pharmacy experience with medication information was developed to explain the cause and effect of challenges faced with current pharmacy medicationinformation. Also, the major challenges patients with low health literacy face with current medication information from the pharmacy were limited time with pharmacists, understanding medication information, forgetting to take medication, side effects and food-drug interactions. Future interventions targeted to improving pharmacy medication information for the low health literate population should focus on addressing the challenges with limited time with pharmacists, poor understanding of medication information, forgetting to take medications, side effects and food instruction/interactions.

A pilot test of the acceptability and efficacy of narrative and non-narrative health education materials in a low health literacy population

Although entertainment-education narratives are increasingly being used to communicate health information to a diversity of populations, there is limited evidence examining the use of narrative health education videos in low compared with adequate health literacy populations. There are also very few studies directly comparing narrative materials to more traditional, non-narrative materials. Because individuals with low health literacy are less likely than those with adequate health literacy to benefit from health communication interventions, it is especially important to develop an evidence base supporting the use of narrative health education materials in low-literacy populations. This study extends knowledge on the use of narrative health education materials in populations with low health literacy by conducting a randomized trial comparing the acceptability and efficacy (knowledge gain) of two fact-equivalent films, one in a narrative and one in a non-narrative format, on individuals with adequate and low health literacy. This study finds that while both films were well-accepted and produced knowledge gains, the narrative film was more effective in this regard. This effect occurred regardless of health literacy level, indicating that narrative health communication materials are appropriate for individuals with low health literacy and do not exacerbate existing health disparities. These findings add to a small but growing body of evidence testing narrative health education materials in individuals with low health literacy, and provide new evidence supporting narrative, entertainment-education style video as a health communication tool to help reduce health literacy-related health disparities.

Does Mind Exist in Physician’s Mind? A Brief Phone Survey in Bangladesh

Mental health literacy (MHL) has been defined as the knowledge, beliefs and abilities that enable the recognition, management or prevention of mental health problems. From history of demonic procession concept to modern neuroscientific explanation is the outcome of advancement in mental health literacy. It’s now evidence that, neural connections that form networks and circuits in the brain are essential to the existence of the mind. The health infrastructure doesn’t included mental health concept yet in service delivery system in developing part of glove. Medical education in under graduation level is still dominantly focused on physical health. Computer assisted telephone interview (CATI) is a modern method of phone survey and globally many survey done to explore the mental health literacy in population. Prior conventional broad based study; it was a snapshot of current scenario of knowledge among physicians. It was a cross sectional phone survey among physicians in three hospitals at Dhaka city in Bangladesh. Though almost 60% of physicians said that they know the seat of mind in the body, 11% of them said “Heart” is the anatomical location. The prevalence of mental disorders is 18% in child adolescents and 16% among adults in Bangladesh. To combat the situation, sound knowledge of mind, mental health and mental illness is mandatory in physician community. In future, further exploration of mental health literacy MHL could be helpful to detect the gap and to formulate an effective mental health service system.

Improving health literacy in refugee populations.

Improving health literacy in refugee populations.

Role of Dietary Components in Modulating Hypertension.

Hypertension is a major health issue, particularly in medically underserved populations that may suffer from poor health literacy, poverty, and limited access to healthcare resources. Management of the disease reduces the risk of adverse outcomes, such as cardiovascular or cerebrovascular events, vision impairment due to retinal damage, and renal failure. In addition to pharmacological therapy, lifestyle modifications such as diet and exercise are effective in managing hypertension. Current diet guidelines include the DASH diet, a low-fat and low-sodium diet that encourages high consumption of fruits and vegetables. While the diet is effective in controlling hypertension, adherence to the diet is poor and there are few applicable dietary alternatives, which is an issue that can arise from poor health literacy in at-risk populations. The purpose of this review is to outline the effect of specific dietary components, both positive and negative, when formulating a dietary approach to hypertension management that ultimately aims to improve patient adherence to the treatment, and achieve better control of hypertension.

Factors associated with cervical cancer screening in a safety net population.

AIMTo identify factors associated with Papanicolaou-smear (Pap-smear) cervical cancer screening rates in a safety net population.METHODSFrom January 2012 to May 2013, the use of Pap-smear was determined for all patients seen at the breast clinic in a safety net hospital. Health literacy assessment was performed using the validated Newest Vital Sign. The records of patients were reviewed to determine if they had undergone Pap-smears for cervical cancer screening. Sociodemographic information was collected included age, education, monthly income, race/ethnicity, employment, insurance status, and primary care provider of the patient. Logistic regression analysis was then performed to determine factors associated with utilization of Pap-smears. Crude and adjusted odds ratios derived from multivariate logistic regression models were calculated as well as the associated 95%CIs and P-values.RESULTSOverall, 39% had Pap-smears in the prior 15 mo, 1377 consecutive women were seen during the study period and their records were reviewed. Significantly more patients with adequate health literacy underwent Pap-smears as compared to those with limited health literacy (59% vs 34%, P < 0.0001). In multivariate analysis, patients with adequate health literacy, younger patients, and those with later age of first live birth were more likely to undergo Pap-smears. Patients whose primary care providers were gynecologists were also significantly more likely to have Pap-smears compared to other specialties (P < 0.0001). Patients younger than 21 years or older than 65 years underwent screening less frequently (11% and 11%, respectively) than those 21-64 years (41%, P < 0.0001). Race, ethnicity, language, and insurance status were not associated with Pap-smear screening rates.CONCLUSIONPatient health literacy and primary care physician were associated with Pap-smear utilization. Development of interventions to target low health literacy populations could improve cervical cancer screening.

Toward population health literacy, wellbeing, consumer engagement, and information exchange: Developing Omaha System icons for digital platforms

In the digital age, it is critical for both healthcare professionals and consumers to electronically express, receive, and processimportant health information. This is especially true for populations with language barriers and low literacy. Visual literacy andhealth literacy enable optimal health communication and wellbeing. A standardized interface terminology is a linguistic tool thatcan be used to convey health information at the human-computer interface. The Omaha System has been evaluated and foundto be a promising standard for use as a simple, standardized terminology that may promote health literacy and communicationbetween healthcare professionals and consumers. However, a method for visually representing health concepts described by theOmaha System has not been developed. The purpose of this study was to develop a complete set of 42 icons that convey themeaning of each of the 42 Omaha System problem concepts as defined by Martin (2005). Design thinking, universal designmethods, and informal survey evaluations were used to determine appropriate imagery for the icons. Data-based revisions wereincorporated after each of three informal survey evaluations. The resulting set of 42 icons for Omaha System problem concepts isavailable in the public domain. Future plans are to conduct extensive global evaluation of concept validity and usefulness of theicons across literacy levels.

The effectiveness of health literacy interventions on the informed consent process of health care users: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The aim of this systematic review is to establish the best available evidence of the effectiveness of health literacy interventions on the informed consent process for health care users. The specific review question is: What is the effectiveness of health literacy interventions on health care users' informed consent to health procedures processes? INCLUSION CRITERIA Types of participants This review will consider all studies that include adults (18 years or over) receiving care or adults who are proxies of incompetent health care users or of children (parents or guardians) who have been actively involved in an informed consent process regarding health care procedures. Participants may be healthy or may have any kind of physical disability, be recruited in any type of health care environment, including acute (hospital), primary care, psychiatric and aged care, in any health specialty, including medicine, dentistry and pharmacy. Studies whose participants have cognitive impairment will be excluded. Studies on informed consent processes for research participants will be also excluded. Types of intervention(s) The interventions, methods, and strategies will be included if: - they aim to improve the informed consent process related to health issues among health care users or their proxies, - they are designed taking into consideration health literacy as a main concept, and - the intervention is provided by any health care provider. Such interventions my focus on either the material provided (e.g. readability, processability), or the supportive procedure of informed consent (e.g. video) in order to decrease the health literacy TRUNCATED AT 250 WORDS

A mismatch between population health literacy and the complexity of health information: an observational study.

Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these. An English observational study comparing health materials with national working-age population skills. Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified. The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described. Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text + numeracy; 2515/5795 participants (43%) were below the text-only threshold, while 2905/4767 (61%) were below the text + numeracy threshold. Univariable analyses of social determinants of health showed that those groups more at risk of socioeconomic deprivation had higher odds of being below the health literacy competency threshold than those at lower risk of deprivation. Multivariable analysis resulted in some variables becoming non-significant or reduced in effect. Levels of low health literacy mirror those found in other industrialised countries, with a mismatch between the complexity of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals' communication, and improving written health information.

A critical review of population health literacy assessment.

BackgroundDefining health literacy from a public health perspective places greater emphasis on the knowledge and skills required to prevent disease and for promoting health in everyday life. Addressing health literacy at the community level provides great potential for improving health knowledge, skills and behaviours resulting in better health outcomes. Yet there is a notable absence of discussion in the literature of what a health literate population looks like, or how this is best assessed.DiscussionThe emphasis in assessing health literacy has predominantly focused on the functional health literacy of individuals in clinical settings. This review examines currently available health literacy assessment tools to identify how well suited they are in addressing health literacy beyond clinical care settings and beyond the individual. Although public health literature appears to place greater emphasis on conceptualizing critical health literacy, the focus continues to remain on assessing individuals, rather than on health literacy within the context of families, communities and population groups. When a population approach is adopted, an aggregate of individual health literacy assessment is generally used. Aggregation of individual health literacy fails to capture the dynamic and often synergistic relationships within communities, and fails to reflect societal influences on health knowledge, beliefs and behaviours.We hypothesise that a different assessment framework is required to adequately address the complexities of community health literacy. We assert that a public health approach, founded on health promotion theories provides a useful scaffold to assess the critical health literacy of population groups. It is proposed that inclusion of community members in the research process is a necessary requirement to coproduce such an appropriate assessment framework.SummaryWe contend that health literacy assessment and potential interventions need to shift to promoting the knowledge and skills essential for critical health literacy at a societal level. The challenge for researchers is to negotiate the myriad of complexities associated with each concept and component required for this task.

Defining, measuring and improving health literacy

Objective This paper provides an overview of current research and debate about the definition and measurement of health literacy, and the use of different health education methods to improve health literacy in populations. Definition and measurement Health literacy describes a person’s ability to perform knowledge-based literacy tasks (understanding and using information) that are required to make health related decisions in a variety of different situations. These cognitive and social skills are content and context specific, and are greatly influenced by a person’s age and stage in life. In these circumstances, developing a “universal” population measure of health literacy has been very difficult. Improving health literacy Health literacy can be improved through education and can be regarded as a measurable outcome to health education. As with all forms of education, significant differences in educational methods, media and content will result in different learning outcomes. Improving health literacy involves both the transmission of health information, and support to develop confidence to act on that knowledge. This will best be achieved through more per sonal forms of communication, and through community based educational outreach. Conclusions Applying the concept of health literacy in this way will support more comprehensive options for health improvement, disease prevention and more successful disease self-management among individuals with established illness. However, these approaches are less well tested through systematic research than work in clinical settings and further research is needed to develop the empirical basis for the concept. (HEP. 2015; 42: 450-455.)

Adult Oral Health Literacy Among Urban And Peri-Urban Population In And Around Chennai, India - A Comparative Study

ABSTRACT Aim Poor oral health literacy can impede one's ability to seek oral health and make appropriate oral health care decisions. The study was conducted with an aim to assess and compare the oral health literacy among urban and peri-urban adult population in Chennai, India. Materials and Methods A cross sectional study was conducted among 100 subjects each selected from peri-urban and urban areas in Chennai city. The oral health literacy was assessed by administering the Rapid Estimate of Adult Literacy in Dentistry (REALD-30). The data obtained was analyzed using Mann Whitney U test. Results The mean oral health literacy score for peri-urban people was 2.7 ± 1.19 and for urban people was 6.35 ± 2.12 and this difference was statistically significant (z value -10.37, p value - 0.001). Conclusion The oral health literacy of peri-urban adult population was found to be low when compared to the urban population.

Health literacy, source of information and impact on adherence to therapy in people living with HIV.

IntroductionAdequate information and health literacy (HL) has a high impact on patients understanding on the causes and consequences of many chronic diseases, including HIV, and is a crucial prerequisite to ensure adherence to therapy regimens. Several Austrian patient organizations developed an online survey together with MSD (the so-called “PAB-test”) aimed to evaluate how people living with HIV perceive the level of care in Austria.Materials and MethodsAn online survey has been developed to assess HL in people living with HIV and to evaluate the impact of HL on therapy adherence. HL was assessed with seven items regarding the self-rated comprehension of HIV related information, which showed a high reliability (Cronbach's alpha=0.876). A low health literacy was defined by reaching a score below the median of 20 points in the related indicator.ResultsA total of 303 subjects completed the questionnaire. Women slightly had more often a low HL than men (57.1% vs 44.7%, p=0.335). Heterosexual subjects had more often a low HL compared to homosexual ones (58.3% vs 38.1%, p=0.007). Health literacy slightly increased with age (not significant). An increasing education level correlated with higher HL, (66.7%, 46.2%, and 38.9% of persons showed low HL with primary, secondary and tertiary education, respectively, p=0.037). The number of missed appointments with the HIV physician was significantly higher in the low HL population (30.0% vs 14.4%, p=0.002), which also showed to be more prone to interrupt the therapy without consulting a physician (22.4% vs 9.8%, p=0.006). The low HL population, however, did not report of having forgotten the medication intake more often than the one with high HL (33.1% vs 39.1%, p=0.305). The most important source of information is the treating physician, followed by NGOs/patient organizations and the internet (Figure 1). ConclusionsThere are significant differences in HL between different sub-groups in the HIV community. Low HL is significantly associated with a higher frequency of missed doctor appointments and interruptions of treatment, but does not impact adherence to therapy (self-reported). The identified information providers (medical doctors, NGOs/patient organizations) should be encouraged to contribute towards increased HL in HIV patients.

English-Spanish Equivalence of the Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT)

Unbiased measurement instruments are needed to reliably estimate health literacy in diverse populations. The study aimed (a) to evaluate measurement equivalence of Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) and (b) to compare Health LiTT scores between English- and Spanish-speaking individuals. Health LiTT and several patient-reported outcome instruments were completed by adult patients receiving care for type 2 diabetes at a safety net clinic. English-Spanish measurement equivalence was evaluated with an item response theory approach to differential item functioning (DIF) detection and impact. Health LiTT scores were compared by language using multivariable linear regression. Approximately equal numbers of English-speaking patients (n = 146) and Spanish-speaking patients (n = 149) with type 2 diabetes were enrolled. English participants were primarily non-Hispanic Black (65%); all Spanish participants were Hispanic. Six Health LiTT items were flagged for DIF. The Pearson correlation between unadjusted and DIF adjusted scores was 0.995; the mean difference of individual difference scores was 0.0005 (SD = 0.0888). After adjusting for predisposing characteristics, enabling resources and need for care, Health LiTT scores were comparable for Spanish-speaking individuals versus English-speaking individuals. The effect of DIF items on Health LiTT scores appeared to be trivial. English-Spanish equivalence of Health LiTT will permit researchers to determine the independent effects of limited English proficiency and limited literacy.

Path analysis to identify factors influencing health skills and behaviors in adolescents: a cross-sectional survey.

BackgroundStudies conducted in the past mostly rely on models of functional health literacy in adult populations. However, such models do not satisfy the need for health intervention in adolescents. The identification of key factors influencing adolescents' health literacy is essential in developing effective prevention and intervention measures. This study aimed to test a theoretical model of predictors on health skills and health behaviors in adolescents.MethodsA cross-sectional survey was conducted in Guangdong using a multi-stage stratified cluster sample design. A representative random sample of 3821 students aged 13–25 years was selected using multi-stage stratified cluster sampling. The path analysis was used to test a hypothesized model of health literacy.ResultsThe path analysis showed that knowledge of infectious disease (β = 0.26), health skills (β = 0.22), health concept (β = 0.20), general health knowledge (β = 0.15), gender (β = 0.12), and school performance (β = 0.06) had positive direct effect on health behaviors in adolescents. The explanatory variables accounted for 43% of the variance in explaining health behaviors. Knowledge of infectious disease (β = 0.30), health concept (β = 0.17), general health knowledge (β = 0.13), and school performance (β = 0.05) had positive indirect effect on health behaviors through the impacts on health skills.ConclusionThis study identified several direct and indirect factors influencing health skills and health behaviors in adolescents. These findings will assist health professionals designing effective health interventions that aim to improve health skills and health behaviors in adolescents.

Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services.

BackgroundCardiovascular diseases (CVD) are leading causes of mortality and morbidity among Indigenous people in New Zealand, Australia and Canada and are a major driver of the inequities in life expectancy between Indigenous and non-Indigenous people in these countries. Evidence-based pharmaceutical management of CVD can significantly reduce mortality and morbidity for persons diagnosed with CVD or for those at intermediate or high risk of CVD. Health literacy has been identified as a major barrier in the communication and implementation of appropriate pharmaceutical management plans for CVD. Addressing health literacy is particularly relevant in Indigenous populations where there are unique health and adult literacy challenges.Methods/designThis study will examine the effect of a customized, structured CVD medication programme, delivered by health professionals, on the health literacy of Indigenous people with, or at risk, of CVD. Primary outcomes are patient’s knowledge about CVD medications; secondary outcomes examine changes in health literacy skills and practices. The study will employ a multi-site pre-post design with multiple measurement points to assess intervention efficacy. Participants will be recruited from four Indigenous primary care services in Australia, Canada and New Zealand. Three educational sessions will be delivered over four weeks. A tablet application will support the education sessions and produce a customized pill card for each participant. Participants will be provided with written information about CVD medications. Medication knowledge scores, and specific health literacy skills and practices will be assessed before and after the three sessions. Statistical analyses will identify significant changes in outcomes over each session, and from the pre-session one to post-session three time points.DiscussionThis study will make an important contribution to understanding the effect of a structured primary care-based intervention on CVD health literacy in Indigenous populations. The study also illustrates the incorporation of Indigenous health research principles and processes in clinical trials and provides insights that may be useful in other contexts.Trial registrationAustralian and New Zealand Clinical Trials Register (ACTRN12612001309875; date of registration 18/12/2012).

Measuring health literacy in caregivers of children: a comparison of the newest vital sign and S-TOFHLA.

We examined the performance of the Newest Vital Sign (NVS) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA) in caregivers of children. Caregivers of children ≤12 years old seeking care for their child in a pediatric emergency department (ED) were tested using the NVS and the S-TOFHLA to measure health literacy. The results were compared with ED use outcomes. The S-TOFHLA was found to have a ceiling effect as compared to the NVS; few caregivers scored in low literacy categories (P < .0001). This finding was demonstrated in both lower (P = .01) and higher (P < .001) educational attainment groups. The NVS was predictive of ED use outcomes (P = .02 and P < .01) whereas the S-TOFHLA was not (P = .21 and P = .11). The measures do not seem to function similarly nor predict health outcomes equally. The NVS demonstrates sensitivity in identifying limited health literacy in younger adult populations.

Uncovering health literacy: Developing a remotely administered questionnaire for determining health literacy levels in health disparate populations.

Low health literacy contributes to health disparities. We sought to develop and evaluate a remotely administered tool to measure health literacy in health disparate populations. The basic research design involved asking the remotely administered questions in conjunction with an existing and valid measure of health literacy, the S-TOFHLA, to a non-representative convenience sample of individuals drawn from lower income communities. The measures of the remotely administered questions were then correlated with the results of the S-TOFHLA to determine if there was a connection between the two measures. We found a statistically significant correlation between a single question in the remotely administered survey and the validated S-TOFHLA measure. This research supports previous work that points to the importance of just a single remotely administered question in terms of correspondence with the S-TOFHLA. Develop a questionnaire that can be remotely administered to check for Health Literacy. Correlation analysis is conducted between various questions and S-TOFHLA scores to determine criterion validity. A single question, "How confident are you in filling out medical forms by yourself?" outperforms other measures in correlating with the S-TOFHLA scores. Further assessment of the confidence question both in isolation and in conjunction with other literacy identifiers should be conducted. Also, this question should be tested against other measures of health literacy beyond the S-TOFHLA.

당뇨교육자료 자료의 이독성과 적합성 평가

The aim of this study was to evaluate the readability and suitability of patients' education materials on DM. A total of 34 materials on DM from public health centers, general hospitals, and internet web sites were evaluated for readability by 'graded system of vocabulary', and suitability by 'The Korean version of SAM(Suitability Assessment of Materials)'. On the average, 28.3% of 1st grade reading level words, 27.1% of 5th grade level and over were included in educational materials. For suitability, 6(17.6%) were judged superior, 20(58.8%) adequate, 8(23.6%) inadequate. The reading level of the materials was higher than the recommended reading level(6th grade reading level). For suitability, most of materials were inadequate in some of items such as 'summary or review included', 'context given', 'interaction used'. It is proposed that in the development of patients' educational materials, health literacy of target population should be considered.