Health Literacy In Population Research Articles

Addressing Mental Health Literacy in a UK university campus population: Positive replication of a Canadian intervention

Objectives: Mental health concerns on university campuses are increasing in the UK. Improving mental health literacy (MHL) for students may be a useful part of an integrated approach to effectively address these concerns. This study evaluated a previously demonstrated effective Canadian campus MHL resource in a UK student sample. Design: This cross-sectional study conducted on one UK campus reports on student’s opinions about the impact of the Transitions (2nd edition) resource as well as applying a standard measure of MHL. Methods: Online survey using a convenience sample of students during semester 1 conducted over a 1-week period at a large UK university. Results: Use of Transitions (2nd edition) improved student self-reported mental health knowledge, decreased stigma and increased help-seeking intent. Significant ( p < .05) improvement in a standard MHL assessment was also found. Conclusions: These results suggest that the Transitions resource may be a helpful intervention in addressing student mental health in a UK university campus setting.

Measurement of health literacy in patients with cardiovascular diseases: A systematic review.

While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.

Quantifying OHIP in the Context with Oral Health Literacy in Rural and Urban Population

The present study was undertaken to assess the knowledge and awareness of oral health literacy among rural and urban people and to correlate it with the oral health-related quality of life (OHRQoL). The present study was conducted among the rural and urban population visiting the outpatient department. The study questionnaire was used to assess oral health literacy and these questions were framed based on the various aspects like general demographics, dental visit, and dentition status. A validated questionnaire to record the oral health impact profile (OHIP) was used to assess the quality of life. Further, the rapid estimate of adult literacy in dentistry-30 (REALD-30), the word recognition test, was used to assess oral health literacy. Out of 1,000 participants, 500 were from the urban population and 500 from a rural area. The mean age of participants in the rural and urban population was 32.22 ± 10.66 and 30.43 ± 10.3, respectively. The mean score of OHIP in rural and urban participants was found to be 6.46 ± 6.815 and 6.34 ± 8.492, respectively. The mean score of REALD-30 in rural and urban participants was found to be 12.88 ± 7.214 and 20.9 ± 7.334, respectively. Results suggest that dental health literacy have an independent effect on dental health outcomes.

The WHO European Action Network on Measuring Population and Organizational Health Literacy: perspectives for the participation of the Russian Federation

The WHO European Action Network on Measuring Population and Organizational Health Literacy: perspectives for the participation of the Russian Federation

Levels of understanding of the rules of correct medical usage among vietnamese pharmacy students: a cross-sectional study.

SummaryBackgroundComprehensive misunderstanding about medicine usage is often associated with high treatment risks which have led to unexpected and adverse effects or even death. Many researches assessing health literacy have been undertaken, but only in adults. This study was undertaken to evaluate the level of understanding in students of medical terms and its correlation with gender, grade and parental occupation.MethodsA cross-sectional study was conducted from September to October 2017 with 594 students (28.6% of men and 71.4% of women) of Hanoi University of Pharmacy from freshman to fifth-year students chosen randomly. The knowledge of pharmacy students was assessed by a questionnaire including 25 medical terms. Descriptive statistics and Chi-square test were used with p < 0.05 as level of statistical significance.ResultsThe level of understanding of students was high with most of medical terms reaching over 70% correct answers. A positive significant association between health literacy and education was found with higher knowledge demonstrated in upper years, while there was no difference among students with and without parents belonging to the medical field. Regarding the relation with gender, there was no significant correlation for most medical terms.ConclusionsLevels of understanding of medical terms in pharmacy students was high, presenting a significant association with education. This study should be extended in order to assess the level of health literacy in various populations, thereby indirect evaluating implementation of medical preventive programs.

IUHPE Position Statement on Health Literacy: a practical vision for a health literate world

The International Union for Health Promotion and Education (IUHPE) Position Statement on Health Literacy provides an overview of existing evidence and continuing debate on health literacy. Developed by the IUHPE Global Working Group on Health Literacy, including experts from around the globe, the Statement provides a basis for discussion and advocacy, by and with IUHPE, both within the health promotion community, and among stakeholders and partners in health promotion. The Statement offers a detailed introduction to the concept of health literacy, calling for global action to improve health literacy in populations. It positions health literacy as an important and modifiable social determinant of health, that plays a significant role in broadly-based strategies for health promotion. The Statement emphasises the necessity of a systems approach to health literacy, underpinned by global, national, regional and local policies. It summarises key evidence to guide practice and policy development, recognising the importance of continued investment in intervention research, in professional and consumer capacity building, and in the transfer of research findings into frontline health promotion practice. In summary, health literacy is understood as an important cross-cutting issue in health promotion throughout the lifespan, which has practical application in guiding clinical practice, public health interventions and public policy for the advancement of global health.

Lung cancer screening: assessment of health literacy and readability of online educational resources

BackgroundLung cancer screening can reduce mortality but can be a complex, multi-step process. Poor health literacy is associated with unfavorable outcomes and decreased use of preventative services, so it is important to address barriers to care through efficient and practical education. The readability of lung cancer screening materials for patients is unknown and may not be at the recommended 6th grade reading level set by the American Medical Association. Our goals were to: (1) measure the health literacy of a lung cancer screening population from an urban academic medical center, and (2) examine the readability of online educational materials for lung cancer screening.MethodsWe performed a retrospective cross sectional study at a single urban academic center. Health literacy was assessed using three validated screening questions. To assess the readability of educational materials, we performed a Google search using the phrase, “What is lung cancer screening?” and the Flesch-Kincaid Grade Level (FKGL) formula was used to estimate the grade level required to understand the text.ResultsThere were 404 patients who underwent lung cancer screening during the study period. The prevalence of inadequate/marginal health literacy was 26.7–38.0%. Fifty websites were reviewed and four were excluded from analysis because they were intended for medical providers. The mean FKGL for the 46 websites combined was 10.6 ± 2.2.ConclusionsLow health literacy was common and is likely a barrier to appropriate education for lung cancer screening. The current online educational materials regarding lung cancer screening are written above the recommended reading level set by the American Medical Association.

From the Health Literacy Survey Europe (HLS-EU) to Measuring Population and Organizational Health Literacy (M-POHL)

The HLS-EU project (2009-2012) supported by EU-SANCO for the first time measured health literacy of general populations with a comprehensive concept and instrument comparatively in 8 European member states. This led to WHOs publication The solid facts – Health Literacy (2013) and a number of further countries used the HLS-EU concept, instrument and study design. To enable standardized benchmarking between member states WHO-Europe initiated under its umbrella of the European Health Indicator Initiative (EHII) the Action Network on measuring population and organizational health literacy (M-POHL). Within this network more than 20 countries are preparing a next European Health Literacy Survey for 2019. Furthermore the network will work on concept and measurement instruments for assessing organizational health literacy in health care and beyond. The input will give an overview on the planned activities of the M-POHL network.

Focus on health literacy, lifestyle, and health care of Roma population in Pleven region, Bulgaria

Focus on health literacy, lifestyle, and health care of Roma population in Pleven region, Bulgaria

From the Health Literacy Survey Europe (HLS-EU) to Measuring Population and Organizational Health Literacy (M-POHL)

From the Health Literacy Survey Europe (HLS-EU) to Measuring Population and Organizational Health Literacy (M-POHL)

9.G. Round table: Health workforce meets health services research

Aim The aim of this round table is to provide an overview of important recent insights and developments in the domain of health literacy research and policy in Europe. The implications for research, policy and practice will be discussed with the audience. There will be five short presentations: 1. Quick scan of health literacy developments in Europe in the past five years. Jany Rademakers, PhD, Head research department Nivel, Utrecht, Professor Health literacy and patient participation, CAPHRI, Maastricht University, the Netherlands. 2. Health literacy in Childhood and Adolescence; main consortium findings. Orkan Okan, PhD., Senior researcher, project manager HLCA, University of Bielefeld, Germany. 3. From the Health Literacy Survey Europe (HLS-EU) to Measuring Population and Organizational Health Literacy (M-POHL). Jurgen M. Pelikan, PhD Professor em. sociology (University of Vienna), Director, Competence Center Health Promotion in Hospitals and Health Care, at Gesundheit Osterreich GmbH (Austrian Public Health Institute). 4. The development of the social movement of health literacy in Europe and beyond. Kristine Sorensen, PhD, Global Health Literacy Academy, Denmark. 5. Towards holistic health literacy policies in Europe; results of a recent WHO evidence synthesis. Gill Rowlands, PhD, Professor of General Practice, Newcastle University, UK . Key messages: Health literacy is an important public health asset. Health literacy policies should be targeted at different levels and areas of society.

The association between quality of life(QOL) and health literacy among junior middle school students: a cross-sectional study

BackgroundLower health literacy is associated with poor quality of life (QOL) among patients with chronic disease; little is known about this relationship among the general population, especially for child and adolescent. To fill this gap, this paper aimed to investigate the association between health literacy and QOL in junior middle school students, and explore how QOL varies by health literacy.MethodsAn anonymous cross-sectional survey was conducted among junior middle school students (aged 12–15) from Shapingba district, Chongqing in China, and participants were recruited using stratified cluster sampling. Health literacy and QOL were measured using two validated scales, and quantified using a five-point Likert scale with health literacy classified as low, medium, or high. We used multivariable logistic regression to test adjusted association between health literacy and QOL.ResultsA total of 1774 junior middle school students were evaluated, with the mean age was 13.8 ± 1.0 and of whom 905 (51.0%) were male. About 25.5% of the research subjects had a low health literacy. When controlling for age, grade, family structure and other covariates, highest discrimination was found among participants with low to high health literacy. Overall, Students who equipped with higher health literacy was associated with greater QOL (P < 0.01), and this discrimination remained significant in subscales: physiological well-being (P < 0.01), mental well-being (P < 0.01), social well-being (P < 0.01) and pubertal well-being (P < 0.01).ConclusionsThe prevalence of low health literacy among junior middle school students in Chongqing area was relatively high, and inadequate health literacy may contribute to poorer QOL among junior middle school students. It merits further longitudinal studies to confirm the impact of health literacy on QOL. Overall, to improve students’ QOL, public health efforts for further improving awareness and enhancing effective promotion and education are urgently needed in junior middle school students, especially for low health literacy populations.

Health literacy and quality of life following rectal resections for cancer

Background: Health literacy can be a stronger predictor of an individual’s health status than income, employment status, education level, and racial or ethnic group. The prevalence and impact of low health literacy in the rectal cancer patient population has received little attention. This study is a cross-sectional population survey to determine if there is a relationship between health literacy and quality of life in rectal cancer patients.Methods: All rectal cancer patients having a clinical encounter with the Colorectal Unit at Westmead Hospital will be invited to participate in the study. Two validated health literacy screens (REALM-SF and NVS) were administered along with the EORTC QLQ-C30 quality of life assessment. The association between health literacy and quality of life will be examined using Spearman regression.Results: 92 patients were recruited between March 2015 and July 2016. A significant proportion of our patients were found to have low health literacy (29.3 percent and 54.5 percent as measured by the REALM-SF and NVS, respectively). The mean QLQ-C30 summary score was 71.5 and the mean global health score was 69.4 (SD 23.3). There appeared to be no statistically significant correlation between health literacy and quality of life in our study. There was a moderately positive correlation between the NVS and REALM-SF (rho = 0.36, P &lt;0.001).Conclusions: A significant proportion of our patients that have had rectal resections for cancer have low health literacy. We have not been able to demonstrate an obvious association between health literacy and quality of life in the present study.

Association of Oral Health Literacy and Dental Visitation in an Inner-City Emergency Department Population.

To examine the association between oral health literacy (OHL) with sociodemographic variables and dental visitation in adults presenting to an urban emergency department (ED). Methods: This was a cross-sectional study of a convenience sample of 556 adults aged 18–90. Interview data from the study were used to collect self-reported sociodemographic characteristics and dental visitation history. The OHL of the study participants was measured using the Health Literacy in Dentistry scale (HeLD-14), and the score was dichotomized into low and high OHL. Bivariate associations between sociodemographic variables and OHL were conducted using chi-square tests, and logistic regression was used to examine the association between OHL and dental visitation within the past year. Results: Sixty percent of participants reported having visited a dentist within the past year. Over two-thirds of the sample was classified as having low OHL. Low OHL was more common in non-White races, less-educated, single, unemployed, and lower-income individuals, and those without a primary care physician or dental insurance (p < 0.05). Patients with low oral health literacy were 39% less likely to have visited the dentist in the past year (OR = 0.61; 95% CI 0.38, 0.96). Conclusions: This study highlights significant disparities in OHL. Interventions targeted toward the unique needs of underserved populations should be developed to improve health outcomes.

Qualitative exploration of critical health literacy among Afghan and Congolese refugees resettled in the USA

Objectives: Previous research that revealed a high prevalence of low health literacy among immigrants and refugees tended to over emphasise functional health literacy as a risk factor for low health status and poor disease management. Despite a significant knowledge gap, little has been investigated regarding critical health literacy (CHL) in refugee populations whose culture deeply interweaves individual and contextual capacity to promote health. Design: This study adopted a qualitative approach to explore CHL that is built through community health workshops (CHWs) with Afghan and Congolese refugee communities in US resettlement. Setting: As part of a community-based participatory research project, the study was conducted with Afghan and Congolese refugees resettled in the USA. Method: A series of open-ended questions for focus group interviews were embedded in each workshop session explore health literacy skills and capacity over time. This study adopted a hybrid thematic design whereby the conceptual framework of CHL was applied to emergent themes from the data. Results: Thematic analysis revealed four major CHL thematic domains, as experienced and demonstrated by Afghan and Congolese refugee participants: (1) critical appraisal, (2) self-efficacy and confidence, (3) empowerment, and (4) collective problem solving. Conclusion: Study findings underline the importance of health education validating existing cultural knowledge and practices in a group setting so as to facilitate the building and enhancement of social support systems and community action for health promotion.

Progress in Implementing National Policies and Strategies for Health Literacy-What Have We Learned so Far?

Health literacy has been a prominent issue on the agenda of the World Health Organization (WHO) for almost two decades. WHO recently established a strong global mandate for public policy action on health literacy by positioning it as one of three key pillars for achieving sustainable development and health equity in the Shanghai Declaration on Health Promotion. Several countries have national health literacy policies, with many others expected to develop them in the immediate future. It is, therefore, timely to examine current policy approaches to health literacy. The purpose of this study was to analyze a selection of existing policy documents for their strengths, limitations and themes, and offer observations about their potential to improve health literacy and health outcomes. In doing so our intention is to offer lessons and advice from early adopters that will have usefulness for future policy development and implementation. We selected six policies for review; Australia, Austria, China, New Zealand, Scotland, and the United States. We used a set of criteria to guide a systematic analysis of policy documents for their context, intended target audiences, objectives, proposed actions and interventions, evidence of financial investment and intentions to monitor outcomes. We observed a number of common features that provide helpful signposting for future policy development in other countries. All represent a response to perceived deficiencies in the quality of patient communication and patient engagement. Most present health literacy as a universal challenge, with some also identifying groups who are of higher priority. They all recognize the importance of professional education in improving the quality of communication, and most recognize that the health literacy responsiveness of the health system needs to be improved. However, there was significant variability in linking resources to specific strategies and actions, as well as in the systems for monitoring progress and accountability for progress. This variability reflects important contextual differences between countries and health systems. However, this lack of specificity will likely have an impact on the priority given to improving health literacy and on the long-term sustainability of defined actions to improve health literacy in populations.

Validation of the Cancer Health Literacy Test-30 for Populations Without Cancer.

Background:Cancer incidence continues to be common and highly consequential for future cancer patients, family members, and other untrained caregivers. Because low health literacy increases the likelihood of poor health outcomes, those with low health literacy would benefit from interventions to improve cancer health literacy.Objective:Our study was designed to address the need for measuring cancer health literacy in populations without cancer.Methods:The Cancer Health Literacy Test-30 (CHLT-30) was psychometrically tested on 512 people without a cancer diagnosis.Key Results:In this population without cancer, the CHLT-30 had strong psychometric properties including unidimensional measurement structure, high reliability, and invariant measurement between gender, race/ethnicity, and educational-attainment groups.Conclusion:These results support the use of the CHLT-30 to measure cancer health literacy in research studies of family members of people with cancer or the general public. The potential for using the CHLT-30 in clinical practice to assess the need for education for general patient and cancer patient populations is a future direction. [HLRP: Health Literacy Research and Practice. 2018;2(2):e58–e66.]Plain Language Summary:Psychometric evidence suggests that the CHLT-30, originally developed for cancer patients, can be used to measure cancer health literacy of individuals with no history of cancer as well.

Short Assessment of Health Literacy (SAHL) in Portugal: development and validation of a self-administered tool.

The goal of this study was to adapt, improve and validate a short, self-administered health literacy assessment tool for European Portuguese-speaking adults. Health literacy tools are of great importance to health authorities and professionals, as low or inadequate health literacy, that is, a limited capacity to handle health-related information, is associated with higher morbidity and mortality. The 18-item Short Assessment of Health Literacy for Brazilian Portuguese-speaking adults (SAHLPA-18) was adapted into European Portuguese. The European Portuguese tool (SAHLPA-23) includes five additional items. The SAHLPA-23 was tested in a convenience sample of 503 participants from two Portuguese regions. Socio-demographic data, literacy and cognitive indicators were collected. Participants also completed a questionnaire on comprehension of written health materials. Construct validity was assessed through correlations between SAHLPA-23 scores and education, literacy, and cognitive variables and score on the comprehension questionnaire. The psychometric properties of the new tool were compared with those of the SAHLPA-18. The mean SAHLPA-18 and SAHLPA-23 scores were 13.9 (77.2%; SD=2.9) and 18.3 (79.6%; SD=3.8), respectively. Both tools showed adequate reliability (Cronbach's α>0.7). SAHLPA-23 was more highly correlated with all study variables than SAHLPA-18. Although both instruments displayed acceptable discriminative power, SAHLPA-23 had better accuracy than SAHLPA-18 (DeLong's method: ΔAUC=0.09, Z=3.36; P<0.001). The SAHLPA-23 is an independent, feasible and innovative tool for estimation of health literacy in the Portuguese adult population.

Abstract P4-11-04: Talking about risk in the context of GEomic profiling tests (TARGET)

Abstract Background: Risk of recurrence scores from genomic profiling tests such as OncotypeDX® and EndoPredict® are being used increasingly with other clinico-pathologic features to help determine the likely benefit of adjuvant chemotherapy in early stage breast cancer. Decision-making requires the balancing of likely absolute benefits in terms of preventing recurrence versus the treatment related side effects. Health literacy and numeracy skills in the general population are often poor thus explaining risk and uncertainty can be confusing especially when set against a backdrop of fear and anxiety. As clinicians are facing more of these types of conversations with their patients we developed an educational program to help when discussing genomic test results. Methods: The development of the educational package followed discussions with key clinicians who routinely used genomic profiling tests, clinician-scientists and a review of the risk literature. We mapped out the difficulties they encountered when explaining high, intermediate and low risk test results together with the added challenges faced when communicating with patients with different personality and socio-educational characteristics. As clinicians and their patients may both have a measurable intolerance to uncertainty this may contribute irrespective of the recurrence score (RS) to seemingly irrational decisions about treatment. We rehearsed simulated patients (actors) experienced in improvisation to create different characters and filmed unscripted genomic test result consultations with cancer clinicians. This process proved successful in previous educational initiatives aimed at improving communication about clinical trials. (Jenkins et al 2006; Fallowfield et al 2012). Results: The educational package comprises an interview with Professor Mitch Dowsett explaining the science behind gene expression profiling tests, a lecture on the psychology of risk with group exercises and strategies on how to communicate together with 5 filmed scenarios with a timecoded facilitator handbook. The scenarios depicted are based on real clinical situations and demonstrate some of the issues discussing RS with low risk patients who nevertheless wish to have chemotherapy as well as high risk patients who are averse to chemotherapy. Conclusion: Discussions about the logic and rationale behind different treatment recommendations for breast cancer have become increasingly complex. Clinicians need an increased repertoire of communication skills to explain risks and benefits. We are now evaluating the efficacy of TARGET prior to training facilitators to roll the program out. Citation Format: Fallowfield LJ, Jenkins VA. Talking about risk in the context of GEomic profiling tests (TARGET) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-04.

Assessment of health literacy in adult population of Karachi: a preliminary investigation for concept-based evidence

Health literacy is pre-requisite for better health outcomes. Health literacy is an unexplored concept in Pakistan. This study aimed to assess concept-based health literacy level in the adult population of Karachi. A cross-sectional survey was conducted in 2015, the respondents were recruited from three randomly selected towns of Karachi. A multistage random sampling technique was used to recruit 315 adult participants who were interviewed on validated the Health Literacy Survey Questionnaire (HLS-Asia-Q). Basic demographics, responses of each question and health literacy matrix were used to compile the results. The health literacy was limited in the majority (82.4%) of the population. Health Promotion domain scored least on the matrix (24.3±9.8) irrespective of gender, age, education, and profession. Most of the respondents (70%) faced difficulty in finding and understanding health information for their well-being. The health educators (health care professionals) can play a major role in helping to enhance the health literacy and act as an advocate for health education.