Health Literacy Measurement Tools Research Articles

A comparison of health literacy measurement tools in a sample of college students

A comparison of health literacy measurement tools in a sample of college students

Measurements of traditional Chinese medicine health literacy regarding chronic pain: a scoping review

Chronic pain is a prevalent health condition that imposes a significant burden on the global health system. Health literacy is a determinant of the quality of pain management which directly impacts public and individual health. However, the existing health literacy measurements have predominantly focused on medical models stemmed from Western culture and the knowledge of non-Western health models has largely been neglected. This review scopes refereed health literacy publications with regard to traditional Chinese medicine and chronic pain to explore and identify 1) the conceptual basis underlying the development of traditional Chinese medicine health literacy in this area, and 2) measurement tools used in this area and their associated psychometric qualities. Twenty-eight journal articles were assessed and the results showed that most studies’ conceptual frameworks were unable to cover three key health literacy aspects defined by the World Health Organization (access, understand, and apply). Furthermore, the identified health literacy measurement tools generally lacked rigorous psychometric evaluation. Future studies should focus on exploring a comprehensive model that encompasses various health models and developing measurement tools with more culturally representative psychometric assessments.

Generating qualitative evidence of the validity of the Health Literacy Questionnaire Parent

Abstract Background Health literacy refers to the skills needed to access, understand, and navigate health information and services. The Health Literacy Questionnaire (HLQ) is a widely used validated measure of health literacy capturing nine distinct domains. The HLQ-Parent is a recent adaption of the HLQ which has been designed to capture the nuanced health literacy skills required by primary care givers of children. Generating qualitative evidence of validity of such tools is an important element of the validation process as it captures understanding and interpretation of items which is not achievable by quantitative methods alone. Therefore, the purpose of this study was to generate qualitative evidence of the validity of the HLQ-Parent. Methods A qualitative study implementing the HLQ-Parent during face-to-face cognitive interviews with concurrent probing was conducted. Primary carers of children aged 16 or under living in England were recruited via voluntary organisations supporting families. Qualitative data analysis was conducted on the audio recordings in the form of text summaries. Parents’ chosen HLQ-Parent responses were compared to their narrative responses and coded by the researcher as match, no match or unclear. Parents’ narrative responses were also compared to the HLQ-Parent item intent descriptions and coded as concordant, discordant, or unclear. Results Overall, participants (n = 9, mean age 40 years, 88.9% female) narrative responses matched to their chosen HLQ-Parent response, while their narrative responses were concordant with the HLQ-Parent item intent descriptions. Two participants narratives did not match their responses for the item:’ I have enough information to help me deal with my child’s health’. Conclusions The qualitative data provided evidence that participants understood and answered the HLQ-Parent items as intended. Study results contribute validity evidence for the use of HLQ-Parent to measure parental health literacy. Key messages • This study contributes evidence to the validity of the HLQ-Parent. • Qualitative methods provide valuable insights that enhance the overall understanding of health literacy measurement tools.

Public Health Literacy: a concept to develop – Qualitative study among public health professionals

Abstract Background Health literacy can be defined as individuals’ motivation and skills to access, understand, evaluate, and utilize information to make decisions about their health. Despite Sorensen’s widely used definition encompassing both individual and population levels, also known as Public Health Literacy, it remains poorly detailed and is rarely taken into account by measurement tools. As evidenced by the Covid-19 health crisis, limited public health literacy impacts reluctance to accept government recommendations, vaccine hesitancy, and fosters mistrust of science and conspiracy theories in the health field. The main objective of this study was to derive specific public health knowledge and skills from public health professionals for the general population constituted the first step of the development of a public health literacy measurement tools. Methods A qualitative study, based on ten semi-structured interviews with public health professionals from various settings (academic, hospital, health prevention, and promotion), working across various public health fields (nutrition, sexual health, mental health), has been conducted since March 2024. Results Preliminary analysis identified three main themes: (1) fundamental concepts including identification of health determinants, epidemiology and the purpose of public health interventions, (2) critical skills including the assessment of the level of evidence and reliability of public health information, and (3) civic orientation including environmental impact on health and community approach to interventions. Conclusions These detailed insights will guide the creation of a valid measurement tool for public health literacy. This will facilitate the investigation of specific impacts on people’s adherence to public health interventions or messages and the development of actions targeting literacy in a more holistic manner. Key messages • Specific public health dimensions have been identified to enrich the existed definition of health literacy. • Public health concepts, reliability of public health information and community approach constitute the core of public health literacy.

Digital health applications and health literacy: an explorative analysis

Introduction. In 2020, Digital Health Applications (known as DiGA) have been introduced to the German healthcare system. DiGA are medical devices based on digital technologies that can be prescribed by physician and psychotherapists and reimbursed by health insurance companies. DiGA must demonstrate a positive healthcare effect, e.g. by improving of health literacy. Health literacy as a concept has received increasing attention in recent years but has also been subject to a vivid debate on its theoretical underpinning and methodological challenges. Method & Analysis. For this study, all 53 DiGA listed in the official registry were reviewed. We searched the DiGA registry to answer the following research question: do DiGA measure health literacy and which health literacy measurement instruments are applied? Results. Of the 53 DiGA listed, 29 are permanently and 24 provisionally listed in the DiGA directory. Although seven DiGA use health literacy measurement tools, the theoretical or conceptual explanation of these tools and the decision to use them is lacking. Conclusion. This paper argues that there is a need to empirically investigate the motivation of DiGA developers, taking into account the use and non-use of health literacy measurement tools.

Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland.

Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.

A Review of Health Literacy Measurement Tools from the Health Literacy Tool Shed Database

A Review of Health Literacy Measurement Tools from the Health Literacy Tool Shed Database

Prevalence and determinants of health literacy among the adult population of Qatar.

Health literacy (HL) is both a direct determinant and a mediator of health outcomes. Research on the prevalence and determinants of HL in terms of its functional, communicative, and critical domains is scarce in the state of Qatar and its surrounding regions. Thus, this study aims to fill the knowledge gap in this area, estimate the levels of functional, communicative, and critical health literacy among the general adult population, and identify its determinants in the state of Qatar. An analytical cross-sectional study with a disproportionate stratified random sampling technique was conducted in 2022. A representative sample of phone numbers was obtained from the Cerner database at Hamad Medical Corporation and approached via well-trained data collectors. A socio-demographic and health-relevant factor questionnaire and the validated All Aspects of Health Literacy scale (AAHLS) were used to collect the data on functional, communicative, and critical HL and their determinants. Descriptive analysis, independent sample t-test, ANOVA, and linear regression were used and yielded the outcomes on HL levels as low, adequate, and high in percentages and the HL determinants. A total of 770 participants were included. The study found that 41.5%, 29.3%, and 29.2% of them have adequate, high, and low overall HL levels consecutively. People who participated in the study are older adult, are of Arabic ethnicity, are of Qatari ethnicity, have a lower level of education, have close relatives with a lower level of education, have a lower income, are non-migrants, are not living within a family, sought medical care within the last week, and who do not know if they have a chronic disease or do not have lower overall HL levels compared to the other groups. After linear regression analysis, only the participant's level of education and "last time sought medical care within last week" variable predict the overall HL score. Almost half of Qatar's adult population has an adequate HL level, comparable to the HL levels in other regions, despite the limitation in comparison due to variation in context and the HL measurement tools used. The possible determinants are amenable factors to focus on while designing HL interventions and providing healthcare.

Health literacy strengths and challenges of people in New South Wales prisons: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

BackgroundHealth literacy is an important factor for enabling people to manage their health and live long fulfilling lives. People in prison are frequently from marginalised communities, often out of reach of conventional community based health organisations, and have poorer health outcomes. It is essential to understanding the health literacy profiles of people in prison, and its contribution to the well-established health inequities and outcomes of this population. This study aimed to use a multi-dimensional health literacy measurement tool to describe the strengths and challenges of adults incarcerated in NSW prisons.MethodsA cross-sectional survey was conducted for people in prison across 14 publicly operated metropolitan prisons. Data were collected from 471 participants using the Health Literacy Questionnaire (HLQ). Participant characteristics and health conditions were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between participant characteristic groups.ResultsParticipants’ median age was 38.0 (range 19 – 91) years. Males comprised 81% of the sample, 21% identified as Aboriginal and/or Torres Strait Islander, and 53% reported a health problem. People in prison had lower scores for all nine HLQ scales when compared to the general Australian population. Small to medium ES were seen for mean differences between most demographic groups. Compared to males, females had lower scores for several of the HLQ scales including ‘having sufficient information to manage health’ (ES 0.30 [95% Confidence Interval (CI) 0.07, 0.53]), ‘ability to actively engage with health care professionals’ (ES 0.30 [95% CI 0.06, 0.53]), ‘navigating the healthcare system’ (ES 0.30 [95% CI 0.06, 0.53]), and, ‘ability to find good health information’ (ES 0.33 [95% CI 0.10, 0.57]). Differing health literacy scale scores with small to medium ES were found when comparing participants by legal status. Mainly small ES were seen when comparing other participant characteristic groups.ConclusionsThis study provides insights into the health literacy strengths and challenges for people in NSW prisons. These findings highlight the important role health literacy could have in addressing health disparities in this vulnerable population and can inform prison health services.

Development and Validation of a Sexual Health Literacy Measurement Tool for Pregnancy Prevention Among Adolescents (SHL-PPA).

Several measurement tools have been developed for health literacy. However, little emphasis has been placed on the development of sexual health literacy (SHL) in adolescents. This paper describes the development and validation of an SHL measurement tool for pregnancy prevention among adolescents (SHL-PPA). This study explores research and development (R&D) and presents three stages of R&D, including a literature review, the Delphi approach, and a valid and reliable questionnaire. Three groups were used for the population and sampling: 18 experts, five competent people, and 654 adolescents. An online self-assessment tool was used. The data analysis methods used were median, interquartile range, content validity index, Cronbach's alpha coefficient, and exploratory factor analysis. The results show that the definition of SHL for adolescents was "cognitive, social, and cultural skills that determine the motivation and ability of an adolescent to access and sufficiently understand sexual health information and services, which results in them being capable of sexual health assessment and making decisions to prevent pregnancy". The final devised SHL-PPA included 33 items and the three following components: 1) accessibility to sexual health information and services, 2) an understanding of sexual health information and services and appraisal of sexual health to prevent pregnancy, and 3) applying the obtained sexual health information and skills to prevent pregnancy. This study proves that the SHL-PPA is appropriate for Generation Z teenagers, particularly for online self-assessment of SHL. An online self-evaluation using the SHL-PPA demonstrated that related organizations should develop online activities or programs to improve teenage girls' pregnancy-prevention behavior.

Health literacy of patients with heart failure in a dutch population

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO) Background Limited Health Literacy affects about 3 in 10 persons in the Netherlands. Especially for people with chronic conditions like heart failure, adequate health literacy is needed to maintain, monitor and manage their health and their chronic condition. While nurses are expected to meet the specific support needs of their patients, many find it difficult to recognize and assess the level of health literacy of their patients. Purpose To examine and compare health literacy in patients with heart failure patients from the nurses’ perspective against two health literacy measurement tools. Methods Patients with heart failure were recruited in the outpatient cardiology departments of four different hospitals in the Netherlands. Information about health literacy of the patients was collected with a self-reported questionnaire (Set of Brief Screening Questions - SBSQ) and with the Newest Vital Sign-Dutch (NVS-D). Finally, nurses and nurse practitioners assessed health literacy of the patients on a visual analogue scale from 0-6. Additionally, demographic data (gender, age, level of education and native language) and clinical data (NYHA class and medication use) were collected. Results 61 patients with heart failure were recruited during 2022. Mean age was 68.5 (±14.6), 66% were men, 61% had a lower educational level. Most patients (86%) were native Dutch speakers and had a NYHA classification between II-III (46%). The mean number of used cardiac medication was 5.8 (±1.7). 55 patients completed the SBSQ, fifteen (27%) scored an average ≤ 2, indicating inadequate health literacy. The NVS-D was completed by 53 patients. Twenty-seven patients (51%) scored 0-1, suggesting limited health literacy. Fourteen patients (26%) scored 2-3, indicating possible limited health literacy. The nurses’ assessments (using >3 on the visual analogue scale as adequate health literacy), indicated 35 patients (63%) as having adequate health literacy. There was only poor to slight agreement with the results of the SBSQ (Kappa: 0.198). For comparison with the NVS-D, the visual analogue scale was divided into three groups (limited health literacy (<2), possibly limited health literacy (2-4) and adequate health literacy (>4). This resulted in 10 patients (18%) with limited health literacy according to nurses, 23 (41%) with possibly limited health literacy and 23 (41%) with adequate health literacy. There was also poor agreement between the nurses’ assessment and the NVS-D results (Kappa: 0.133). Conclusion(s) Health literacy is vital for patients with heart failure to process and apply health related information. Alhough there is no gold standard measuring health literacy yet, this study shows that nurses’ assessment does not agree with the SBSQ and the NVS-D. To take health literacy into account during communication, nurses can use the SBSQ, noting that the SBSQ seems to underestimate limited health literacy, while the NVS-D seems to overestimate it.Table 1:Characteristics of patientsTable 2:HL of heart failure patients

Evaluation of a New Performance-Based Health Literacy Measurement Tool for Individuals With Chronic Airways Disease.

Low health literacy is a global challenge. Health literacy is positively correlated with chronic airways disease desirable outcomes. Despite the importance of health literacy in disease management, current health literacy measurement tools are suboptimal. As part of a multi-stage project to develop a performance-based, disease-specific Vancouver Airways Health Literacy Tool (VAHLT) for individuals with chronic airways disease, this study assessed the relationships between the VAHLT scores and characteristics of patients with chronic airways disease. The primary aim of the study was to provide preliminary evidence of construct validity of the VAHLT. A cross-sectional study design was applied. Study subjects were recruited from 6 specialty care clinics to complete the VAHLT measurement tool. Demographic and clinical data, including quality of life and disease control, were collected via validated questionnaires. The study subjects also completed a spirometry test. Inferential analysis was conducted by using mean difference testing and correlational methods. A total of 320 subjects were recruited, and, after imputing missing data, 315 were ultimately analyzed. The subjects were predominantly women (61%), white (83%), had a post-high-school education (74%), and a mean ± SD age of 65.2 ± 13.2 y. Age was significantly negatively correlated with the VAHLT scores (P = .004); the subjects with a post-high school education had significantly higher VAHLT scores than those with a high school education or less (P < .001). No significant sex or ethnicity related differences in VAHLT scores were observed. For clinical outcomes, no significant differences were found between the VAHLT scores and disease severity or measures of quality of life and asthma control. We report a chronic airways disease-specific health literacy measurement tool developed with the involvement of patients and professionals. Age and education were highly correlated with health literacy, which emphasizes the importance of addressing these factors in health literacy interventions among patients with chronic airways disease.

Developing a Health Literacy Scale for adults in Hong Kong: A modified e-Delphi study with healthcare consumers and providers.

Health literacy (HL) refers to individuals' abilities to process and use health information to promote health. This study aimed to develop the first HL measurement tool for the Chinese Hong Kong population. A two-phase methodology was adopted. In Phase I, evidence synthesis with a deductive method was conducted to formulate the item list from the literature. In Phase II, a modified e-Delphi survey was conducted among stakeholders (i.e., healthcare providers and healthcare consumers) to confirm the content validity of the item list. The stakeholders were invited to rate the relevance of each draft item on a 4-point scale and provide suggestions for revisions, removalor adding new items. In Phase I, a total of 34 items covering functional, interactiveand critical HL were generated. In Phase II, to obtain a balanced view from experts and laypeople, healthcare professionals (n = 12) and consumers (n = 12) were invited to participate in the Delphi panel. The response rates of the three rounds were 100%. After the third round, the consensus was reached for 31 items, and no further comments for adding or revising items were received. All items exhibited excellent content validity (item content validity index: 0.79-1.00; K*: 0.74-1.00). A Health Literacy Scale for Hong Kong was developed. Compared with existing HL scales, the scale fully operationalized the skills involved in functional, interactiveand critical HL. The Delphi study shows evidence supporting the high content validity of all items in the scale. In future studies, these items should undergo rigorous testing to examine their psychometric properties in our target population groups. By illuminating the details in the development process, this paper provides a deeper understanding of the scale's scope and limitations for others who are interested in using this tool. Public as healthcare consumers, in addition to healthcare providers, were involved in developing a new HL scale for this study. The input from the public contributed to examining the scale's content validity by judging whether all items reflected the skills that they need to find and use health-related information in their daily life.

DIGITAL TECHNOLOGY USE IN TURKEY AND THE NEED FOR NEW eHEALTH LITERACY MEASUREMENT TOOLS

Aim of the study: Digital health technologies, which cause the reshaping of today's patient-health relationship have been reflected in every field of health services. In a setting where the patient-health relationship is so dependent on the use of digital tools and the internet, it has become one of the most important elements for the development of their health for users to have the necessary digital skills and eliminate false and unnecessary information and data and acquire their health needs. Thus measuring the digital health literacy of consumers became a necessity. The aim of this study is to clarify the need for developing or adopting new digital health literacy measurement tools in Turkey. &#x0D; Materials and Methods: For the purpose to reveal the state of digital health literacy in Turkey the reports announced by different international and national institutes were searched in this descriptive research. The prevalence of the use of social media, the increase in the number of internet users and mobile devices in recent years, individuals’ reasons for using the internet, and the ratio of searching health issues in this data were compiled. Additionally, the digital/eHealth literacy scales developed or adopted in Turkish by researchers were searched from databases.&#x0D; Results: The results showed that the adaptation of Turkey and its people to e-health is very high and Turkish people take the lead the way in terms of accessing health-related information, integrating with the health system, and using health-related applications. So the need for digital health literacy scales and their potential use in Turkey was reported in this study. According to the results of the study only one measurement tool, developed by Norman and Skinner (2006) was adopted in Turkish and used by Turkish researchers. This study mostly used ten digital/eHealth literacy instruments were introduced and the gap in this area was argued. Although there are many digital/eHealth literacy scales adopted in various countries, in Turkey researchers stay behind in that situation. The need for developing or adopting new digital/eHealth literacy scales is obvious.

A systematic review of the effectiveness of community interventions to improve parent health literacy

Abstract Background Many community-based interventions have been developed to increase parent/caregiver health literacy, yet no systematic review of their effectiveness has been published. Therefore, the aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents/caregivers. Methods A systematic review of six databases; MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source were conducted to identify relevant articles. Risk of bias were assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane Collaboration Risk of Bias in Non-Randomised Studies of Interventions. The study findings were grouped and synthesised following the Synthesis Without Meta-analysis framework. Results Eleven community-based health literacy interventions for parents/caregivers were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. The risk of bias was high in over half the studies (n = 7) Studies were heterogeneous preventing a meta-analysis. Discussion Although no definitive conclusion of the effectiveness of community-based interventions can be drawn there are suggestions of improvement in many of the studies included in this review. The review has brought into question whether the health literacy measurement tools used met the needs of assessing the interventions outcomes. When comparing the cost and resources needed for digital with in person interventions, the findings of this review have implications for both practise and research. Key messages

5.K. Workshop: National and European studies on health literacy in children and adolescents

Abstract Health literacy describes how people use health information to make informed decisions in context of healthcare, disease prevention and health promotion. Enhancing health literacy of populations is critical and in particular important at an early age, which is understood to be more sustainable because health literacy contributes to improved personal health and development. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering target group specific interventions and services requires precise data generation on the state of health literacy in early age. In the past decade, several conceptual approaches have been undertaken but methodological sound, validated and reliable measurement tools are still scarce. Available systematic reviews show that most tools originated from North America and/or English speaking countries. However, in the past years European researchers have been involved with research on health literacy in childhood and adolescence, the result of which culminated into heavy progress regarding the development of health literacy measurement instruments, including generic health literacy, digital health and mental health literacy. These new developments lead to the availability of validated tools for school-aged children, including primary and secondary school children. The purpose of this workshop is to bring together five contemporary health literacy studies conducted in child and adolescent populations across Europe, including national and European-wide studies. Both methodological findings regarding the measurement tool and empirical data will be introduced. The first presentation emerges from the HLCA HL-Kids project, which has been conducted in Germany and focusses on primary schoolchildren, using the HLS-Child-Q15 tool. The second presentation originates from the Netherlands where the HLS-Child-Q15 tool was adapted to Dutch children. The third presentation aims at health literacy of adolescents in secondary school-age in Germany, by using the MOHLAA-Q tool. The fourth presentation originates from the WHO-led HBSC study, which has been conducted by using the HLSAC questionnaire. The final presentation will focus on the first digital health literacy measurement tool for secondary schoolchildren, which has been developed within a German study in schools. Each project will be given ten minutes to present their findings, including questions, which will be followed by Q&amp;A and an open discussion with the audiences. This workshop offers a forum for researchers, practitioners and policy-makers interested in health literacy measurement in children and adolescents. By dialogue and two-way communication, vivid interaction will be ensured, allow building synergies, and facilitate networking and capacity building. Key messages • Health literacy contributes to improved personal health and development of children and adolescents. • The measurement of health literacy is key to public health intervention success and needs theory driven, validated and reliable instruments.

우리나라 헬스리터러시 측정 도구의 연구 동향 분석: 주제범위 문헌고찰(Scoping review)

Objectives: This study aims to provide a descriptive review of the published health literacy measurement tools developed and validated in South Korea. Methods: Using Scoping Review methods, a literature review was conducted by scanning international and Korean databases (PubMed, CINAHL, Scopus, RISS, SCIENCEON, KoreaMed). Among the 181 articles explored, 26 were included in the review. Results: Of the 26 articles (27 tools) reviewed, 17 measured general health literacy, while nine were content/context specific. Among the 17 general health literacy measures, 12 tools were translated (from REALM, NVS, Chew, HLS-EU, and HL-SDHQ) and five were newly developed in the Korean context. Except for the REALM-family measures, all the general health literacy instruments apply multi-dimensional characteristics. Most health literacy measures had acceptable reliability (α=.70) and reported a diverse validation process (81% of the 26 articles). Conclusion: Newly developed health literacy measures need to be validated in a cultural and language-specific context. Future health literacy measures should focus on specific information concerning health literacy measures, such as time for evaluating literacy status, representative sampling for testing, and understudied populations, such as young individuals. Future systematic reviews should be conducted with further rigorous quality assessment of the health literacy instruments in Korea.

Exploring chronic airways disease patients’ perspectives on self-management topics

ObjectivesIn this study, we explored chronic airways disease (CAD) patients' responses to health literacy (HL) communication domain questions within disease self-management scenarios, as part of a larger CAD HL measurement tool development study. MethodsAdult asthma and chronic obstructive pulmonary disease (COPD) patients from specialty care respiratory clinics were initially presented with realistic disease management scenarios and asked to share information they would communicate. Participants’ responses were grouped into response categories that were reviewed and verified by key informants. A new cohort of CAD patients then responded to the same scenarios and had their answers placed into the developed response categories by trained interviewers. Results19 initial stage participants' responses informed response categories for the following self-management topics: Inhaler Use (n = 20); Prednisone Use (n = 30); Flu (Influenza) (n = 35); and Weather Forecasting & Air Quality Index (n = 29). 141 participants’ responses were categorised during the second stage. ConclusionsSpecialty care CAD patients displayed an understanding of key information to communicate across disease self-management topic. Our two-step, patient-driven approach may interest researchers investigating health-related communication from patients' perspectives. Practice implicationsFindings may illuminate potential areas to investigate communication gaps among CAD patients; further investigation is warranted among non-specialty care patients.

Development of Digital Health Literacy Instruments for Students of the Faculty of Health Science, Universitas Dian Nuswantoro

Background and Objective: In the health sector, students' ability to filter incoming information and make sound decisions is critical. The purpose of this research is to create a digital health literacy measurement tool for health students.&#x0D; Methods: This research is a study of developing a digital health literacy measurement tool for health faculty students whose validity and reliability have been tested. Online questionnaires were distributed to 337 active students. The questionnaire went through several stages of development, including literature review, expert review, trial and field test. &#x0D; Results: The questionnaires related to digital competence and health literacy were used to conduct the literature review. Following various reviews, the main references for this research are "Digital competency framework for citizens-DigComp 2.1" and "Health literacy scale." According to the expert's opinion, the invalid (unimportant) questions were "I can distinguish appropriate and inappropriate digital content to share on social media so that my privacy and that of others are not jeopardized." and "I know how to find useful health information on the internet." Questions were removed in order to be distributed to trials. According to the test results, all questions meet the validity assumption. The Pilot Test results were tested on 337 respondents during the field test stage to ensure that all valid questions and question items were accepted.&#x0D; Discussion: This study found 24 good questions to measure digital health literacy based on nine indicators, namely: Access to Health Information (2 questions), health information management (2 question), integration of health information (2 questions), and evaluation of health information (2 questions), information and data literacy (2 question), communication (1 question), collaboration (2 question), digital content creation (2 question), safety (4 questions), and problem-solving (5 questions).

An Integrated Framework to Conceptualize and Develop the Vancouver Airways Health Literacy Tool (VAHLT).

There is currently no comprehensive tool to assess the functional health literacy (HL) skills of chronic airway disease (CAD) patients. The purpose of this article is to describe the development of a new HL measure, the Vancouver Airways Health Literacy Tool (VAHLT). The tool was developed through the following phases: (1) Tool conceptualization, consisting of: (A) a systematic review (SR), (B) focus group sessions with CAD patients to understand barriers and facilitators to CAD management, (C) a survey with key-informants to obtain strategies to mitigate self-management barriers and validate patient-derived topics, and (D) respiratory physicians’ review of the topics; (2) Scenario and item development; and (3) Tool testing and content validation. The SR identified the lack of a valid HL measurement tool for CAD patients. Patients provided an initial shortlist of disease-related self-care topics. Key-informants helped to finalize topics for inclusion. Respiratory physicians and patients contributed to the development of a scenario-based questionnaire, which was refined during three rounds of testing to develop a 44-item instrument comprising nine self-management passages. We highlight the holistic process of integrating information from the literature with knowledge gained from key stakeholders into our tool framework. Our approach to stakeholder engagement may be of interest to researchers developing similar tools, and could facilitate the development and testing of HL-based interventions to ultimately improve patient outcomes and reduce the burden on the healthcare system.