Health Literacy Measures Research Articles

Developing a Framework to Measure Health Literacy Demands of Consumer-Facing Healthcare Organization Websites

Many consumer-facing healthcare organization websites are challenging for people with low e-health literacy skills to navigate and use the information to make informed decisions. Though searchers may be familiar with how to use the Internet, navigating website designs, often referred to as eHealth literacy, can make finding health information confusing. Health literacy demands, related to eHealth literacy skills concerning the content and design, can make the difference between consumers’ frustration and success. In this study, we aimed to create a framework to measure the accessibility and usability of healthcare organization consumer-facing websites using this question, “How can the information offered, and navigation of consumer-facing healthcare organization websites be improved to increase accessibility and usability?” We scored select healthcare organizations’ consumer-facing websites including their home page and two patient education pages, using Social Cognitive Theory and Health Literacy constructs both of which promote better accessibility and usability of health information. In addition, we analyzed how the health literacy demands of these pages support or obstruct the eHealth literacy skills of consumers. Results indicated that only 50% of Social Cognitive Theory constructs and 47% of Health Literacy constructs were observed. However, by examining the missing constructs healthcare organizations can assess where to focus consumer-facing website improvement efforts. Therefore, we concluded that Social Cognitive Theory combined with Health Literacy constructs offer a viable framework for measuring and potentially improving consumer-facing healthcare websites.

Developing a Standard Tool for Measuring Health Literacy Related to Transfusion-Transmitted Infections

Background Transfusion-transmitted infections (TTI) are among the most critical challenges of blood transfusion. Patients with lower health literacy can have adverse consequences for blood transfusion and due to the lack of standard tools for measuring health literacy related to TTI, this study was conducted to develop a standardized tool for assessing Health literacy associated with TTI. Aim This study aimed to develop a standardized tool for assessing Health literacy related to TTI. Material and Methods This study was a cross-sectional analytical study of the tool development and validation type, according to the definitions provided for health literacy, questions were designed in the five areas of search, understanding, evaluation, decision-making, and application. The questionnaire was provided to relevant experts to evaluate the content validity with a qualitative and quantitative approach. After making corrections according to the experts’ opinions, the Content Validity Index (CVI) and the Content Validity Ratio (CVR) were checked. It was given to people who were at least literate in reading and writing levels to check the quantitative and qualitative face validity. Finally, the structural validity of the tool was checked by performing a confirmatory factor analysis and its reliability by calculating Cronbach's Alpha. Results The CVR and CVI had an average of 0.86 and 0.93 respectively. The reliability of the questionnaire was calculated using Cronbach's alpha coefficient of 0.744. In examining the structural validity of the tool, the root mean squared error (RMSE) index was less than 0.0001, the Goodness of Fit Index (GFI) was 0.975, the Adjusted Goodness of Fit Index (AGFI) was 0.957, Bentler and Bonnet's Normed Fit Index (NFI) was 1 and Comparative Fit Index (CFI) was 0.856. Conclusion The tool developed is reliable and valid, and can be used to measure the level of health literacy related to transfusion-transmitted infections.

Sowing seeds of awareness: a cross-sectional analysis of mental health literacy and help-seeking in Irish farmers

BackgroundFarmers around the world are at risk of depression, anxiety, and suicidal ideation yet many avoid seeking help. In Ireland, farmers’ mental health is a national concern, as farmers face barriers of masculine norms around help-seeking. This study aimed to examine the prevalence and relationship between mental health literacy and mental health help-seeking in the Irish farming community. It also aimed to identify if mental health literacy or mental health help-seeking differed depending on gender, age, education, health status and income level.MethodsWe conducted a cross-sectional assessment of 351 Irish farmers’ mental health literacy and help-seeking using validated psychometric measures: the Mental Help Seeking Intention Scale (MHSIS), the Attitudes Toward Seeking Professional Psychological Help Short Form (ATSPPH-SF), and the Multicomponent Mental Health Literacy Measure (MMHL).ResultsIrish farmers’ mental health literacy and help-seeking scores were interrelated. Though low, farmers’ scores were comparable to the general population and higher than some European samples. Despite broadly favourable attitudes towards seeking professional mental health help, Irish farmers perceived significant barriers to accessing care and exhibited stoic health attitudes. Farmers with less education and men were particularly at risk.ConclusionIrish farmers’ stoic attitudes may be a response to their perceived lack of services. Interventions providing mental health literacy education and improving access to existing mental health services are particularly important for this population of farmers.

Exploring the Association Between Adolescents' Health Literacy and Health Behavior by Using the Short Health Literacy (HLS19-Q12) Questionnaire.

Health literacy (HL) is an important element of public health that is linked to health behavior in children and adolescents. This study aimed to investigate the structural validity and reliability of the HLS19-Q12 in the adolescent population, to measure the general HL of adolescents, and to assess the relationship between adolescents' HL and health behavior. This cross-sectional study involved 825 students aged 15-19 years attending Lithuanian gymnasiums. The participants completed an online survey that collected information on key sociodemographic, HL, and health behavior indicators. Factor analysis, Cronbach's alpha, and McDonald's omega were used to validate the Lithuanian version of the HLS19-Q12. Health behavior indicators, including physical activity, smoking, alcohol consumption, self-rated health, and body mass index (BMI), were measured. We used regression analyses to assess the associations. The HLS19-Q12 showed an acceptable reliability index (Cronbach's α = 0.885, McDonald's omega ω = 0.877) and adequate structural validity (comparative fit index = 0.89, Tucker and Lewis's index of fit = 0.88, root mean square error of approximation = 0.06). We found that 67.1% of the adolescents had excellent or sufficient HL, 27.7% had problematic HL, and 5.2% had inadequate HL. Compared with girls, boys had greater HL. HL was positively related to physical activity and self-rated health and negatively related to alcohol use and smoking. HLS19-Q12 is a reliable and valid measure of HL among adolescents in upper grades; higher levels of HL have been found to result in better health behaviors.

Health literacy measurement: a comparison of four widely used health literacy instruments (TOFHLA, NVS, HLS-EU and HLQ) and implications for practice.

Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach's alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman's R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76-0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r =0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.

Exposure to violence and other determinants of health literacy among Palestinian adolescents: a cross-sectional study

BackgroundUnderstanding health literacy and its predictors is fundamental for adolescents to have healthy lives. This study investigated the association between exposure to violence and other factors with health literacy levels among Palestinian middle school students.MethodsThis cross-sectional study included middle school students. We used the validated Arabic version of the Health Literacy Assessment Scale for Adolescents to measure health literacy levels, and asked adolescents 11 questions to assess whether they were exposed to various forms of violence. We used binary logistic regression to identify the factors associated with each health literacy subscale.ResultsAmong the 816 students, 20.4%, 30.5%, and 50.5% had low functional, confusion, and communication health literacy levels, respectively. Exposure to political violence was significantly associated with lower levels of functional health literacy (OR: 2.65, 95%CI: 1.71–4.08) and low confusion health literacy (OR: 1.96, 95%CI: 1.31–2.94). Domestic and school violence were associated with low levels of confusion health literacy (OR: 1.82, 95%CI: 1.30–2.55).ConclusionExposure to different forms of violence predicted low levels of health literacy among Palestinian middle school students. This study identified the need for middle school students to acquire the skills required to analyse and integrate the health information they receive. Therefore, there is a need for regular interventions that target an increase in their critical health literacy.

The role of health literacy in enhancing preventive healthcare: A comprehensive review of challenges, interventions, and future directions

Health literacy is a fundamental aspect of healthcare, influencing an individual’s ability to understand, access, and apply health information to make informed decisions. In preventive healthcare, higher health literacy is crucial for promoting healthy behaviors and improving overall health outcomes. This review explores the multidimensional nature of health literacy, examining its role in disease prevention and its impact on access to preventive services. While individuals with greater health literacy are more likely to engage in preventive behaviors, low health literacy is associated with poor health outcomes, decreased utilization of preventive measures, and increased healthcare costs. The challenges of promoting health literacy are multifaceted, including barriers related to the complexity of health information, cultural and socioeconomic disparities, and inadequate tools for measuring health literacy in specific populations. This review also highlights key interventions and programs designed to enhance health literacy, such as community-based initiatives, educational strategies, and digital health tools.

The validity and reliability of the Slovenian version of the health literacy questionnaire short-form (HLS-EU-Q16) among adults and older adults.

Health literacy is an important predictor of health behavior and self-rated health, playing a crucial role in shaping public health outcomes. Valid and reliable health literacy assessments are essential for effectively tailoring health interventions, particularly in different cultural contexts. Several questionnaires have been developed to measure health literacy, including the widely used 47-item Health Literacy Questionnaire and its shorter versions. However, the validity of these shorter and more time efficient HLS-EU versions, such as the 16-item HLS-EU-Q16, has been less extensively researched in different age subgroups. Given Slovenia's aging population and the differences in health literacy between adults and older adults, it is important to assess whether the HLS-EU-Q16 performs reliably across these groups. Therefore, the present study aimed to examine the validity and reliability of the 16-item health literacy questionnaire (HLS-EU-Q16) in Slovenia across two age groups: adults and older adults. We analyzed representative Slovenian sample data from the Health Literacy of Adults study. The sample included 2,327 adults aged 23-64 years (53.7% women) and 876 older adults aged 65-99 years (55.7% women). Construct validity revealed a modified three-factor structure of the HLS-EU-Q16 among adults, reflecting a broader conceptualization of health literacy that encompasses overlapping domains of health promotion, disease prevention, and health care. In contrast, a two-factor structure emerged among older adults, indicating a more consolidated approach where these domains are perceived as part of an integrated health management strategy. This suggests that adults may conceptualize health literacy across multiple, yet interconnected dimensions, while older adults approach it more holistically. Convergent validity, reliability, concurrent-predictive, concurrent, and discriminant validity results were satisfactory for both age groups. Predictive validity, however, provided somewhat inadequate results, as the tool poorly predicted certain health behaviors, such as smoking, alcohol consumption, and physical activity, in both age groups. Overall, the HLS-EU-Q16 demonstrated adequate validity and reliability among both adults and older adults, indicating that it is an appropriate instrument for assessing health literacy in Slovenia.

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

Measuring health professionals' capability to respond to health consumers' health literacy needs: a scoping review.

Health literacy-responsive health professionals will be increasingly important in addressing healthcare access and equity issues. This international scoping review aims to understand the extent and ways in which health professionals respond to healthcare users' health literacy, identifying tools used to measure health literacy responsiveness and training to support the development of these attributes. Four online databases were searched. Using Covidence software and pre-determined inclusion/exclusion criteria, all articles were screened by two authors. Data were extracted using a researcher-developed data extraction tool. From the 1531 studies located, 656 were screened at title and abstract and 137 were assessed at full text; 68 studies met the inclusion criteria and 61 were identified through hand searching resulting in 129 papers in total. Five overlapping thematic elements describing thirty attributes of health literacy responsive health professionals were identified: (i) communication, (ii) literacies, (iii) andragogy, (iv) social/relational attributes and (v) responding to diversity. Other concepts of 'tailoring' and 'patient-centred care' that cut across multiple themes were reported. Forty-four tools were identified that assessed some aspects of health literacy responsiveness. Thirty of the tools reported were custom tools designed to test an intervention, and 14 tools were specifically employed to assess health literacy responsiveness as a general concept. Seventy studies described education and training for health professionals or students. This scoping review provides a contemporary list of key attributes required for health literacy-responsive health professionals, which may serve as a foundation for future health literacy research including the development of curricula in health professional education and tools to measure health professional health literacy responsiveness.

A literature review of health literacy competency for health professionals

Purpose: This study aimed to provide a descriptive review of health literacy competency questionnaires and to identify their attributes for developing a health literacy competency measurement tool to be used by Korean health professionals.Methods: A literature review was conducted through a search in international and Korean databases (PubMed, CINAHL, RISS, and KISS) for articles published between 2010 and 2024. A total of 2,200 articles were explored, out of which 6 studies met the inclusion criteria.Results: In Canada, an initial set of health literacy competency questionnaires was developed; subsequently, two questionnaires were developed in China and Brazil. Another study was translated using the initial Canadian study questionnaires, and two studies were modified. All six studies meeting the inclusion criteria employed a Delphi process involving 20~41 expert panels. Among the six studies, only one reported the psychometric properties of the questionnaires used. The reviewed questionnaires comprised knowledge, attitude, skills, and practice domains based on Bloom’s taxonomy. Knowledge and skills were commonly included factors in the questionnaires.Conclusion: There were 17 knowledge, 10 attitude, 13 skills, and 13 practice attributes for each area of the reviewed questionnaires. “Easy-to-read materials,” “plain language,” and “teach-back” were identified as appropriate attributes for measuring health literacy competencies. Among the questionnaires, there were many items and many overlapping items between the domains. Further studies are required to refine their essential attributes and to verify the instruments’ psychometric properties in order to increase their feasibility.

Assessing Health Literacy, Learning Needs, and Patient Satisfaction in Cancer Care: A Holistic Study in the Omani Context

Background: Health literacy is essential in cancer care, affecting patient outcomes, perception, and involvement in healthcare decisions. Purpose: This study aimed to evaluate and identify gaps and relationships between the levels of health literacy, learning needs, and satisfaction with educational activities among cancer patients in Oman. Methods: A cross-sectional study was conducted among 323 cancer patients at the Sultan Qaboos Comprehensive Cancer Center, University Medical City, in Muscat, Oman. Data were collected using a self-administered questionnaire, which measured health literacy using the Health Literacy Instrument for Adults (HELIA), assessed learning needs based on importance, and evaluated satisfaction with educational activities. Descriptive statistics and correlation analyses were conducted using SPSS version 23 to identify relationships between the variables. Results: The average health literacy score was 4.36, indicating a generally high level of health literacy among the participants. Learning needs were highest for chemotherapy and hormonal therapy (mean = 4.65), while satisfaction with education activities was highest for overall experience (mean = 4.38). However, there were notable gaps between the perceived importance of learning needs and satisfaction with educational activities, particularly in chemotherapy and hormonal therapy (gap = 0.46). A moderate positive correlation was found between health literacy and learning needs (r = 0.341, p = 0.022), while a stronger positive correlation existed between health literacy and satisfaction with educational activities (r = 0.58, p < 0.00001). Conclusion: Improving health literacy and addressing gaps in learning needs and educational satisfaction are crucial for enhancing cancer care outcomes and patient satisfaction in Oman.

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.

Health literacy and COVID-19 pandemic impacts among adults in rural northern Arizona.

Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona. A cross-sectional, interviewer-administered survey was conducted with 119 adults from June 2020 to August 2021. Participants were recruited from two federally qualified health centers and by word of mouth. The Newest Vital Sign was used to measure health literacy, and the Epidemic-Pandemic Impacts Inventory was used to measure the effects of the COVID-19 pandemic on various aspects of personal and family life (eg spent more time on screens and devices, had family celebrations canceled or restricted). Descriptive, bivariate, and multivariable linear regression statistics were computed. Nineteen percent of participants had limited health literacy, and participants had an average of 22 individual impacts and 2 household impacts of the 92 COVID-19 impacts assessed. Multivariable regression model results showed that being male versus female or having public only versus any private insurance was significantly associated with fewer individual COVID-19 impacts on average. Being black, Indigenous, people of color versus White or being Hispanic, Latino, or Spanish versus not were each associated with significantly more individual COVID-19 impacts on average. Limited versus adequate health literacy was significantly associated with more household COVID-19 impacts on average. Sensitivity analysis results further showed that limited versus adequate health literacy was associated with significantly higher adjusted rates of household social, emotional, and infection COVID-19 impacts. This study's findings highlight the importance of assessing and accounting for health literacy in clinical practice and health services research addressing the impacts of the COVID-19 pandemic and future emergency events.

1.K. Scientific session: Health literacy of children and adolescents across Europe

Abstract Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. 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 targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents. Key messages • Child and adolescent health literacy is an important, yet under-researched public health topic. • Child health literacy is an important predictor of their health behavior and outcomes.

Does School Education Improve Children’s Health Literacy? Evidence from a Performance-Based Survey

Abstract Background Children begin using digital sources of health information at a young age and are quickly exposed to a variety of unmoderated health content. Health literacy helps children navigate, understand, evaluate, and act on this content. But is the educational system preparing young people for these tasks? This study develops a validated, performance-based measure of health literacy and applies it to a sample of 9- to 13-year-old children (grades 4 to 7). Methods A performance-based tool to measure children’s health literacy was developed through expert consultation and qualitative and quantitative pretesting. The tool uses vignettes and quizzes and captures three dimensions of health literacy: nutrition, physical activity, and psychosocial health. The validated tool was then used in a cross-sectional survey of Austrian children aged 9 to 13 years (n = 780): Diet, Physical Activity, and Psychosocial Health. Results Results show that the performance-based health literacy scores do not correlate with self-reported scores. Girls (vs. boys) and native speakers perform better on the performance-based literacy test, while boys and children reporting more robust financial backgrounds overestimate their literacy on self-reported questions. Most importantly, the data do not show meaningful increases in performance-based health literacy across grade levels. For nutrition literacy, the study even shows a slight negative trend across grade levels. Conclusions This study questions the heavy reliance on self-reported health literacy, which is often confounded with self-efficacy and social environment. Performance-based instruments are needed to measure health literacy as an educational outcome. This study presents one of the first validated instruments. Most importantly, the study shows that the current educational system may not produce meaningful increases in performance-based health literacy, calling for deeper educational reforms. Key messages • Performance-based health literacy is a distinct concept from the subjective health literacy measures that dominate current health literacy research. • Performance-based health literacy did not increase with grade level, indicating a poor performance of the education system in strengthening health literacy.

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.

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Health literacy, nutrition literacy, and B vitamins status in patients with recurrent ischemic heart disease episodes: A hospital-based cross-sectional study

Background: In Oman, ischemic heart disease (IHD) is the most common type of cardiovascular disease, and there are multifactorial causes, including nutritional deficiencies of B vitamins (folate and B12) and health illiteracy. Objective: This study aimed to characterize the health literacy, nutrition literacy, and B-vitamin (folate and B12) status of patients with recurrent episodes of IHD. Methods: This cross-sectional study was conducted over a period of 5 months from February to June 2022. The enrolled study participants had an angiographically proven recurrence of IHD, and they were interviewed using a study questionnaire to identify their sociodemographic data, health status, and nutrition status. Folate and B12 were measured in the sera of the study participants. Results: Most participants were in their middle age (62%), and the frequency of the IHD recurrence was noticed among men, married, and unemployed. The serum values of folate and vitamin B12 were within the normal range among the IHD patients. Health literacy categories were affected by the employment status (χ2 1 = 6.05, P = 0.01), and the binary logistic regression confirmed the statistical significance between employment status and health literacy (odds ratio; 1.7, P = 0.005). Nutrition literacy had a significant difference regarding the education variable (χ2 1 = 8.34, P = 0.004), and the sociodemographic variables were not associated with nutrition literacy. Conclusion: The investigated health and nutrition literacy measures might be used for assessing IHD patients’ literacy and detecting any deficits that needed to be improved.