Citizen Health Literacy Research Articles

Barriers to Personalised Prevention: Perspectives from a Multi-Stakeholder Consultation

Abstract Background The high and increasing burden of Non-Communicable Diseases (NCDs) demands a healthcare shift towards prevention. Personalised preventive interventions (PPIs) that consider biological, sociocultural, environmental, and behavioural characteristics of individuals, are not as widely adopted as other personalised medicine approaches. To identify the main barriers and gaps that are hindering the adoption of PPIs in healthcare systems, we consulted a wide range of European stakeholders, including health professionals, policy makers, citizens and patients, and researchers. Methods The consultation process included experts’ interviews and an online survey, taking place over 10 months in 2023/2024. Interviews were analysed using qualitative Thematic Analysis. The online survey development was based on the barriers identified by the interviewed experts, complemented with findings from the literature. Respondents scored their level of agreement/disagreement using a 6-point Likert scale. Descriptive statistical analysis was performed. Results A total of 26 semi-structured interviews and 270 complete surveys were obtained. Overall, the main barriers highlighted were: 1) Health systems strategies are geared towards curative care and not prevention. 2) Awareness and understanding of the concept of PPIs is low. 3) There is a lack of basic and life-long training for health professionals on PPIs; 4) There is insufficient evidence for PPIs to raise the necessary policymakers’ interest. 5) Health literacy of citizens and patients is low. 6) There is insufficient prevention research, evidence of cost-efficiency and regulation procedures for translation into health practice. Conclusions Identified barriers are interconnected and the challenges extend beyond prevention to personalized medicine interventions. Collaborative efforts are needed to elevate visibility and engage stakeholders, facilitating integration of PPIs into healthcare systems for widespread adoption. Key messages • This consultation offers valuable insights on challenges that need to be addressed to enable the integration of PPIs into healthcare and reduce the burden of NCDs. • Investments in disease prevention and PPIs should stand as a global key priority.

The relationship between health literacy and health-related quality of life in Chinese older adults: a cross-sectional study.

This study aimed to examine the relationship between health literacy and health-related quality of life in older adults. A cross-sectional survey design was used. We used a self-administered questionnaire to assess sociodemographic factors of older adults, the Chinese Citizen Health Literacy Questionnaire (HLQC) and the 36-item Chinese version of the Short Form 36 (SF-36) to measure health literacy and quality of life, respectively, among older adults. Between September 2011 and June 2012, information was collected from 1,396 older adults in 44 nursing homes in four cities through face-to-face interviews. The mean health literacy level of older adults in nursing homes was relatively low (71.74 ± 28.35). Health-related quality of life scores were moderate (104.77 ± 16.92). There were statistically significant differences in the effects of health literacy, education level, former occupation (professional), marital status (widowed) and race on health-related quality of life. Improving health literacy is considered an important intervention to promote health-related quality of life in older adults in nursing homes.

Dopunsko zdravstveno osiguranje u funkciji doprinosa razvoju održivog sistema zdravstvene zaštite u Republici Srbiji

Law on Health Insurance regulates three types of voluntary health insurance - complementary, supplementary and private health insurance. These are promising insurance products and the author selected supplementary health insurance. What is the potential of this type of cover? What are conditions for its development? Are the institutional prerequisites for creating a sustainable healthcare system fulfilled in our legislation? After analyzing the relationship between supplementary and voluntary health insurance, the author singles out the health literacy of citizens, potential service users as a prevailing factor in the current regulatory framework. By promoting supplementary health insurance as a product directly linked to compulsory health insurance a message is being sent that the healthcare cost risk in one part of compulsory healthcare can be transferred to insurers offering voluntary health insurance. Author proves that this encourages the inclusion of private insurers in financing the costs of compulsory healthcare, thus achieving cooperation between the private and state sectors with the aim of sustainable development of the healthcare system.

Investigation of health literacy status and related influencing factors in military health providers of Chinese People’s liberation Army, a cross-sectional study

ObjectiveThe aim of this study was to investigate health literacy and analyze its influencing factors in military health providers of the Chinese People’s Liberation Army (PLA Army).MethodsFrom November to December 2018, cluster sampling was used to select 1512 military health providers from the Army Medical University. Health literacy was measured by using the Chinese Citizen Health Literacy Questionnaire (HLQ) (2015 edition). Influencing factors that may affect health literacy were assessed using the chi-square test and multivariate logistic regression models.ResultsThe knowledge rate of health literacy was relatively low (21.6%). The knowledge rate of health-related skills (HRS, 18.7%) was the lowest of the three aspects of health literacy, and the knowledge rate of chronic diseases (CD, 19.6%) was the lowest of the six dimensions of health literacy. Participants who were older, were female, were of Han ethnicity, were the only child in their families, came from urban areas, never used tobacco, and had higher household income were likely to have higher health literacy.ConclusionThe health literacy levels of military health providers of the PLA Army are relatively low. Further research and health education are necessary to improve health literacy.

Faktori koji utiču na razvoj dobrovoljnog zdravstvenog osiguranja u Republici Srbiji

Voluntary health insurance enables a higher level of healthcare services for users and provision of healthcare services not included in the compulsory health insurance system. One of the main advantages of further development and growth of voluntary health insurance in the Republic of Serbia is a significant reduction of expenses of citizens in the entire healthcare system. A key argument in favour of voluntary health insurance is that, in the context of limited public resources for healthcare, it can advance healthcare policy goals by easing fiscal pressure on the healthcare sector. The situation and trends in the real sector influence development of the insurance sector. In order to improve voluntary health insurance, it is necessary to establish cooperation within compulsory and voluntary health insurance, work on connecting state and private healthcare institutions, provide better promotion of services and influence the increase in health literacy of citizens. Better connection of private and public healthcare institutions, compulsory and voluntary health insurance, better promotion of service packages, better information provided to citizens about this type of health insurance, as well as increasing the standard of living, influence development of the basic factors of voluntary health insurance.

Health-related Programme and Activities of Public Libraries: A proposed framework

While the way we consume information in our society is evolving, libraries are also dynamic and ever-changing. Libraries still matter, whether because of their access to a vast collection of books, the expertise of their librarians, or simply because they're a fantastic location. Public libraries can reach out to their users through these activities, creating awareness and interest in healthy lifestyles, providing access to high-quality health information, and eventually improving citizen health literacy. A framework is proposed by synthesizing prominent pieces of literature to guide through the rest of the study in providing a reference for the library for establishing health-related activities or programmes. Keywords: Online learning; digital resources; Malaysian students; Higher education eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by E-International Publishing House, Ltd., UK. This is an open-access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under the responsibility of AMER (Association of Malaysian Environment-Behavior Researchers), ABRA (Association of Behavioral Researchers on Asians), and cE-Bs (Centre for Environment-Behavior Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.

Does health literacy promote COVID-19 awareness? Evidence from Zhejiang, China.

BackgroundHealth literacy (HL) is considered a crucial determinant of disease prevention and control. However, the role of HL in the Coronavirus Disease 2019 (COVID-19) pandemic has not been studied using provincial representative data among Chinese residents. This study aimed to assess the association between HL and COVID-19 awareness among Zhejiang residents based on the 2020 China Health Literacy Survey (CHLS).MethodsThe study was conducted among 5,596 residents aged 15–69 in Zhejiang using multistage, stratified, and probability proportional to size sampling. COVID-19 awareness and HL were assessed using the “Chinese Citizen Health Literacy Questionnaire (2020)” in Zhejiang. The covariates were divided into predisposing factors, enabling factors, and need factors according to Anderson's model. Data were analyzed by the chi-square test and logistic regression.ResultsThe study showed that HL and COVID-19 awareness levels of residents were 24.84% and 8.06%, respectively, in Zhejiang in 2020. After adjusting for covariates, residents with adequate HL were more likely to have better COVID-19 awareness (odds ratio [OR] = 5.22, 95% CI = 4.13–6.59, p < 0.001). Three dimensions of HL (knowledge and attitudes, behavior and lifestyle, and health-related skills) were associated with COVID-19 awareness. Additionally, COVID-19 awareness was associated with age, occupation, family size, annual household income, and chronic conditions.ConclusionCOVID-19 awareness is significantly associated with HL, suggesting that promoting HL is an important component of health education, disease prevention, and health promotion in response to the COVID-19 pandemic and even possible public health emergencies in the future.

How to make more people adopt healthy behaviors? Assessing health literacy, health promoting lifestyle and their association of community residents in Shenzhen, China.

IntroductionHealth literacy (HL) has been concerned a key factor for determining the use of health information and promoting health. The study aimed to explore the relationship between different health literacy types and health promoting lifestyle (HPL) in different health literacy population.MethodsThe survey analyzed a sample of 16,921 community residents in Shenzhen. The Chinese Citizen Health Literacy Questionnaire and health-promoting lifestyle profile II (HPLP- II) were used to assess health literacy and health promoting lifestyle.ResultsParticipants were divided into different populations based on the correlation between HL and HPL. The low-HL and medium-HL populations were judged to lack health literacy, and demographic characteristics were significantly different between different HPL levels in low-HL and medium-HL populations. There were 6 types of HL, and health information literacy (β = 0.08, P < 0.001) and chronic disease literacy (β = 0.08, P < 0.001) positively predicted HPL in the low-HL population. In the medium-HL population, the results of reward and punishment analysis showed that health information was a basic factor, chronic disease was performance factor, medical care was a motivating factor for HPL; there were 6 dimensions of HPL, and health responsibility (HR), stress management (SM) and physical activity (PA) were not significantly different in medium-HL population. The results of regression analysis showed that HR and PA had a great impact on HPL (HR: β = 0.193, PA: β =0.179, β for other dimensions was 0.186, 0.176, 0.171, 0.164), but the HR and PA standardized scores were lowest in the HPL dimensions (HR: 69.42, PA: 68.5, lower than other dimensions), so it may be HR and PA that cause HPL unchanged between groups in the medium-HL population.ConclusionsDifferent HL levels have different relationships with HPL, and different HL types have different effects on HPL. Shenzhen community residents need to improve their HL, and they have great potentials for further progress to improve the population health. Public health policy makers need to consider formulating different policies for people with different HL levels.

The effect of health literacy on health status among residents in Qingdao, China: a path analysis

BackgroundHealth literacy is a public health goal which can be used as an independent factor of health outcomes. This study aimed to assess the association between health literacy and health status, as well as the two mediating factors of behavior and self-efficacy among residents aged 15–69 years in Qingdao.MethodsA cross-sectional survey was implemented among residents aged 15–69 years (N = 3793) in Qingdao, China. A combination of stratified cluster random and proportional probability sampling methods was used to select subjects for this study. Data were collected using “The Chinese Citizen Health Literacy Questionnaire (2019)”. We proposed a hypothetical model for the relationship between sociodemographic characteristics, health literacy, self-efficacy, health behavior, and health status, and used path analysis to validate the hypothesis.ResultsThe path analysis showed that higher education (β = 0.293) and income (β = 0.135) are positively and directly associated with greater health literacy, which was positively associated with health status (β = 0.057). Health literacy is a direct influencing factor of health behavior (β = 0.070) and self-efficacy (β = 0.099). Health behavior (β = 0.041) and self-efficacy (β = 0.173) exerted a positive direct effect on health status. The model explained 14.1% of variance for health literacy, 3.8% for self-efficacy, 5.7% for health behavior, and 15.0% for health status.ConclusionsHealth literacy was identified to be a critical factor in health status. The results emphasized that the dissemination of health knowledge, development of healthy behavior, and cultivation of self-efficacy should be jointly promoted to reinforce the level of health status among residents in future work.

Health literacy of college freshmen in jiangsu, China: A 3-year longitudinal survey.

Health literacy (HL) has become an important public health issue and received growing attention in recent years. However, knowledge about the HL of adolescents and young adults is limited.[1] This study aimed to investigate the awareness rate of HL and its related factors among college freshmen in Jiangsu, China. And the results were used to support the promotion intervention to improve the HL of at-risk groups among this population.A total of 25,272 freshmen were surveyed through multi-stage stratified random sampling from 20 colleges and universities in Jiangsu province between 2016 to 2018. Data were obtained using the “Chinese Citizen Health Literacy Questionnaire” (2013 edition). Multiple logistic regression analysis was conducted to determine the factors influencing HL levels.The awareness rate of HL of college freshmen in Jiangsu province was 26.6% among the 25,272 subjects. The awareness rate of HL tended to increase from 2016 to 2018, which was 17.9%, 21.5%, and 39.6%, respectively (P < 0.001). Specifically, except for chronic diseases, knowledge and attitudes, knowledge and attitudes toward health-related behavior and lifestyle, health-related skill and scientific views of health, infection diseases, safety and first aid, medical care, health information awareness rate all have improved to a certain degree (P < .001). The independent factors associated with HL awareness rate were sex (odds ratio [OR] = 1.099, (1.039 –1.164)), residence (urban: OR = 1.141, (1.056∼1.234)), educational system (OR = 2.133, (1.975–2.305)), only child or not (OR = 1.087, (1.018–1.161)), family structure (OR = 1.192, (1.078–1.319)) and maternal education level (high school: OR = 1.183 (1.067–1.313); university and more: OR = 1.481 (1.324–1.658)).Awareness rate of HL of college freshmen is associated with multi-complex factors, further works are recommended to improve the HL levels of college freshmen, especially for the aspect of chronic diseases.

Exploring health literacy in Wuhan, China: a cross-sectional analysis

BackgroundIn recent years, research on health literacy has become increasingly focused on the health care system and public health. This cross-sectional study aimed to investigate health literacy and analyse the risk factors that affect health literacy in Wuhan, China.MethodsMultistage stratified random sampling was used to select 5304 urban and rural residents aged 15 to 69 years from 204 monitoring points in 15 districts of Wuhan. Using the Chinese Citizen Health Literacy Questionnaire (HLQ) (2018 edition), a face-to-face survey was conducted from November to December 2018. Risk factors that may affect health literacy were assessed using the Chi-square test and multivariate logistic regression models.ResultsThe knowledge rate of health literacy was relatively low (19.3%). The knowledge rate of health-related behaviour and lifestyle (BAL, 17.3%) was the lowest of the three aspects of health literacy, and the knowledge rate of chronic diseases (CD, 19.0%) was the lowest of the six dimensions of health literacy. Respondents who lived in urban areas, had higher education levels, worked as medical staff, had a higher household income and did not suffer from chronic diseases were likely to have higher health literacy.ConclusionsThe health literacy levels of citizens in Wuhan are insufficient and need to improve.

The health literacy status and influencing factors of the high-risk stroke population in Jilin Province

Health literacy has become an increasingly concerning public health issue. However, the health literacy of the high-risk stroke population has never been analyzed. Therefore, the purpose of this study was to investigate the health literacy and influencing factors of the high-risk stroke population. A total of 588 subjects in the high-risk stroke population aged 45–69 years in Jilin province were surveyed with the “Chinese citizen health literacy survey” from May 2017 to October 2018. Descriptive analysis, Chi-square test, and binary logistic regression analysis were used to analyze the data. A total of 2000 questionnaires were distributed, and the effective recovery rate reached 95%. There were 588 subjects meeting the high-risk conditions of stroke. The health literacy level of the high-risk stroke population was 18.03%, which indicated that the overall level was low. Binary logistic regression analysis showed that a monthly household income equal to or higher than 5000 yuan (odds ratio [OR] = 3.48; 95% confidence interval[CI] =1.51–7.99), married status (OR = 4.74; 95% CI =1.00–22.47), and good family function (OR = 15.39; 95% CI =1.46–162.15) were correlated with a good health literacy status. The level of health literacy in the high-risk stroke population was low in Jilin province. The household income, marital status, and family function were influencing factors of health literacy.

Investigation of Health Literacy Status in Beijing, China.

Background:The Chinese government uses health literacy as an evaluation to estimate population health status in national strategic planning. A health literacy survey system for the city of Beijing, China was established in 2012 with triennial surveys to obtain representative data for the whole city.Objective:The objective of this study was to examine results of the 2015 Beijing Health Literacy Survey and to identify population subgroups that may warrant intervention due to high risk for not having adequate health literacy.Methods:This was a cross-sectional study in which participants were selected by multistage stratified cluster sampling. The information was collected in 2015 in face-to-face interviews on the Chinese Citizen Health Literacy Questionnaire. A total of 12,876 interviews were included in the final analyses. Weighting was conducted in all statistical analyses to obtain representative estimates, and multiple logistic regression was applied to examine the independent influencing factors on health literacy level (adequate/inadequate).Key Results:Overall, 28% of participants had adequate health literacy. Urban residents had a higher proportion of participants with adequate health literacy compared to rural residents (29.5% vs. 19%, p < .01). Women (29.7%) had a higher proportion of participants with adequate health literacy compared to men (29.7% vs. 26.4%, p < .01). The proportion of participants with adequate health literacy was significantly different among age groups (χ2 = 332.9, p < .01). Residents age 25 to 34 years had the highest rate of adequate health literacy (33.9%). The proportion of participants with adequate health literacy increased as participants obtained more education (χ2 = 818.4, p < .01). Residents in households with higher income had a higher rate of adequate health literacy (χ2 = 462.4, p < .01). Gender, age, education, and household income were independently associated with the level of health literacy.Conclusions:Substantial variation exists in health literacy level among age groups, gender groups, and education groups. Taking these disparities into account is important when developing health policies and allocating resources. [HLRP: Health Literacy Research and Practice. 2020;4(3):e174–e184.]Plain Language Summary:The results of this investigation revealed the health literacy status of residents in Beijing, China, and the high-risk population that may be more likely to have low health literacy. Targeted health education interventions may be helpful to improve health literacy.

Health Literacy Risk in Older Adults With and Without Mild Cognitive Impairment.

BackgroundThe relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment. Some researchers have found that health literacy risk may be associated with cognitive impairment in older adults.ObjectivesThe purpose of this study was to delineate the difference in health literacy risk between older adults with mild cognitive impairment and those with normal cognitive function.MethodsWe conducted a survey study to explore the health literacy risk in older adults with and without mild cognitive impairment. Data were collected from 412 subjects between 60 and 91 years of age (260 without and 152 with mild cognitive impairment) between June and December 2016 in China. Cognitive function was measured using the Mini-Mental Status Examination, Montreal Cognitive Assessment, Global Deterioration Scale, Activities of Daily Living, and Hamilton Depression Rating Scale. Health literacy was measured using the Chinese Citizen Health Literacy Questionnaire.ResultsThe scores of total health literacy and its three dimensions (basic health knowledge and mind, basic skills, and health lifestyle and behavior) were lower in those with mild cognitive impairment. Older adults with normal cognitive function had adequate or marginal health literacy levels, whereas those with mild cognitive impairment had marginal or inadequate health literacy levels. Using multiple logistic regression analysis, we found that health literacy risk, education level, age, marital status, and body mass index were independent risk factors for mild cognitive impairment.DiscussionThese results suggest that low health literacy may be a predictor of mild cognitive impairment. Screening for lower health literacy risk should be included in multidimensional geriatric evaluation.

Health Literacy, Physical and Mental Health, and Activities of Daily Living Among Older Chinese Adults in Nursing Homes

It is very important to estimate the prevalence of inadequate health literacy and determine whether or not health literacy level differences predict the physical and mental health status of older adults. A cluster sampling method was selected. A total of 1396 older adults were interviewed. Three instruments were included: the Chinese Citizen Health Literacy Questionnaire, Short Form 36, and Activity of Daily Living (ADL) Scale. The health literacy scores were very low (71.74 ± 28.35). The physical and mental health scores were all moderate. The ADLs was ⩾22, which suggests that the ADLs of older adults were poor. The major influencing factors of physical health include health literacy, ADL, alcohol consumption, household income, marital status, and former occupation. The major factors influencing mental health included ADL, former occupation, age, and smoking. Health literacy was associated with physical health, but was not associated with mental health. Improving health literacy could increase health management and health status of older adults.

Validation of a newly adapted Chinese version of the Newest Vital Sign instrument.

ObjectiveTo develop a Chinese version of the Newest Vital Sign (NVS-CHN) instrument and evaluate its psychometric properties.MethodsTo deal with cross-cultural adaptation problems, after translation of the NVS into Chinese, the Delphi method was used for experts and cognitive testing was used for participants. A cross-sectional study including 351 participants was conducted to assess the validity of the NVS-CHN. Internal reliability, criterion validity, and known-groups validity were investigated. The NVS-CHN was further validated against a suitable standard, the Chinese Citizen Health Literacy Questionnaire (CCHLQ).ResultsThe validity of the NVS-CHN was established by conducting a Delphi survey (three rounds) and cognitive testing (three rounds). Cronbach’s alpha was 0.71, indicating that internal consistency was acceptable. A Spearman’s correlation coefficient of 0.68 between the NVS-CHN and CCHLQ revealed excellent criterion validity. Differences in NVS-CHN scores by education level confirmed known-groups validity. A receiver operating characteristics analysis showed that the area under the curve was 0.81, indicating that the NVS-CHN was an accurate health literacy assessment tool. A score ≥ 4 out of 6 best identified participants with adequate health literacy.ConclusionsThe NVS-CHN has excellent psychometrical reliability and validity, which make it a suitable tool to evaluate health literacy in China.

The role and competences of health professionals in a new healthy ageing approach

Demographic change and health is an important theme all over the world. It is one of the grand societal challenges of the European Union: we have an fast ageing population, people live longer but with more chronic diseases, and the cost of health and social care increase. Solutions are to be found in a combination of prevention, innovation, technology and entrepreneurship. Active and healthy ageing gives a fruitful approach to solve the challenges of demographic change and health. In the Netherlands, healthy ageing not only focusses about older people with diseases: we have a life cycle approach, from growing up healthy to growing old. The focus is on functioning and health and participation. We use a new definition of health as the ability to adapt and selfmanage in the face of social, physical and emotional challenges. Nurses play an important role in this approach. In the international ELLAN project, a European Core Competence Framework is developed for health and care professionals working with older people. In this framework, assessment performance indicators are specified for each CanMed role. In October 2018 a new book is published, in which from the background of healthy ageing and demographic change, these competences are described. The roles of (geriatric) nursing in this Healthy Ageing approach include: Strengthen selfmanagement and resilience of patients; contribute to prevention and health literacy of citizens; focus on functioning and the ability to adapt and selfmanage and; use interdisciplinary innovative methods in health improvement like health technology. Introduction: The old age of an individual has always been interesting and attractive. That work can be understood as a presentation of the concept of “healthy ageing” but mainly focused on the individual. The concept of an ageing population is a relatively new problem from the historical point of view. It can be observed that in 1950 no country had more than 11 percent of its population aged 65 and over. Looking at the year 2000, the highest was 18 percent. However, the problem will rise dramatically by 2050 when it could reach 38 percent. Projections indicate that in 2050 there will be a larger number of older people aged 60 or over than adolescents aged 10–24. To address this problem, different solar PV modules cooling systems are investigated, developed, and employed. These systems are cooling the PV modules by different methods and techniques. Unfortunately, there is no universal approach to assess the effectiveness of applied cooling techniques. In this paper, a method and criterion for the PV modules’ cooling system effectivity assessment are proposed. Methods: Four independent researchers used combinations of keywords such as healthy ageing and World Health Organization, and found 637 521 articles. After adding specific keywords including long-term integrated care, human resources, research, ageism, economic issues, investment, implementation and age-friendly city the search was limited to studies. The search was also limited to studies of humans and articles written in English. After a careful review of their abstracts, the articles were identified as papers focusing on the researched topic. With this restriction, the search provided the articles and after reading the complete texts, 46 of the most relevant articles were included in this review. Conclusions: The global population is ageing rapidly. These changes highlight the need to adapt person-centred integrated care focusing on the needs of older people and their preferences and guaranteeing access to multiple age-friendly services closely engaged with families and communities. Public health policies should address the diversity of health and functional states experienced by older people and maximize the number of people who achieve positive trajectories of ageing. Integration initiatives need actions at macro-levels (legislation, funding), at meso-levels (age-friendly environment) and at micro-clinical levels. However, few countries have managed to sustainably deliver integrated care for older people and evidence for the effectiveness of integrated care approaches remains inconsistent.

Effectiveness of the teach-back method for improving the health literacy of senior citizens in nursing homes.

To explore the effectiveness of the teach-back method for improving the health literacy of older adults in nursing homes in Ürümqi, the capital of Xinjiang, China. Among the 27 registered nursing homes, 10 were selected randomly by size and divided into the intervention and control groups. A total of 127 older adults in the intervention group and 136 in the control group met the inclusion criteria. The intervention and control groups were educated by using the teach-back and traditional methods, respectively, in this 6 month study. The Chinese Citizen Health Literacy Questionnaire was used to evaluate the effects of the interventions. Pre-intervention, the health literacy level of the cohorts was relatively low. Postintervention, the total health literacy score of the intervention group increased, while the total health literacy score of the control group had increased to a lesser extent. The total and four-dimension scores of the two groups were statistically significant. The intergroup difference in the two groups, and the intervention group's total health literacy score and each dimension score were higher than in the control group; these differences were statistically significant . The teach-back method can improve the health literacy level of older adults through short-term educational intervention. The teach-back method should be adopted by more healthcare providers and applied to improve the health literacy education of older adults.

Health literacy, self-care agency, health status and social support among elderly Chinese nursing home residents

Objective: The purpose of this study was to evaluate the relationship between health literacy, self-care agency, social support and health status among elderly Chinese nursing home residents in Xinjiang. Design: Participants were selected using a stratified cluster random sampling design. Setting: The study was conducted from September 2011 to June 2012 in 44 nursing homes in four cities of Xinjiang, China. Methods: A total of 1,452 participants aged between 60 and 99 years met the study inclusion criteria. Data were collected using the Chinese Citizen Health Literacy Questionnaire, the Exercise of Self-Care Agency Scale, the Social Support Rating Scale, the Short Form 36 Health Survey Questionnaire and the Activities of Daily Living Scale. Subsequently, 1,452 questionnaires were distributed with a response rate of 96.14% (1,396 of 1,452). Results: Path analysis with structural equation modelling was used to test a hypothesised model linking health literacy to self-care agency, social support and health status. The optimal fitted model indicated that pathways linking health literacy to health status consisted of one direct path (path coefficient = .074) and three indirect paths (path coefficient = .194), with a total path coefficient of health literacy to health status being .268. Conclusion: Improving health literacy may enable older adults to more appropriately use self-care agency and social support as part of health promotion. The outcomes of this study suggest that to enhance the effects of health promotion interventions, health professionals should aim at raising the health literacy levels of elderly people in China.

Global Health Systems and Policy Development: Implications for Health Literacy Research, Theory and Practice.

Accessible and responsive health systems are critical to population health and human development. While progress has been made toward global health and development targets, significant inequities remain within and between countries. Expanding health inequities suggest a widespread and systemic neglect of vulnerable citizens, and a failure to enshrine within policies a responsibility to tailor care to the variable capabilities of citizens. Implementation of health and social policies that drive the design of accessible health systems, services, products and infrastructure represents the next frontier for health reform. Within this chapter we argue the need to consider health and health literacy across policy domains, to operationalize the intent to address inequities in health in meaningful and pragmatic ways, and to actively monitor progress and impact within the context of the Sustainable Development Goals (SDGs). We contend that viewing and developing policies and systems within a health literacy framework will assist in placing citizens and equity considerations at the center of development efforts. In this chapter, we explore the relationship between health literacy and equitable access to health care, and the role of health system and policy reform. We first explore international policies, health literacy, and the SDGs. We then explore national policies and the role that national and local services and systems play in building health literacy, and responding to the health literacy challenges of citizens. We discuss the World Health Organization's (WHO) Framework for Integrated People-Centered Health Services and the way in which health services are being encouraged to understand and respond to citizen health literacy needs. Each section of the chapter ends with a summary and a review of health literacy research and practice. Throughout, we illustrate our points through 'vignettes' from around the world.