Health Literacy Program Research Articles

Using Social Ecological Theory to Identify Factors Associated With Risky Sexual Behavior in Cambodian Adolescent Girls and Young Women Aged 10 to 24 Years: A Systematic Review

There is an increase in risky sexual behavior (RSB) in Cambodian female youth aged 10 to 24 years, which can contribute to detrimental sexual and reproductive health due to the increased risk of acquiring sexually transmitted infections, unintended pregnancies, or abortions. Bronfenbrenner's social ecological model was used to identify factors at personal, microenvironment, and macroenvironment levels potentially associated with RSB. A systematic literature review employing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted to search 8 databases for articles published between 1994 and 2019. A risk of bias tool was applied for methodological quality of the 4 included studies. RSB is associated with multiple factors including sexual debut at young age, alcohol and substance abuse, multiple partners, living away from parents or orphan status, peer delinquency, non-use of condoms by partners, transactional sex, low education and socioeconomic status, and no access to sexual and reproductive health services. Multipronged preventive strategies operating at different levels are recommended in terms of including sex education and increasing reproductive health literacy programs at the schools and community programs for safe sex, condom use and sexual negotiation skills, and access to modern contraceptive methods.

Laypeople's source selection in online health information‐seeking process

AbstractFor laypeople, searching online health information resources can be challenging due to topic complexity and the large number of online sources with differing quality. The goal of this article is to examine, among all the available online sources, which online sources laypeople select to address their health‐related information needs, and whether or how much the severity of a health condition influences their selection. Twenty‐four participants were recruited individually, and each was asked (using a retrieval system called HIS) to search for information regarding a severe health condition and a mild health condition, respectively. The selected online health information sources were automatically captured by the HIS system and classified at both the website and webpage levels. Participants' selection behavior patterns were then plotted across the whole information‐seeking process. Our results demonstrate that laypeople's source selection fluctuates during the health information‐seeking process, and also varies by the severity of health conditions. This study reveals laypeople's real usage of different types of online health information sources, and engenders implications to the design of search engines, as well as the development of health literacy programs.

Embedding a Health Literacy Intervention Within Established Parenting Groups: An Australian Feasibility Study.

Background:A significant proportion of new parents in high-income countries have lower health literacy, but few health literacy interventions exist for this group.Objective:This study investigated the feasibility of delivering health literacy content within existing postnatal parenting groups.Methods:Multicenter feasibility study using a seven-group pre-test post-test design. Parents older than age 16 years with children between age 4 and 26 weeks with sufficient English fluency were invited to participate in a 4-week health literacy program (four 2-hour sessions) delivered by trained facilitators (e.g., child and family health nurses). Mixed-methods evaluation was used, with quantitative data analyzed descriptively and qualitative data (e.g., focus groups, observations, interviews) analyzed using the Framework approach.Key Results:Our health literacy program was successfully delivered at six sites in New South Wales, Australia, in 2018. Our recruitment strategy was successful in reaching diverse learners (N = 73), many who were born in a country other than Australia. However, few had limited health literacy as assessed by a subjective, single-item measure, and only half completed the follow-up questionnaires. High baseline knowledge, skills, and confidence among participants limited the potential for change in these quantitative outcomes but shed light on the utility of different measurement instruments in this context. Qualitative analyses suggested that the health literacy program aligned well with the institutional objectives of child and family health services and was acceptable to learners from diverse cultural backgrounds. However, in its current form, it may be perceived as too simple for learners with higher levels of education and literacy.Conclusions:Our study has offered practical insights into the feasibility of embedding a health literacy intervention into established postnatal parenting groups and shown how program resources and facilitator training could be adapted to make the program more suitable for a range of learners and better support facilitators. [HLRP: Health Literacy Research and Practice. 2020;4(1):e67–e78.]Plain Language Summary:This study looked at the feasibility of delivering a 4-week health literacy program to new parents using existing postnatal parenting groups in New South Wales, Australia. Although the program was generally acceptable to learners and facilitators, this study offers several strategies to further improve the program so that it better supports facilitators and suits a wider range of learners.

Learners’ experience and perceived impact of a health literacy program in adult basic education: a qualitative study

Qualitative interview study. We conducted semistructured interviews as part of the evaluation of the 18-week health literacy program, with participants purposively recruited from six health literacy classes (n = 22). Researchers trained in qualitative methods interviewed adult learners either face to face or over the phone using a topic guide. Data was analysed using the Framework method, a matrix-based approach to thematic analysis. The majority of interviewees were female, lived in metropolitan areas and were from non-English-speaking backgrounds. Most had existing self-reported health problems and inadequate functional health literacy. Most participants described positive impacts of the health literacy course on their language, literacy and numeracy skills, functional health literacy skills, and health knowledge. They also reported being able to translate this into health actions including interacting with providers, accessing and using healthcare, and managing health and illness (e.g. making healthier food choices). Learners also described positive social outcomes of the course, including feelings of connectedness and interpersonal trust within a new network of learners, and reported sharing new knowledge with others in their communities. The findings add value to existing limited evidence that has demonstrated the untapped potential of adult basic education to develop health literacy skills among socially disadvantaged groups. Learners valued the opportunity to share experiences in structured group learning, and reported confidence to transfer new knowledge into their home and wider social network.

Predicting disclosure and help-seeking in university students with psychosocial problems based on stigma and attitudes towards disclosure and help-seeking

Despite high prevalence of mental health problems among university students, there’s a gap between the need for help and the actual treatment received. This study investigated disclosure on distress and hazardous alcohol use and help-seeking behavior in a sample of 1,791 students of a Dutch university of applied sciences. Students’ perceived public and personal stigma, and attitudes towards disclosure and help-seeking were assessed as possible predictors of disclosure and help-seeking behavior. Results of the analysis of variance and logistic regression analysis indicated that perceived public and personal stigma did not predict disclosure and helpseeking behavior, but that attitudes towards disclosure and help-seeking did. Students with both distress and hazardous alcohol use have the least tendency to disclose their problems to family, friends or classmates, but at the same time they do tend to seek help. Disclosure and seeking help for mental health challenges are health promoting competencies that seem to need more attention in university students. Although further research needs to validate these findings, it is recommended to promote disclosure and help-seeking among students by investing in mental health literacy programs, to educate students about mental health issues, raise awareness on available mental health services and their potential benefits.

Utility of medicines information leaflets in hypertensive care in a setting with low health literacy: A cross-sectional study.

Introduction:Higher levels of health literacy improve utilization of health information, medication adherence and outcomes. Few studies evaluate the utility of medicines information in hypertensive care in settings with low health literacy.Aim:To determine the level of health literacy and utility of medicines information leaflets (MILs) among hypertensive patients in public health care in Namibia.Methods:A hospital-based survey among hypertensive patients receiving care at a referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s health literacy and utility of MIL were assessed using three literacy tools and a survey questionnaire. Quantitative data were analysed using descriptive statistics and qualitative thematic content analysis for factors associate with the utility of the MIL.Results:Of the 139 patients, 63% were female and the mean age was 45.7 (range: 19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of Literacy in Medicine (REALM) score <44, that is, unable to read simple health materials), 38.8% had positive Single Item Literacy Screener (SILS) scores (⩾2, require help to read medicines information) and 66.9% had inadequate skills for comprehension, appraisal and decision-making with regard to health information (Health Literacy Skills Instrument-Short Form (HLSI-SF) score <70%). The level of access to and utility of MIL were low, 32.4% and 34.6%, respectively. The main factors associated with poor utility of the MIL were low patient health literacy, lack of guidelines on the use of MIL and MIL written in non-native languages.Conclusion:Low rates of health literacy and utility of MIL were observed among hypertensive patients in Namibia. The integration of health literacy programmes, and MIL guidelines are needed to promote utility of medicine information and improve medication adherence.

Development and Validation of the EspaiJove.net Mental Health Literacy (EMHL) Test for Spanish Adolescents.

There is evidence of the effectiveness of implementing mental health literacy (MHL) programs. However, there are substantial limitations in the instruments available for measuring MHL. This study aimed to develop and validate the EspaiJove.net MHL test (EMHL) for Spanish adolescents by assessing its psychometric properties. The development of the EMHL test was conducted using item pool generation and a pilot study. A convenience sample of students aged 13–15 years (n = 355) participated in the validity study. Reliability was assessed for internal consistency and via test-retest. Convergent validity was evaluated by comparing the effect sizes among known groups with different levels of mental health knowledge, the correlation with mental health-related instruments, and the item discrimination index. A final version of a 35-item EMHL test was obtained with two parts: (i) a binary choice format (yes/no) for the identification of mental disorders; (ii) a multiple choice question with four possible answer options. Internal consistency was acceptable in the first part (Cronbach’s alpha = 0.744; Guttman’s lambda 2 = 0.773) and almost acceptable in the second part (Cronbach’s alpha = 0.615; Guttman’s lambda 2 = 0.643). The test-retest evaluation supported the stability of the test (first part, ICC = 0.578; second part, ICC = 0.422). No ceiling and floor effects were found. The EMHL test scores discriminated between known groups with different levels of mental health knowledge and it is associated with several-related constructs of MHL. Conclusions: The EMHL test is a relevant measure for assessing MHL in adolescents into Spanish context with acceptable validity and stability.

Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China.

WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. ABSTRACT: Introduction Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.

Protecting the U.S. Population’s Health Against Potential Economic Recessions and High Unemployment and the Endemic Inflation of Health Care Costs

Because employers provide health insurance, they play a major role in the population’s health and in its security. In the United States, historically, employment has always been the cornerstone of private health insurance. In fact, 90 percent of people under 65 get their health insurance through employment. But the health of the labor market varies and with it the health of the population it serves. Economic struggles leads to less disposable income and bad health. Job security has been revisited and is no longer a guarantee. In most households, both parents are working and any layoff or illness is tantamount to major stress on their health because the U.S. health care system is the most expensive in the industrialized world. While the economy has recovered from the 2007-2008 Great Recession, the prospect of future economic recessions is still looming and when the next one hits, the impacts have the potential to be great and widely felt because the recipe for disaster is ubiquitous: an unaffordable health care system that is spiraling out of control. Medical bills are often synonymous with bankruptcy. Health care costs are constantly rising and Americans are hit with higher out-of-pocket costs on a regular basis. Because the health care system is price-based and not value-based, its efficiency is hindered. That is, although the U.S. spends twice as much in health care compared with the other OECD countries, its health outputs are inferior to those of countries such as Canada, France, Germany, Japan, and the United Kingdom. Developments in communication and information technologies may be a golden opportunity to reverse the trend. These technologies may help improve the effectiveness of public health interventions. Telehealth or telemedicine, by integrating the patient – and because it’s moving to urban areas – is pivotal. Improving access, ensuring quality, and controlling costs to reduce wasteful spending should be the top priorities of health policy makers. Besides technology, emphasis should be put on health literacy programs and the valorization of communities. Also, there has been a lot of debate on whether the U.S. should embrace universal health coverage (UHC), also called Medicare-for-all or a single-payer system, or even a socialized medicine modeled after the U.K.’s health care system. At each end of the spectrum, proponents and opponents make their case using, of course, different arguments. The former think that health care should be made a fundamental right of citizenship while the latter think that health care is after all a service and people should pay for what they get, although amongst them some think that a public option – where private insurance and government insurance for all coexist – might be a better alternative to straight and universal socialized medicine benefiting every American regardless of their socioeconomic status.

Developing Self-concept, Coping Skills, and Social Support in Grades 3–12: A Cluster-Randomized Trial of a Combined Mental Health Literacy and Dialectical Behavior Therapy Skills Program

A multisite cluster-randomized trial (by school) was conducted to examine the effects of a combined mental health literacy and dialectical behavior therapy skills program implemented by teachers on three protective factors related to social and emotional well-being. The sample of eight schools that were randomly assigned to intervention included 995 students in 40 3rd–12th grade classrooms in two Canadian cities. Student-reported measures of self-concept, coping skills, and social support were collected three times in the year (October, February, and June). Results indicated large effects for the program on all measures (g = 1.00 to 1.39). Program effectiveness did differ by city, but did not differ between elementary versus secondary schools, or by student gender, ethnicity, or disability status. The implications of the study for universal school-based mental health programming are discussed.

Protocol for a phase III wait-listed cluster randomised controlled trial of an intervention for mental well-being through enhancing mental health literacy and improving work friendliness in Hong Kong

BackgroundMental health has long been recognised as a major global health issue. Some work-related characteristics have been identified to be associated with common mental health problems, and thus the workplace is an important venue for the prevention of mental health problems and promoting mental wellness. Burnout is one of the important aspects of workplace organisational stressors and, in recent years, the lack of mental health literacy has also been identified as a fundamental issue. Studies have demonstrated that an improvement in mental health literacy is an effective measure for enhancing mental well-being. It would be prudent to combine an organisation-directed component and the enhancement of mental health literacy in an intervention programme. This trial will examine the novel approach of an intervention aiming to provide an evidence-based prevention programme.MethodsThis study utilised a wait-listed cluster randomised control trial design. Using branch offices as the primary sampling units, employees from three large companies in different industries will be recruited. Upon enrolment and after the baseline assessment of the outcome measures, participants nested in the branch offices will be allocated to the intervention or wait-listed arms. The intervention programme comprises of two main elements: an organisation-directed component and individual-directed psychoeducation training. This intervention will be delivered by a senior social worker well-versed in workplace issues over a period of 3 months. The trial will determine whether an integrated workplace mental health literacy and well-being programme is effective in increasing the mental health literacy scores and reducing burnout and stress scores, as measured by standardised and validated scales.DiscussionIf the trial results are in line with the hypothesis that supports the efficacy of the intervention programme, this will provide an evidence-based approach for an effective workplace mental well-being intervention programme that could not only enhance the understanding of mental health issues, but also reduce work-related burnout and stress as well as increase workers’ quality of life.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000464167. Registered prospectively on 20 March 2019.

Teen Mental Health First Aid as a school-based intervention for improving peer support of adolescents at risk of suicide: Outcomes from a cluster randomised crossover trial.

The aims of this study were to assess evidence for a novel, universal mental health literacy programme in the school setting (teen Mental Health First Aid) as an intervention to improve peer support towards adolescents at risk of suicide and to examine whether participation in a school-based programme dealing with suicide was distressing to participants. In a cluster randomised crossover trial, Australian high school students aged 15-17 years (N = 1605, 44.74% female, Mage = 15.87) received either teen Mental Health First Aid or a matched control physical first aid course. Data were collected before, immediately after and 12 months after training through online surveys assessing correct recognition of suicidality and intentions to help a fictional peer (John) who was depicted as experiencing depressive symptoms and suicidal thoughts in a vignette. Students were also asked whether any information in the training or surveys was found distressing and completed a validated measure of psychological distress (the Kessler Psychological Distress Scale). Students receiving teen Mental Health First Aid training were much more likely to report an increase from pre- to post-training in recognition of suicidality (OR = 1.97, 95% CI = [1.14, 3.39], p = 0.02) and appropriate first aid intentions towards a peer at risk of suicide than students receiving physical first aid (OR = 35.40, 95% CI = [19.86, 63.14], p < 0.001). Twelve months after training, most effects were still significant. Although a greater proportion of teen Mental Health First Aid participants self-reported feeling briefly distressed after the training, there was no evidence of greater distress at 12 months on the Kessler Psychological Distress Scale. teen Mental Health First Aid is effective in increasing recognition of and intentions to assist a suicidal peer. Although the open discussion of mental health first aid for a suicidal peer was distressing for some students, results suggest this was transient and not associated with harm. Future studies are required to ascertain whether these increases are indeed associated with better provision of support and prevention of youth suicide.

Diabetes distress in Indonesian patients with type 2 diabetes: a comparison between primary and tertiary care

BackgroundThe number of people living with diabetes mellitus (DM) in Indonesia has continued to increase over the last 6 years. Four previous studies in U.S have found that higher DD scores were associated with worse psychological outcomes, lower health-related quality of life (HRQoL) and increased risk of T2DM complications. In this study, we aimed to firstly compare DD scores in Indonesian T2DM outpatients treated in primary care versus those in tertiary care. Subsequently, we investigated whether socio-demographic characteristics and clinical conditions explain potential differences in DD score across healthcare settings.MethodsA cross-sectional study was conducted on Java island in three primary care (n = 108) and four tertiary care (n = 524) facilities. The participants completed the Bahasa Indonesia version of the Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). Ordinal regression analysis was conducted with the quartile of the summation of the DD score as the dependent variable to investigate how the association between the level of healthcare facilities and DD altered when adding different variables in the model.ResultsThe final adjusted model showed that the level of healthcare facilities was strongly associated with DD (p < .001), with participants in primary care having a 3.68 times (95% CI 2.46–5.55) higher likelihood of being more distressed than the participants in tertiary care. This association was detected after including the socio-demographic characteristics and clinical conditions as model confounders.ConclusionsThis is the first study in Indonesia to compare DD scores within different healthcare facilities. We recommend a regular DD assessment, possibly closely aligned with health-literacy partner programs, especially for T2DM patients in primary care settings.

English as a Second Language Health Literacy Program

English as a Second Language Health Literacy Program

Assessing the Effectiveness of Teachers’ Mental Health Literacy Training in Cambodia: A Randomized Controlled Trial

School-based mental health literacy (MHL) programs are used to reduce stigma and promote help-seeking among students and teachers. This study aimed to adapt and evaluate a teacher-delivered MHL program in Cambodia, where the impact of MHL programs has not previously been evaluated. 67 teachers and 275 students from a high school in Phnom Penh voluntarily completed the study. School staff were randomly assigned, and classrooms purposively assigned, to either a 2-day MHL training program or a control condition. Four teachers in the intervention condition were also pragmatically selected to deliver a 6-week classroom MHL curriculum to students; these teachers receive an extra day of implementation training. Teacher and student MHL were assessed before and after the intervention. Results showed significant improvements in all indicators of teacher and student knowledge and attitudes about mental illness; largest improvements were in teachers’ perceptions of dangerousness and willingness to interact. This pilot RCT supports the potential benefits of school-based MHL training in Cambodia, where there is substantial mental health stigma and discrimination. However, small to moderate effect sizes, particularly for students outcomes, suggest a need for further refinement and testing of the curriculum to optimize impact, including further consideration of implementation strategies and supports.

A Brief Sports-Based Mental Health Literacy Program for Male Adolescents: A Cluster-Randomized Controlled Trial

Adolescents are at increased risk of mental illness and prefer to seek help from informal supports. By increasing knowledge and skills, peers may act as gatekeepers to mental health services. The aim of the current study was to assess the effects of a brief sports-based mental health literacy program to increase competencies and intentions to both provide and seek help for mental health problems among adolescent male sports participants. A cluster-randomized controlled trial was conducted with measures taken at 3 time points: baseline (2 weeks prior to intervention), immediately postintervention, and at 1-month follow-up. Adolescents were randomized to either the intervention group (n = 47) or a waitlist control group (n = 55) at a team level (n teams = 9). Participants were 102 male adolescents 12–18 years of age (M = 14.30, SD = 1.75) from a community football club in New South Wales, Australia. A 45-min Help Out a Mate (HOAM) workshop was delivered around a usual team practice session. Compared to the waitlist control, participants in the HOAM condition reported significant increases in knowledge of signs and symptoms of mental illness, intentions to provide help to a friend who may be experiencing a mental health problem, and attitudes that promote problem recognition and help-seeking. There were no between-group differences in confidence to provide help, personal help-seeking intentions, and psychological distress. The results suggest that a brief intervention can be effective at improving the mental health literacy of young men when delivered within a sports context. Lay summary: Compared to a waitlist control, the Help Out a Mate group showed improvements in mental health literacy for depression and anxiety and intentions to provide help along with sustained improvements in attitudes that promote help-seeking and reduce stigma. Personal help-seeking intentions did not change as a result of the program.

Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory.

Understanding depression as biologically caused has been shown to impact both treatment preferences and prognostic pessimism. Attribution theory has been posited as an explanation for this relationship. Given that evidence-based psychotherapy is effective yet often not delivered to individuals with depression, the present study sought to determine factors that impact treatment credibility. Non-treatment-seeking, depressed individuals (n=229) were randomly assigned to read a psychoeducation article about depression that consisted of a biological causal explanation, psychosocial causal explanation, or a non-causal control. Attributional dimensions of locus, stability, and control were examined as mediating the relationship between causal explanation and treatment credibility and prognostic pessimism. Individuals in the biological condition were more likely to find antidepressant medication a credible treatment for depression. The manipulation had no direct effect on preference for psychotherapy orprognostic pessimism. Attributional dimensions of locus, stability, and control did not mediate the relationship between causal explanation and treatment credibility. To the extent that the psychosocial article increased perceived instability of the depression cause, however, prognostic pessimism was reduced. The present study has implications for framing education about depression in mental health literacy programs and public awareness campaigns. This study found that conceptualizing depression as biologically caused increased the credibility of medication but not psychotherapy Participants reading a biological explanation of depression demonstrated an increase on some aspects of stigma and prognostic pessimism Emphasizing the person-environment interaction rather than biological causes decreased the perceived stability of depression which was associated with a decrease in prognostic pessimism.

Evaluation of an Australian Health Literacy Program Delivered in Adult Education Settings.

Background:Adult education targeting health literacy (HL) may bring added value in the form of improved health.Objective:This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy.Methods:This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content); the remainder (n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention.Key Results:Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on individual-level functional HL (e.g., reading a thermometer; HL group 18.4% vs. standard group 7.2%; p = .001), confidence (HL group 0.34 vs. standard group 0.06; p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence (p < .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct; p = .022); confidence (p = .008); ability to actively manage health (HLQ) (p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health.Conclusions:Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S42–S57.]Plain Language Summary:We compared the effect of an adult education-based health literacy (HL) program versus a standard language, literacy, and numeracy program on students' HL skills and psychosocial outcomes. Although students in both trial arms improved their skills, students in the HL program had better outcomes with higher HL, greater confidence, and higher health knowledge scores at 6 months.

Development and Implementation of the How to Talk to Your Doctor HANDbook Health Literacy Program in Rural Counties.

Background:Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The How to Talk to Your Doctor (HTTTYD) HANDbook Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care.Brief Description of Activity:We describe development of the HTTTYD HANDbook Program delivered through the Cooperative Extension Service to educate adults who are eligible for Medicaid and have low health literacy. HTTTYD HANDbook implementation is described using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (and specifically the reach, adoption, implementation, and maintenance dimensions).Implementation:The HTTTYD HANDbook was developed using health literacy best practices with user-centered design, and it was field tested with community members with varying levels of health literacy. Reach, adoption, implementation, and maintenance of the HTTTYD HANDbook were assessed by tracking distribution of HTTTYD HANDbook Program materials, return submission of evaluation and tracking instruments, adherence to program and data collection/submission protocols, and program continuation.Results:Overall reach into the population was 6 per 10,000; about 25% were Medicaid recipients and 28.2% had low health literacy. Most participants were age 65 years or older. Of the 72 counties with program access, 52.7% requested HTTTYD HANDbook Program materials; 31% adopted the program, but only 30% of these counties adhered to program implementation and data collection protocols. Reach and adoption were higher among rural counties, and rural counties were more likely than nonrural counties to maintain the HTTTYD HANDbook Program.Lessons Learned:The HTTTYD HANDbook Program addresses barriers to engagement in patient-provider communication for rural, low-income community members. Programs can be implemented in community settings through established local organizations, such as county extension offices, to increase access for rural adults. Implementation barriers included staff turnover and transportation of program materials. Online facilitator training availability had little impact on adherence to program protocols. Organizational context and established procedures for program delivery and evaluation should be considered in adoption decisions and integrated into implementation protocols. [HLRP: Health Literacy Research and Practice. 2019;3(3):e205–e215.]Plain Language Summary:The How to Talk to Your Doctor HANDbook Program was created with people from the community to help patients prepare for doctor visits. The How to Talk to Your Doctor HANDbook Program helps patients to overcome barriers to talking to their doctor so that they can better understand how to get healthy and stay healthy.

Effect of health literacy program on improving of elderly women awareness and self-practice about vaginal atrophy

As the number of elderly persons in our country increases, vaginal atrophy affects 10 to 40% of postmenopausal women worldwide. Promotion of health literacy level is one of the main non-pharmaceutical measures proposed to older adults. Aim of the study:To determine the effect of health literacy on improving of elderly women awareness and self-practice about vaginal atrophy. Subjects and Method: quasi-experimental research design was used in this study. Setting: The study was conducted in two geriatric clubs at Assiut City (Geriatric club of Legitimacy Assembly and Geriatric club of Islamic Cultural Center). Sample: The total number of elderly women attending to previously mentioned setting (200) it was taken to assessment of health literacy. The program was conducted on participants who had low level of health literacy for (100) elderly women and was using purposive sampling in this study. The main results yielded by the study, proved that a highly statistical significant difference between pre & posttest program as regarding health literacy awareness and self-practice about vaginal atrophy for elderly women. This study concluded that the health literacy program was effective on improving the awareness and self-practice about vaginal atrophy for women. This study recommended that be conducted on another sample acquired from different age & areas for generalization in Egypt.