Promoting Health Literacy Research Articles

Portuguese adaptation of the Chronic Heart Failure Knowledge Questionnaire (KQCHF)

BackgroundA patient’s knowledge of heart failure (HF) is associated with better outcomes. The more information patients have about their illness, the less likely they are to be readmitted to the hospital. Such knowledge includes the cause, symptoms, probable duration, and expected evolution of the clinical picture. In Portugal, a tool for testing patient knowledge is an unmet need. Therefore, this study aimed to adapt and test the Chronic Heart Failure Knowledge Questionnaire (KQCHF) for the Portuguese context.MethodsThis work includes three cross-sectional studies. In Study 1, subjects were divided between before and after receiving information about HF. In Study 2, participants answered the questionnaire before and after reading the brochure. In Study 3, KQCHF was applied to patients with HF. Studies 1 and 2 were carried out in the general population. Study 3 was carried out with HF outpatients. Convenience sampling was applied to participants in the three studies.ResultsIn Study 1 (n = 45), those who received information had better scores (9.2 ± 1.9) than those who did not (6.0 ± 2.3). In Study 2 (n = 21), the scores were higher after reading the brochure (10.4 ± 1.7 vs. 6.5 ± 2.9). In Study 3 (n = 169), women had better scores than men (9.1 ± 2.1 vs. 8.3 ± 2.2, overall: 8.5 ± 2.2), and knowledge was correlated with education (r = .340, p < .001) and age (r = -.170, p = .030).ConclusionThe Portuguese adaptation of KQCHF captured relevant knowledge about HF and has shown promising results for clinical and research purposes. The questionnaire can be useful in assessing HF patients’ knowledge of their disease and as a basis for the implementation of general and personalised educational strategies to improve HF knowledge and, therefore, promote health literacy and self-care.

Understanding Critical Health Literacy Among Adolescents: Psychometric Properties of the CHLA Questionnaire in Lower Secondary Schools in Norway.

Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA-Q). A cross-sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13-15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha. The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability. The results indicate acceptable fit of the CHLA-Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL.

Developing health literacy events: a case study of teachers designing health curricula

Objective: In response to the question ‘how can teachers develop health literacy events that leverage students’ cultural and linguistic resources’, this study highlights how two teachers developed a culturally and linguistically responsive curriculum that sought to promote health literacy. Design: The study details findings from a larger partnership between an urban university and a bilingual urban school in the USA. Researchers and teachers conducted a year-long project oriented towards co-designing a curriculum that integrated students’ cultural and linguistic repertoires with health literacy. Over one academic year, teachers planned, implemented, studied and modified curricular units that drew on students’ cultural and linguistic resources related to health. Setting: The study focuses on two Spanish-English bilingual teachers working in a third-grade (8–9 year olds) dual-language classroom in a multilingual urban community in the midwestern USA. Method: Data collected included classroom conversations, teacher-researcher and university researcher conversations, classroom work and teacher-derived analytic documents. Data were coded and analysed to understand how teachers made sense of what happened within specific health literacy events to develop a single descriptive case study. Results: Three events are focused on demonstrating how teachers developed health literacy by building on students’ pre-existing cultural and linguistic resources. Teachers moved from using teacher-centred forms of nutrition education to using student-developed health content that articulated with health concerns in the community. Conclusion: Using a funds of knowledge approach to integrating health literacy into the curriculum, teachers helped students draw on cultural and linguistic resources, building self-confidence, and developing an interest in gathering evidence and presenting health-related findings.

Current state, equality level and trends of self-rated health among old adults with intact physical condition

BackgroundSelf-rated health among old adults (SHOA) indicates individuals' subjective assessments and evaluations of their overall health based on objective physical circumstances. The purpose of this study was to analyze the current state and influencing factors of the subjective perception-based self-rated health (SH) by qualifying selected older adults with similar objective physical conditions, as well as to explore the equality and changing trends of SHOA based on influencing factors.MethodsThis study designed a cross-sectional study, conducted in three provinces in east, central and west China, and included 1,153 older adults (> = 60 years) with intact physical condition (IPC). The current state of SHOA and its influencing factors were analyzed using mean comparisons and Logistic regression (LR) models. The equality level and trend of SHOA's effect on health literacy, health habits, and access to health care were determined using the Lorenz curve, Gini coefficient, and Vector Autoregression (VAR) model.ResultsThe mean SHOA with IPC was 74.37 ± 13.22. Findings from LR modeling indicated that SHOA with IPC was mainly influenced by age and communication methods (P < 0.05). It was also observed that the total Gini coefficient of the allocation of SHOA with IPC based on communication methods was equal to 0.0188, and the VAR results showed that the total effect of change in SHOA on health literacy among older adults was negative and its duration of the effect exceeded 50.ConclusionsThe SHOA with IPC was shown to be better and was primarily influenced by age and communication methods. The observed effect of SHOA on health literacy was negative and lasting. To improve SHOA with IPC even further, policymakers could consider promoting the use of modern and convenient communication methods (such as smartphones) through training and purchasing subsidies, as well as focusing on increasing sustained attention and promoting health literacy and behavior among older adults with improved SH.

Health literacy among adolescents and young adults in the Eastern Mediterranean region: a scoping review

ObjectivesFor adolescents and young adults, most health literacy research has been conducted in Western countries, but few studies have been conducted in the Eastern Mediterranean region (EMR). This review aimed...

Health Literacy in Adults with Chronic Diseases in the Context of Community Health Nursing: A Scoping Review

Background: Health literacy was identified as a main determinant in self-care of chronic diseases. This results in responsibilities for health professionals for daily practice. For primary care setting, special requirements arise due to the heterogeneity of communities. The objective of this scoping review was to explore and map the scope of the research material on strategies led by community health nurses to improve health literacy in (patients with) chronic diseases. This review aimed to identify gaps in the literature and existing approaches on promoting health literacy by community nurse practitioners. Methods: The following criteria were included for the research: Adults with chronic diseases, health literacy, community health nursing and primary healthcare. All types of searches for studies from 1970 to present were carried out in electronic databases and in a Google and a Google Scholar search. The search procedure is presented in a flow chart. Results: From all reviewed studies, nine records were included in the review. Findings with regard to the increase in health literacy in self-management of chronically ill patients were identified. Conclusion: Studies focusing on specific demands with regard to the role of community health nurses need to be carried out in depth.

Promoting Health Literacy among LESLLA Learners: Empirical Findings and Practical Implications

Promoting Health Literacy among LESLLA Learners: Empirical Findings and Practical Implications

Promoting Health Literacy among LESLLA Learners: Empirical Findings and Practical Implications

Promoting Health Literacy among LESLLA Learners: Empirical Findings and Practical Implications

Factors related with nursing students' health literacy: a cross sectional study.

Nursing professionals have a crucial role in promoting health literacy in health services, so it is necessary to ensure health literacy skills in future health professionals. The objective of the study was to examine the health literacy of nursing students and its associated factors. A cross-sectional descriptive study was carried out on 460 nursing students. For data collection, a semi-structured questionnaire was obtained on sociodemographic characteristics, perception and health care, use of the health system and lifestyles. In addition, health literacy was assessed using the European Health Literacy Questionnaire. 6.1% of the participants had an inadequate level of health literacy and 36.5% problematic. The probability of having sufficient health literacy is directly associated with age; and inversely with smoking, prolonged screen time and living alone (p < 0.05). A large percentage of nursing students need to improve their health literacy skills. It is necessary to integrate a greater number of contents in health literacy in the curriculum of nursing students.

Consequences of China’s special send-down movement on infectious disease control in rural areas: a natural experiment

BackgroundChina's send-down movement in the 1960s and 1970s, as a natural experiment, provides a unique opportunity to investigate the relationship between peers' dissemination of health literacy, community health workers, and infectious disease control in areas with weak health systems and inadequate human resources. To address the lack of studies on the health effects of the send-down movement, this study examined the associations between prenatal exposure to the send-down movement and infectious diseases in China. MethodsWe analyzed 188,253 adults born in 1956–1977 with rural hukou who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China. Difference-in-difference models were used to detect the effect of the send-down movement on infectious diseases. Infectious diseases were ascertained by using the combination of self- or family members’ reports and on-site medical diagnosis of disabilities attributed to infectious disease by experienced specialists. The density of the relocated urban sent-down youth or “sent-down youths” (SDYs) in each county defined the intensity variable of the send-down movement. ResultsIndividuals in SDY-receiving areas with increased intensity of prenatal exposure to the send-down movement had a decreased probability of infectious diseases (β = −0.0362, 95% CI: 0.0591, −0.0133) after controlling for a set of regional and cohort characteristics. This association was stronger in counties with more prevalent infectious diseases prior to the send-down movement (β = −0.0466, 95% CI: 0.0884, −0.0048) than in those with less prevalence (β = −0.0265, 95% CI: 0.0429, −0.010). No substantial differences were found across sex-specific groups or by strictness of send-down movement implementation. On average, prenatal exposure to the send-down movement corresponded to a decrease in the probability of infectious diseases in rural areas by 19.70%. ConclusionsFor areas with weak health systems, strengthening community health workers and promoting health literacy may be two key points to address the burden of infectious diseases. Increasing education and primary health care through peer-to-peer dissemination may contribute to the reduction of infectious disease prevalence.

Health Literacy Among University Students in Shaanxi Province of China: A Cross-Sectional Study.

An adequate level of health literacy will help university students to better respond to public health emergencies and reduce unintended harm caused by public health events. The objective of this study was to assess the health literacy levels of students from Universities of Shaanxi province of China, in order to provide a basis for the development of health literacy promotion plan for university students. An online cross-sectional questionnaire survey was conducted at five universities in Shaanxi Province of China on the Wen-Juan-Xing online platform. A purposive sampling method was used to 1578 students via self-administered questionnaire. Comparisons of means were made using the t-test and ANOVA, and comparisons of ratios or composition ratios were made using the χ2 test. The mean score for health literacy was (105.33±10.14) out of 135, and the mean scores for the three dimensions of health knowledge, attitudes and practices were (36.093±4.192), (34.178±4.227) and (35.059±4.515) respectively. Of the total sample, 39.2% were classified as sufficient in health literacy. Female students had higher health literacy level than male students (t=4.064, p=0.044), lower grade students scored higher than higher grade (F=3.194, p=0.013), students from urban cities scored higher than those who came from rural areas (t=16.376, p<0.001), and university students with health education experience scored higher than those without (t=24.389, p<0.001). University students' health literacy is closely related to their gender, grades, family location and health education experience.

Intervention strategies and techniques to promote health literacy among socioeconomically disadvantaged groups - a systematic review with albatross plots

Intervention strategies and techniques to promote health literacy among socioeconomically disadvantaged groups - a systematic review with albatross plots

Evaluation of binge drinking behavior among working-age populations in Thailand using GIS: A national survey in 2017

This study identifies the prevalence of binge drinking behaviour and the statistical relationship between local patterns and binge drinking behaviour among the working-age population in Thailand. This study was conducted using The Smoking and Drinking Behaviour Survey 2017 data set from the National Statistical Office of Thailand. Local Indicators of Spatial Association (LISA) were used to identify the spatial autocorrelation between surrounding areas, with binge drinking behaviour among the working-age population in Thailand. Findings showed that among the 61,708 participants, 11.47% engaged in binge drinking behaviour. There was aspatial global autocorrelation between the surrounding areas and binge drinking behaviour among the working-age population, with a Moran’s I value of 0.579. The LISA analysis indicated nine hotspots or high–high clusters. In Thailand, there is a cultural context that encourages risky behaviour such as drinking alcohol beyond the standards set by law. Therefore, to manage this problem efficiently and effectively, the public and private sectors and related agencies should raise awareness about the health effects of binge drinking and promote health literacy to local residents while engaging all sectors in managing alcohol behaviour in all areas. This type of approach is sustainable and can have long-term effects on society.

Maternal educational level and preterm birth: Exploring inequalities in a hospital-based cohort study.

Preterm birth has been related to inequalities in maternal educational level, but the causal mechanism is not entirely known. Some factors associated with preterm birth and low educational level such as chronic medical conditions, pregnancy complications and related-health behaviours could have a mediation role in the pathway. This study aimed to evaluate the association between maternal educational level and preterm birth, analysing the mediation role of these factors. We performed a retrospective cohort study based on hospital electronic records of 10467 deliveries that took place in the Hospital Clínic of Barcelona between 2011 and 2017. Poisson regression was used to obtain crude and adjusted relative risk of preterm birth in women with different educational level and the percentage of change in relative risk was calculated when mediation variables were included in the model. Women with a lower educational level had a higher risk of preterm birth (RR 1.57, 95% CI 1.21, 2.03). The loss of association after the inclusion of body mass index in the model suggests an important mediation role of maternal overweight. Other variables such as smoking, drug use, preeclampsia and genitourinary infections also appear to play a role in the observed inequality between women with different levels of education. Efforts to promote health literacy and to improve preventive interventions, before and during pregnancy, could decrease preterm birth rates and perinatal health inequalities.

Effect of Educational Intervention Based on Orem's Self-Care Theory on Health Literacy in Patients with Prostate Cancer under Chemotherapy: A Quasi-Experimental Study

Background and Objective: Prostate cancer is one of the most common cancers and the cause of death among men. Health literacy helps the maintenance and promotion of people's health through improving self-care behaviors. Therefore, this study was conducted to determine the effect of educational intervention based on Orem's self-care theory on the health literacy of patients with prostate cancer undergoing chemotherapy in Shiraz, 2019-2020. Materials and Methods: In this quasi-experimental study, 134 patients with prostate cancer and under chemotherapy were randomly divided into two control and experimental groups (n=67 each). The control group received routine training, while the experimental group received educational intervention based on Orem's self-care theory. Data was collected via the Health Literacy Questionnaire and analyzed using SPSS software (version 21). Results: The mean health literacy scores in the experimental and control groups were obtained at 97.14±13.02 and 98.41±14.99 before the intervention and 100.22±14.14 and 146.02±9.09 after the intervention, respectively. There was a significant difference between the two groups only after the intervention (P&lt;0.05). A significant improvement was also observed in the mean health literacy score of the experimental group, compared to before the intervention (P&lt;0.05). The results indicated a significant relationship between mean health literacy scores and education and resource access methods (P&lt;0.05). Conclusion: The self-care education based on Orem's theory increased health literacy in patients with prostate cancer undergoing chemotherapy. Therefore, educational intervention based on Orem's self-care theory is suggested to promote health literacy in these patients.

Systematic Review of Health Literacy and Health Promotion in School-Aged Adolescents

Background: The literature has identified gaps in adolescent health literacy (AHL) measurements, as well as how the health literacy (HL) level is related to health promotion (HP) aspects. This study aimed to examine the tools used to measure HL and determine its relation with HP among adolescents. Methods: Three online databases (HINARI, PubMed, and DOAJ) were searched to conduct a systematic assessment of papers published between January 1, 2016, and January 1, 2021. In this review, 373 articles were identified from these databases. After removing duplicates and screening titles and abstracts of articles, 49 full texts were selected for full-text reading. After comprehensive reading, 23 papers were appraised for qualitative synthesis. Results: Of the 23 reviewed papers, 21 focused on assessing AHL measures, and 15 addressed the association between AHL and HP. Seven studies used the HL School-Aged Children instrument. The findings suggested that the methodological and conceptual underpinnings of HL measures are insufficient. Furthermore, HL acts as an independent and positive mediator for many facets of HP. Conclusion: This review offers a warning to practitioners and educationists interested in measuring HL as the number of measurement tools is quite huge with different tools applying different scales.

The Promotion of Health Literacy

Abstract: Progress in predictive medicine has increased the challenges to navigating complex risk information for patients and healthcare professionals. This contribution investigates how people facing the risk of developing Alzheimer’s dementia perceive risk, what aspects are relevant to their health literacy, and how to promote individual health literacy in predictive medicine. We conducted a qualitative study analyzing narrative interviews, body maps, and sociodemographic data from persons who had undergone early predictive procedures in a memory clinic. We understand the promotion of health literacy as an ethical task in predictive medicine and argue for (1) emphasizing personal resources to promote subjective health literacy, (2) reframing communication and decision-making about disease risk, and (3) teaching skills for value-sensitive, individualized risk communication.

Causal Model of Health Literacy in Thai Older Adults with Knee Osteoarthritis

Knee osteoarthritis is the most common form of arthritis causing disability among older adults. Proper self-care is vital and achievable with health literacy. Thai older adults with knee osteoarthritis have been found to have inadequate health literacy, and poor selfcare behaviors for this condition. The purpose of this descriptive cross-sectional study was to test a causal model of health literacy in Thai older adults with knee osteoarthritis, depicting relationships among provider-patient communication, patient engagement, cognitive function, knowledge of knee osteoarthritis, Internet use, social support, social participation, and health literacy. Participants comprised 318 older adults with knee osteoarthritis, selected using multi-stage random sampling from nine community hospitals in a northern Thai province. Data were collected using a demographic data form, the European Health Literacy Survey Questionnaire, the Provider-patient Communication Scale, the Patient Health Engagement Scale, the Montreal Cognitive Assessment-Basic, the Arthritis Knowledge Scale, the Internet Use Questionnaire, the Social Support Questionnaire, and the Community Participation of the Elderly Questionnaire. Data were analyzed using descriptive statistics, Pearson’s product moment correlation, and structural equation modeling. The final model fitted with empirical data and explained 36% of the variance in health literacy with Internet use as the strongest predictor directly affecting health literacy. Internet use and social participation had positive direct and indirect effects on health literacy via cognitive function. Cognitive function and social support positively directly affected health literacy. Patient engagement negatively affected health literacy indirectly via Internet use. Knowledge of knee osteoarthritis and provider-patient communication did not affect health literacy directly or indirectly. In conclusion, nurses should design interventions to promote health literacy of this population by highlighting Internet use, social participation, cognitive function, social support, and patient engagement, with testing in clinical practice.

Pre-emptive emergency service-Preventive missions and promotion of health literacy at the intersections with emergency medical services

In the Emergency Medical Service Acts of the Federal States, the statements in these Acts have so far essentially been limited to the implementation of measures to maintain the health of emergency patients and to transport them to asuitable hospital. Preventive fire protection, on the other hand, is regulated in the Fire Brigade Acts or by statutory ordinances. Increasing numbers of emergency service missions and alack of facilities for alternative care justify the need for apreventive emergency service. This includes all measures that take place before an event occurs in order to prevent emergencies from occurring. As aresult, the risk of an emergency event leading to the emergency call 112 should be reduced or delayed. The preventive rescue service should also help to improve the outcome of medical care for patients. Furthermore, it should be made possible to provide those seeking help with asuitable form of care at an early stage.

Essential Principles to Create an Equitable, Inclusive, and Diverse EMS Workforce and Work Environment: A Position Statement and Resource Document

POSITION STATEMENT Emergency medical services (EMS), similar to all aspects of health care systems, can play a vital role in examining and reducing health disparities through educational, operational, and quality improvement interventions. Public health statistics and existing research highlight that patients of certain socioeconomic status, gender identity, sexual orientation, and race/ethnicity are disproportionately affected with respect to morbidity and mortality for acute medical conditions and multiple disease processes, leading to health disparities and inequities. With regard to care delivery by EMS, research demonstrates that the current attributes of EMS systems may further contribute to these inequities, such as documented health disparities existing in EMS patient care management, and access along with EMS workforce composition not being representative of the communities served influencing implicit bias. EMS clinicians need to understand the definitions, historical context, and circumstances surrounding health disparities, health care inequities, and social determinants of health in order to reduce health care disparities and promote care equity. This position statement focuses on systemic racism and health disparities in EMS patient care and systems by providing multifaceted next steps and priorities to address these disparities and workforce development. NAEMSP believes that EMS systems should: Adopt a multifactorial approach to workforce diversity implemented at all levels within EMS agencies. Hire more diverse workforce by intentionally recruiting from marginalized communities Increase EMS career pathway and mentorship programs within underrepresented minorities (URM) communities and URM-predominant schools starting at a young age to promote EMS as an achievable profession. Examine policies that promote systemic racism and revise policies, procedures, and rules to promote a diverse, inclusive, and equitable environment. Involve EMS clinicians in community engagement and outreach activities to promote health literacy, trustworthiness, and education. Require EMS advisory boards whose composition reflects the communities they serve and regularly audit membership to ensure inclusion. Increase knowledge and self-awareness of implicit/unconscious bias and acts of microaggression through established educational and training programs (i.e., anti- racism, upstander, and allyship) such that individuals recognize and mitigate their own biases and can act as allies. Redesign structure, content, and classroom materials within EMS clinician training programs to enhance cultural sensitivity, humility, and competency and to meet career development, career planning, and mentoring needs, particularly of URM EMS clinicians and trainees. Discuss cultural views that affect health care and medical treatment and the effects of social determinants of health on care access and outcomes during all aspects of training. Design research and quality improvement initiatives related to health disparities in EMS that are focused on racial/ethnic and gender inequities and include URM community leaders as essential stakeholders involved in all stages of research development and implementation.