Health Literacy Research Research Articles

Health Literacy of People with Intellectual Disabilities: How Meaningful Is the Social Context for a Target Group-Oriented Model of Health Literacy?

Health literacy is primarily understood as an individual construct. People with intellectual disabilities still seem to be a "hidden" population in health literacy research. A target-orientated health literacy approach for this population is needed for developing precise and effective interventions that consider social context dimensions. Therefore, the following research question was answered: Which dimensions influence the health literacy of people with intellectual disabilities? A secondary data analysis containing 38 guided interviews with people with mild to moderate intellectual disabilities was conducted. The analysis followed the content analysis by Schreier (2012). Six main dimensions were inductively outlined, which are "interpersonal relationship", "organizations and communities", "healthcare system", "education", "digital interaction spaces", "politics", and "cultural contexts". All these dimensions influence people with intellectual disabilities on an individual level regarding their level of health literacy. The importance of these single dimensions becomes clear, although for now, the link between all these dimensions is not yet considered. In future research, the focus should be on how to develop interventions considering social context dimensions. Furthermore, analyzing the connection between those dimensions seems promising.

Embedding health literacy research and best practice within a socioeconomically and culturally diverse health service: A narrative case study and revised model of co-creation.

Health literacy interventions and research outcomes are not routinely or systematically implemented within healthcare systems. Co-creation with stakeholders is a potential vehicle through which to accelerate and scale up the implementation of innovation from research. This narrative case study describes an example of the application of a co-creation approach to improve health literacy in an Australian public health system that provides hospital and community health services to one million people from socioeconomically and culturally diverse backgrounds. We provide a detailed overview of the value co-creation stages and strategies used to build a practical and sustainable working relationship between a University-based academic research group and the local health district focussed on improving health literacy. Insights from our experience over a 5-year period informed the development of a revised model of co-creation. The model incorporates a practical focus on the structural enablers of co-creation, including the development of a Community of Practice, co-created strategic direction and shared management systems. The model also includes a spectrum of partnership modalities (spanning relationship-building, partnering and co-creating), acknowledging the evolving nature of research partnerships and reinforcing the flexibility and commitment required to achieve meaningful co-creation in research. Four key facilitators of health literacy co-creation are identified: (i) local champions, (ii) co-generated resources, (iii) evolving capability and understandingand (iv) increasing trust and partnership synergy. Our case study and co-creation model provide insights into mechanisms to create effective and collaborative ways of working in health literacy which may be transferable to other health fields in Australia and beyond. Our co-creation approach brought together a community of practice of consumers, healthcare professionals and researchers as equal partners.

Health Literate Schools: Organizational Health Literacy in the School Setting

Abstract Background Fostering health literacy is considered an important objective within school-based strategies of health promotion. To effectively strengthen health literacy in the school setting the approach of organizational health literacy can be transferred to and implemented in schools. This approach combines behaviour-focused measures (providing individual learning opportunities) and environment-orientated measures (changing school's framework conditions). The HeLit-Schools project aims at developing a school-based concept of organizational health literacy and tools to support schools in becoming health-literate schools. Methods Existing concepts of organizational health literacy of other setting are analysed and adapted to the school setting. The concept development includes the expertise of actors from the school field, health literacy research and health sector. They contribute by commenting, reviewing and validating the conceptualization at different stages in the development process. A quantitative assessment of schools’ organizational health literacy is planned to further validate the concept. Furthermore, a screening of existing materials and programs for schools to use to foster health literacy is being conducted. Results The developed HeLit-Schools concept describes eight standards of a health-literate school. Every standard focuses on a specific area within the school's organization that can be addressed and changed in order to strengthen everyone's health literacy at school more effectively. To additionally support schools in fostering health literacy in school as well as in the classroom, a structured collection of existing (teaching) materials and programs was assembled. Conclusions Enhancing schools’ organizational health literacy and thus promoting school development by optimizing schools’ structures, processes and conditions in a health-literate matter can lead to an effective and sustainable strengthening of health literacy of every individual at school.

2.K. Round table: Navigational health literacy. Perspectives from Austria, Germany and Switzerland

Abstract Background Theoretical and empirical studies indicate that a lack of transparency and highly complexity makes it difficult for patients to navigate healthcare systems. This requires the competence to access, understand, appraise, and apply information about the healthcare system, its organizations and proceedings, i.e., navigational health literacy. Since little is known about navigational health literacy, partly due to a lack of measurement tools, a new instrument measuring navigational health literacy was developed as part of the Health Literacy Population Survey Project 2019-2021 (HLS19). It was applied in national health literacy surveys of the three German-speaking countries Austria, Germany and Switzerland among others. The empirical findings obtained in the three German-speaking countries and further perspectives on the topic will be presented and discussed in the workshop. Objectives of the workshop The workshop on navigational health literacy has three key objectives: 1) It gives an overview on the newly developed instrument for measuring navigational health literacy in HLS19, its development and validation; 2) it aims to discuss the distribution of navigational health literacy among the Austrian, German, and Swiss population and to highlight barriers and challenges for patients regarding navigation health literacy; and finally 3) it proposes steps to promote and strengthen navigational health literacy. Added value of the workshop The workshop is designed to enhance the understanding of navigational health literacy and to propose future scenarios and steps for action to develop and implement better health literacy outcomes. By the end of the workshop, participants – will have discussed the methodological approach for measuring navigational health literacy; – will have heard of current data and developments regarding navigation health literacy in Austria, Germany and Switzerland; – will have exchanged ideas and sustainable strategies to strengthen healthcare systems by developing navigational health literacy. The four panelists will give short presentations on: HLS19, navigational health literacy research, the newly developed instrument measuring navigational health literacy in HLS19, key findings of their respective national health literacy surveys, and recommendations and current navigational health literacy initiatives in their countries. In a panel discussion, the panelists and workshop participants will discuss the presented findings and recommendations as well as the need for action regarding implementation strategies, hands-on initiatives, and sustainable solution approaches. Key messages • Navigating healthcare systems and related information proves difficult for major parts of the general population. • There is a need of health literate healthcare systems and organizations reducing the demands placed on patients by providing guidance and support. Speakers/Panellists Doris Schaeffer Bielefeld University, Bielefeld, Germany Lennert Griese Bielefeld University, Bielefeld, Germany Saskia De Gani Careum Center for Health Literacy, Zürich, Switzerland Robert Griebler Austrian National Public Health Institute, Vienna, Austria

Digital health literacy and well-being of students at Sofia University – Bulgaria

Abstract Background During the Covid-19 pandemic the students in the Faculty of Mathematics and Informatics at Sofia University ‘St. Kliment Ohridski’ applied their abilities for searching health-related information and use it as a factor to improve their well-being. Methods The study used the Questionnaire developed by Dadaczynski, K., Okan, O. & Rathmann, K. in 2020 as COVID-19 Health Literacy Survey: University Students (COVID-HL Survey), and the respective Scale Documentation under the Public Health Centre Fulda (PHZF) at the Fulda University of Applied Sciences & Interdisciplinary Centre for Health Literacy Research at Bielefeld University. 216 students, almost 13% (12.78%) of 1.690 students approached, participated. Results There is a correlation as our students reported Very easy or easy to the question how easy they deal with the coronavirus information on the Internet - with 71% choosing from all the information they find, 91% using the proper words to find the information, and 71% finding the exact information. Those results were achieved as our students reported feeling over the last two weeks 27.12% very low, 18.08% low, and only 54.80% high (>50) well-being, measuring the dimensions of psychological general well-being by the WHO-5. Conclusions Our students reported they can search and retrieve the appropriate information on the coronavirus or related topics, and they are satisfied with the information found. Our students’ abilities to search and retrieve health-related information are applicable even under the pandemic pressure, where they contribute to the improvement of their well-being feelings. [This research is supported by the National Scientific Program “eHealth” in Bulgaria.]

Health Literacy and Difficulty Accessing Information About the COVID-19 Pandemic Among Parents Who Are Deaf and Hard-of-Hearing.

People who are deaf and hard-of-hearing (DHH) struggle with information marginalization and limited health literacy, challenging their ability to access information on preventing coronavirus disease 2019 (COVID-19). This study assessed the relationship between language preference, health literacy, and COVID-19 information barriers among parents who are DHH in the United States. Data were drawn from a larger study focused on individuals who are DHH who had given birth in the past 10 years. Respondents completed a web-based survey between March 2020 and July 2021. We segmented respondents by language preference [i.e., American Sign Language (ASL), English, or bilingual ASL/English] and used logistic regression models to test the hypothesis that language preference and health literacy were both associated with COVID-19 information marginalization. Of the total sample (N = 417), approximately 17% had limited health literacy, and 22% reported experiencing difficulty accessing information about COVID-19. In adjusted analyses, respondents with limited health literacy ([adjusted odds ratio] aOR = 2.245) and Hispanic ethnicity (aOR = 2.149) had higher risk of reporting information access barriers. There was no association between language preference and reporting COVID-19 information barriers. However, individuals who are DHH with limited health literacy were at higher risk of experiencing information marginalization during the ongoing COVID-19 pandemic, highlighting the need for tailored information based on access needs. [HLRP: Health Literacy Research and Practice. 2022;6(4):e310-e315.].

The Relationship Between Health Literacy and Mental Health Attitudes and Beliefs.

Mental health first aid programs show promise in reducing stigma and increasing help-seeking. However, the success of these and other mental health interventions are likely affected by health literacy. Yet, health literacy is understudied in the mental health literature and rarely considered in mental health interventions. This study explored the relationship between health literacy and mental health stigma, aversion to mental health help-seeking, and willingness to interact with individuals with mental illnesses. Adults (N = 601, mean age = 45.64) completed online surveys of their health literacy and mental health attitudes and beliefs. Hierarchal linear regression models were estimated to examine the relationship between health literacy and mental health attitudes and beliefs. Path models were estimated to determine if stigma mediated the relationship between health literacy and (1) aversion to help-seeking and (2) willingness to interact with individuals with mental illnesses. Adults with higher functional and communicative health literacy had lower mental health stigma and aversion to mental health help-seeking. Adults with higher communicative health literacy and empowerment were more willing to interact with individuals with mental illnesses. Mental health stigma partially mediated the relationships between communicative health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. Mental health stigma fully mediated the relationships between functional health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. Results support including health literacy in mental health interventions and reiterate addressing stigma in community and clinical settings. [HLRP: Health Literacy Research and Practice. 2022;6(4):e270-e279.] Plain Language Summary: Many adults with mental health problems do not get help because of negative beliefs about mental health. We found that adults with more skills for accessing, understanding, and using health information had fewer negative opinions and were more willing to interact with others with mental health problems. Improving those skills may reduce negative opinions about mental health and seeking help.

Validation of the Short-Test of Functional Health Literacy in Adults for the Samoan Population.

Background:Health literacy encompasses various levels of communication for an individual, provider, and an organization. Validated and reliable tools have been developed to assess health literacy; however, there is a paucity of tools available to assess health literacy in native languages for indigenous and racial/ethnic minority populations.Objective:This article shares the process taken to translate and evaluate validation and reliability of the Short Test of Functional Health Literacy in Adults for use with the Samoan population.Methods:Respondent-driven sampling was used to collect data from 1,543 adults age 45 years and older in American Samoa. A confirmatory factor analysis using a two-factor model for validation was conducted.Key Results:The validation results indicated a “good fit” in multiple indices and Cronbach's alpha indicated high internal consistency in both the English and Samoan languages.Conclusions:Developing culturally validated and reliable health literacy assessment tools is important to help health care professionals decrease health disparities and address inadequate health literacy in all cultures. [HLRP: Health Literacy Research and Practice. 2022;6(4):e247–e256.]Plain Language Summary:The INSPIRE project studied the Short Test of Functional Health Literacy in Adults (STOFHLA) tested on the American Samoan population age 50 years and older. The results would show if the STOFHLA is a valid tool to measure functional health literacy in American Samoa adults.

Health Literacy and Health-Related Quality of Life in Beijing Adolescents: A Path Analysis.

Health literacy is a critical driver of achieving an equitable world for every child and adolescent. Although the relationship between health literacy and health-related quality of life (HRQoL) has been documented, little is known among adolescents. In addition, due to lack of theory-driven empirical research, it remains unknown about the full relationship between health literacy, its antecedents, and HRQoL. This study aimed to apply Manganello's framework to investigate how health literacy was associated with its antecedents and HRQoL in Beijing secondary students. A cross-sectional study was conducted with 650 students in years 7 to 9 from four secondary schools in Beijing. Based on Manganello's health literacy framework, a self-administered questionnaire was used to collect information on health literacy, its antecedents (i.e., sociodemographics, self-efficacy, social support, school and community environment), and HRQoL. The 8-item Health Literacy Assessment Tool was used to measure health literacy (score range 0-37), and the KIDSCREEN-10 was used to measure HRQoL (score range 10-50). Path analysis was conducted to examine the mediating role of health literacy in the relationship between its antecedents and HRQoL. Overall, the average score of students' health literacy and HRQoL was 26.37 (±5.89) and 37.49 (±5.78), respectively. Health literacy was positively correlated with HRQoL (r = 0.36, p < .01). In the final path model, health literacy was not associated with HRQoL. However, students' social support, school environment, and community environment were associated with HRQoL. Health literacy was affected by self-efficacy, social support, and school environment (all p < .05). A range of intrapersonal, interpersonal, and environmental factors were associated with health literacy and HRQoL. A holistic approach is needed to improve health literacy and HRQoL through multilevel intervention strategies such as increasing personal self-efficacy, promoting social support, and creating positive environments. [HLRP: Health Literacy Research and Practice. 2022;6(4):e300-e309.] Plain Language Summary: We investigated how health literacy was related to its influencing factors and HRQoL among Beijing secondary students in years 7 to 9. Health literacy and HRQoL were independent outcomes affected by a range of social-ecological factors including self-efficacy, social support, and perceptions of school and community environments.

The Relationship Between Health Literacy, Self-Efficacy, and Self-Care Behaviors in Older Adults With Hypertension in the North of Iran.

Hypertension is the main risk factor for cardiovascular disease. Low level of health literacy is more common in people with hypertension. Evidence suggests that hypertension is preventable and can be controlled by modifying lifestyle and improving self-care behaviors. This study aimed to determine the relationship between health literacy, self-efficacy, and self-care behaviors in older adults with hypertension. The present study was a cross-sectional study conducted with 150 older adult patients with hypertension admitted to the Cardiac Care Unit (CCU) and post-CCU wards in East Guilan public hospitals in the north of Iran in 2020. Sampling was conducted using a convenience method based on inclusion criteria (age 60 years and older, high blood pressure and taking antihypertensive drugs for at least 6 months, ability to speak and communicate, having the suitable physical condition (not ill) to participate in research and answer questions, and having informed consent to participate in the study). The research instruments included a Health Literacy Questionnaire for Iranian Adults, a self-efficacy questionnaire in patients with hypertension, and a self-care behavior questionnaire for patients with hypertension. Descriptive statistics and multiple linear regression were used to analyze the data using SPSS software version 19. The results showed that most patients had adequate health literacy with a mean score of 116.77 (standard deviation [SD] = 8.34), excellent self-efficacy with a mean score of 23.06 (SD = 1.99) and relatively desirable self-care behaviors with a mean score of 51.79 (SD = 4.37). Findings also indicated that health literacy can predict self-efficacy (beta = 0.262, p = .001) and self-care behaviors (beta = 0.639, p = .000). Based on results, health literacy is a predictor of self-efficacy variables and self-care behaviors. Therefore, planning to improve the health literacy of the older adult to promote self-efficacy and self-care behaviors and ultimately their health is recommended. [HLRP: Health Literacy Research and Practice. 2022;6(4):e262-e269.] Plain Language Summary: This study sought to determine the role of health literacy in predicting self-efficacy and self-care behaviors in older adults with hypertension admitted to CCU and post-CCU wards in East Guilan public hospitals in the north of Iran. Findings of this research demonstrate health literacy can predict self-efficacy and self-care behaviors.

Psychometric Properties of the Mobile Health Literacy Scale in the Workers of an Automotive Metal Sheet Factory in Shahrekord, Iran.

Background:Mobile health (mHealth) literacy refers to the ability to use mobile devices to search, find, understand, evaluate, and use health information to identify or solve a health problem. Health literacy skills are important for improving health information interventions and it will not be possible to investigate this skill unless a valid and reliable tool is developed.Objective:This study aimed to investigate the psychometric properties of the Persian version of the mHealth Literacy Scale in the workers of an automotive metal sheet factory in Shahrekord, Iran.Methods:After forward and backward translation of the scale and ensuring the accuracy of the translation, qualitative face validity was examined by an expert panel and quantitative face validity by 10 workers using the item impact score. Content validity index (CVI) and content validity ratio were investigated by seven experts on health education. To investigate construct validity, the scale was completed by 200 workers. One-factor and two-factor structures of the measure were studied using confirmatory factor analysis and the reliability was evaluated using Cronbach's alpha coefficient.Key Results:The CVI for each of the three parameter (relevance, clarity, simplicity) was rated 0.75 to 1 for each item. Confirmatory factor analysis showed that the one-factor model had a better fit to the data than the two-factor model [goodness of fit index = 0.985(>0.90), comparative fit index = 0.999 (>0.90), Tucker-Lewis index = 0.996 (>0.90), normed fit index = 0.994(>0.90), root mean square error of approximation = 0.038(< 0.08)]. Furthermore, the scale had an acceptable internal consistency (Cronbach's alpha = 0.964).Conclusion:The Persian version of mHealth Literacy Scale has satisfactory reliability and validity and could be used as an effective tool to evaluate mHealth literacy among Iranian workers. [HLRP: Health Literacy Research and Practice. 2022;6(4):e257–e261.]Plain Language Summary:This cross-sectional study was conducted on 200 workers of an automotive metal sheet factory in southwest Iran to investigate the psychometric properties of the Persian version of the mHealth Literacy Scale. The results demonstrated that one-factor structure was more appropriate for evaluating mHealth literacy among Iranian workers.

Housing and Food Insecurity, Health Literacy, and Maladaptive Coping Behaviors.

Stressors related to social determinants of health (SDH), such as housing and food insecurity, are implicated in chronic disease risk. Maladaptive strategies for coping with these stressors may exacerbate risk. Given the limited research on SDH-related stressors and maladaptive coping, this study examined the relationship between two SDH-related stressors (housing and food insecurity) and maladaptive coping behaviors (i.e., emotional eating and stress-related cigarette and alcohol use) in adults. Further, because health literacy (HL), another SDH, may be a protective factor, this study explored whether HL moderated these relationships. Data were collected from adults (N = 500, Mean age = 49.01 years, standard deviation = 16.36; 40% White) in the United States. A series of hierarchical logistic regressions predicting maladaptive coping behaviors from demographics, SDH-related stressors (i.e., housing or food insecurity), and HL variables were estimated. Housing insecurity was associated with increased odds of emotional eating (odds ratio [OR] = 1.48, p < .001), stress-related cigarette use (OR = 1.34, p = .001), and stress-related alcohol use (OR = 1.32, p = .001). Food insecurity was associated with increased odds of emotional eating (OR = 1.49, p = .012), stress-related cigarette (OR = 1.68, p = .002), and stress-related alcohol use (OR = 1.49, p = .013). Higher functional HL scores were associated with decreased odds of emotional eating after accounting for housing (OR = 0.79, p = .017) and food insecurity (OR = 0.76, p = .004). Communicative and critical HL moderated the relationship between food insecurity and emotional eating. Examining HL in relation to SDH-related stressors and maladaptive coping behaviors is complex. HL may be less protective for maladaptive coping behaviors that are likely addictive. Because HL domains may require cooperation between individuals and systems related to stressors, multi-systemic interventions are necessary to reduce maladaptive coping behaviors. [HLRP: Health Literacy Research and Practice. 2022;6(4):e280-e289.] Plain language summary: Stress related to inadequate resources for housing and food may be related to adults' poor coping behaviors (e.g., emotional eating and stress-related cigarette and alcohol use). Adults who experienced housing and food insecurity were more likely to report emotional eating and using cigarettes and alcohol when stressed. Adults with higher functional health literacy were less likely to report emotional eating.

E-Learning Material of Evidence-Based Medicine for Laypersons.

There is a need for evidence-based medicine (EBM) education for laypersons. However, there are few materials or opportunities to learn EBM for Japanese laypersons. The aim of this study was to develop and test the usability of e-learning material on EBM for health-conscious laypersons in Japan. This study was conducted in two steps. First, content elements for the material were identified using purposive evaluation and a prototype of the e-learning material was developed. Following this, usability testing of the material was conducted. A questionnaire survey and qualitative semi-structured focus group interviews were conducted with health-conscious laypersons. Subsequently, the material was refined and finalized. A total of 217 descriptions related to EBM were extracted from 12 materials and were integrated into 56 major elements. Each element was rated from the viewpoint of usefulness for laypersons and reviewed by four expert panelists, and finally 18 elements were confirmed, most of which were critical appraisal skills related to critical health literacy. For the usability testing after constructing the material, 25 laypersons participated, and 19 (76%) felt very/rather much interest in the contents of the material in the questionnaire. The results of five focus group interviews showed that the effectiveness of the e-learning material was influenced by the story and characters, and whether the contents of the material were consistent with interviewees' daily interests. The e-learning material on EBM was found to be of interest to health-conscious laypersons and appeared to be useful in participants' daily lives. This study successfully developed novel e-learning material on the essential components of EBM for laypersons in Japan. [HLRP: Health Literacy Research and Practice. 2022;6(4):e290-e299.] Plain Language Summary: This study developed and tested the usability of e-learning material to encourage health-conscious laypersons in Japan to learn the fundamentals of evidence-based medicine. Most of the contents of the material are related to critical health literacy. The usability testing showed that the material was of interest to non-health professionals and useful for dealing with health information in their daily lives.

Access, understanding, promotion and maintenance of good health: Evaluation of knowledge transfer of people with intellectual disabilities to bridge the health information and disease prevention in public health.

The importance of patient empowerment among people with intellectual disabilities (ID) is steadily growing, yet multiple health and health literacy challenges still make this population more vulnerable to health disparities. Inadequate access to essential health and other basic services and the lack of involvement in health and educational research are some of the most crucial factors contributing to this inequality. A greater effort must be made to include people with ID in health literacy and communication research, preliminary focusing on language, including pictorial language. This community case study aimed to document the experiences of answering a pilot questionnaire to evaluate the problems of people with mild to moderate ID, 6A00.0 and 6A00.1 according to ICD-11. Our results show that most patients acquire health information from their physician or a medical professional. In preparing appropriate questionnaires, special education teachers can give valuable insight. However, participants were easily distracted and needed support in focusing on the questionnaire. Easy-to-read language, a simple format, big fonts and the presence of confidential caretakers are needed. This indicates, that semi-structured interviews with a trained interviewer might be most suitable for measuring the knowledge transfer of people with ID. The results of this case study highlight the need to develop an appropriate questionnaire and emphasize the need for a continued dialogue between people with ID and healthcare providers.

Investigating knowledge structure and research trends in child and adolescent health literacy research through network text analysis

PurposeThis study aims to investigate the knowledge structure and research trends in child and adolescent health literacy research over the past 30 years by using network text analysis. MethodThe study was conducted in four steps: 1) collecting abstracts, 2) keyword extraction and preprocessing, 3) creation of co-occurrence matrix, and 4) text network analysis. ResultsAs a result of the centrality analysis, the upper-ranked core keywords were “health care,” “health behavior,” “prevention,” “treatment,” and “health promotion.” In contrast to earlier times, “barrier,” “caregiver,” “school setting,” and “QOL” have recently emerged as core keywords. ConclusionsOver the past 30 years, child and adolescent health literacy has been importantly addressed in both clinical and public health approaches. The results of the current study provide references for future research in child and adolescent health literacy. Implication for practice and researchThis study suggests the need for additional research on school-based practices that can improve health literacy and for identifying validated and reliable multidimensional health literacy assessment instruments.

Turkish Sign Language Adaptation of the Turkish Health Literacy Scale-32.

Sign language speakers are at a disadvantage in terms of health literacy due to the lack of health education materials in sign languages. Deaf and hard of hearing (DHH) individuals are excluded from health literacy research due to the lack of measurement tools in their language of excellent fluency. This study aims to provide the literature with a tool that allows the measurement of health literacy among DHH individuals. The Turkish Health Literacy Scale (THLS)-32 was translated into Turkish Sign Language (TSL). After the THLS-32 was translated into TSL in video format, it was tested for validity and reliability. The translated version of the scale was administered to participants from a DHH association in Turkey who are fluent in TSL. Subsequently, a study was conducted with 207 DHH individuals. The study group was assessed in terms of their mean index scores and evaluated to have "limited health literacy" according to the THLS-32 classification. We conclude that the THLS-32 in TSL is suitable to measure health literacy in DHH individuals and to assess the impact of the health education system.

Recent Trends in Health Literacy Research, Health Status of the Population and Disease Prevention: An Editorial

One challenge for the development of healthcare systems worldwide is to shape society's health literacy [...].

Digital Health Literacy: Bibliometric Analysis.

BackgroundDigital health is growing at a rapid pace, and digital health literacy has attracted increasing attention from the academic community.ObjectiveThe purposes of this study are to conduct a systematic bibliometric analysis on the field of digital health literacy and to understand the research context and trends in this field.MethodsMethods: A total of 1955 scientific publications were collected from the Web of Science core collection. Institutional co-operation, journal co-citation, theme bursting, keyword co-occurrence, author co-operation, author co-citation, literature co-citation, and references in the field of digital health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools.ResultsThe results demonstrate that the United States has the highest number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in the number of publications, citations, and co-citations. Research areas of highly cited articles in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy.ConclusionsWe summarized research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. We found that digital health literacy has a significant potential to improve health outcomes, bridge the digital divide, and reduce health inequalities. Our work can serve as a fundamental reference and directional guide for future research in this field.

Performing an Organizational Health Literacy Assessment in a Shelter Serving People with Mental Illness.

Background:Health literacy research and practice are constantly evolving. Recent inquiry has highlighted the burdensome literacy demands faced by people with serious mental illness (SMI). Systems, organizational operations, and structures can play a role in decreasing literacy demand, thereby reducing unnecessary challenges for people with SMI.Brief Description of Activity:An organizational health literacy assessment was conducted to explore literacy demands in one mental health shelter and revealed best practice action steps for improving the literacy environment.Implementation:The assessment included an exploration of the shelter environment using The Health Literacy Environment Activity Packet, First Impressions & Walking Interview, and a commonly used shelter document using the Simple Measure of Gobbledygook (SMOG), Suitability Assessment of Materials (SAM), and Centers for Disease Control and Prevention (CDC) Index.Results:The literacy demands of the shelter environment and a frequently used document exceeded the literacy skills of people with SMI. Environment assessment revealed environmental facilitators (e.g., welcoming atmosphere) and barriers (e.g., unclear signage). Document assessment also revealed facilitating factors and barriers. SMOG scores ranged from 11.25 to 11.80 (median: 11.38), meaning 11th to 12th grade-level reading skills are required to understand, use, and take action on the document's content. A SAM score of 50% (adequate) and a CDC Index score of 42.1 (revise and improve) reveal materials contain both facilitating factors (e.g., chunked sections) and barriers (e.g., jargon, mismatched graphics) to use.Lessons Learned:The mismatch between system demands and the literacy skills of people with SMI is more profound than that of the general United States population. Organizational health literacy assessments are achievable and useful for both immediate and long-term action aimed at understanding and improving the organizational health literacy of mental health spaces. Further work is needed to explore the role of behavioral health services in addressing the institutional and programmatic literacy demands that inhibit treatment and recovery. [HLRP: Health Literacy Research and Practice. 2022;6(3):e167–e174.]Plain Language Summary:An organizational health literacy assessment reveals how system demands can be changed to better serve intended users. Engaging in mental health, recovery, and treatment services requires complex literacy skills. Generally, the U.S. adult population does not have the skills to meet such demands, and this is especially true among public mental health service users.

Decision-Making Ability: A Missing Link Between Health Literacy, Contextual Factors, and Health.

Background:Health literacy has often been described as an important precondition for good health decisions, healthy behaviors, and health. However, reviews reveal low evidence for intervention effectiveness through health literacy. This result calls for more investigations to be done in the pathway from health literacy to health, considering intermediate outcomes of health literacy.Objective:This study explores an important immediate objective of health literacy, namely the decision-making ability (DMA) regarding health issues. The study's hypothesis claims the DMA to be an important mediator between health literacy and health outcomes. Furthermore, the study assumes that the effect of the DMA on different health outcomes is not only contingent on health literacy but also on contextual factors. To test the above hypotheses, six different health literacy dimensions and four health outcomes have been analyzed.Methods:Cross-sectional data from the Young Adult Survey Switzerland was used for mediation analyses (N = 4, 569, age, 18 to 25 years, all male). Multiple regression and KHB (Karlson, Holm, and Breen) decomposition analyses were applied to estimate mediation effects between health literacy and health outcomes.Key Results:Five of six health literacy dimensions explained the DMA in a linear regression model. The coefficients of the DMA explaining health outcomes were substantially reduced when health literacy items were included into the models (6.1%–20.3%). Furthermore, the associations between health literacy and the health outcomes were fully explained by contextual factors, except in the mental health model.Conclusions:The results support the hypothesis that higher health literacy levels do not necessarily lead to better health directly. Rather, health literacy is just one of multiple factors contributing to a higher DMA and, further, to favorable health outcomes. The results of this study call for more investigations in the health decision-making process and the role of contextual factors. [HLRP: Health Literacy Research and Practice. 2022;6(3):e213–e223.]Plain Language Summary:The study investigated the ability to make good health decisions while considering health literacy. The results support the intermediate function of the decision-making ability on the path to favorable health outcomes. Furthermore, it is found that the DMA as well as health literacy are highly contingent on contextual factors. The results shed light into the complex decision-making process regarding health issues.