Health Literacy Survey Research Articles

Health literacy among long-term survivors of breast cancer; exploring associated factors in a nationwide sample

BackgroundPoor health literacy may hamper health management and long-term outcomes in breast cancer survivorship. Knowledge of factors associated with poor health literacy is needed to identify survivors in need of additional support and to improve the quality of health care, but is currently scant. Here, we explore health literacy and associated factors in a nationwide sample of long-term survivors of breast cancer.Material and methodsAll survivors aged 20–65 years when diagnosed with stage I–III breast cancer in 2011 or 2012 were identified through the Norwegian Cancer Registry, and invited to participate in the Survivorship, Work and Sexual Health (SWEET) study. Health literacy was measured using The European Health Literacy Survey Questionnaire-12 (HLS-EU-Q12) and analyzed as a continuous and categorical variable. Associations between health literacy and socioeconomic, physical, and mental health variables, including the most common late effects after cancer treatment, were explored in uni- and multivariable linear regression models.ResultsThe final sample consisted of 1355 survivors (48%) with a mean age of 60 years at survey (SD 8.7). Eight years had passed since diagnosis (SD.0.7), and the majority of survivors had high socioeconomic status. Advanced judgment calls concerning treatment and health risks were reported to be the most difficult for survivors to handle. Mean health literacy sum score was 36.2 (range 12–48, SD 5.4). Thirty-nine percent had intermediate, while 19.3% reported marginal or inadequate health literacy. Education, income, age at diagnosis, the personality trait neuroticism, and fear of cancer recurrence were significantly associated with health literacy in the multivariate model, explaining 12% of the variance in health literacy scores.ConclusionLow levels of health literacy were prevalent in this population-based sample of long-term survivors of breast cancer, despite high socioeconomic status. Communicating and interpreting risks seem to be especially challenging. Attention to health literacy at a societal and individual level is necessary in order to provide survivorship care of high quality.

Health Literacy, Socioeconomic Status and Vaccination Uptake: A Study on Influenza Vaccination in a Population-Based Sample.

Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26–1.94, p < 0.001, and OR 1.21, 95%CI 1.00–1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands.

626-P: TheraKey Diabetes 3.0 App: Better Self-Management, Well-Being, Adherence, and Less Diabetes Distress of People with Diabetes

Aim: The TheraKey Diabetes 3.0 app supports people with diabetes (PwD) during diabetes diagnosis and in the further course of the disease by providing personalized content (e.g., information, graphics, educational videos, testimonials, worksheets, interactive elements) , knowledge and skills for better self-management and coping with the diabetes disease or therapy in everyday life. This study examined the effect in terms of patient-reported outcomes. Methods: Online survey of users of MyTherakey Diabetes 3.0 with a pre-post design at 4 (t1) and 12 weeks (t2) . 185 PwD (15,1% type 1 diabetes (T1D) , 79.5% type 2 diabetes (T2D) , 43,2% female, average age 53.5 years, diabetes duration 3,6 (± 7,2) years, BMI 32,3 (± 7,8) kg/m², 34,6% insulin therapy, HbA1c 8,3 ± 2,5%) . Response rate at t2: 55% (n=105) . Diabetes Self-Management: Diabetes Self-Management Questionnaire (DSMQ) , Problem Areas in Diabetes Scale (PAID-5) . Well-being: WHO-5. Active Patient Participation: Patient Activation Measure (PAM-13D) . Self-efficacy expectancy: General Self-efficacy Scale (GSE) . Health literacy: European Health Literacy Survey (HLS-EU-Q16) . Adherence: MARS D. Results: (t2) : DSMQ: 10,5 ± 10,8/13,3 ± 9,5, p&amp;lt;.0 (t1 p&amp;lt;.001) . WHO-5: 10,5 ± 4,4/11,7 ± 4,1, p=.0 (t1 p= .006) . PAID-5: 33,4 ± 22,5/29,6 ± 21,5, p=.015 (t1 p=.181) . MARS-D: 6,3 ± 1,7/6,8 ± 2,5, p=.022 (t1 p=.432) . PAM-13D: 42,7 ± 4,8/43,4 ± 5,1, p=.136 (t1 p=.426) . GSE: 21,4 ± 5,1/21,8 ± 5,0, p=.297 (t1 p=.167) . HLS-EU-Q16: 13,8 ± 7,4/12,4 ± 8,1, p=.036 (t1 p=.793) . Subgroup analyses show that PwD with short (&amp;lt; 1 year) and long duration of diabetes (&amp;lt; 5 years) and PwD-T2D benefit most. Conclusion: After 3 months of using the diabetes app, patient-relevant benefits can be observed in terms of improved self-management, better well-being, reduced diabetes-related burden, and better adherence. It remains unclear why health literacy is declining. The TheraKey 3.0 can positively support PwD in managing their diabetes. Disclosure B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care. D.Ehrmann: Advisory Panel; Dexcom, Inc., Consultant; mySugr, Roche Diabetes Care, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. N.Hermanns: Advisory Panel; Abbott Diabetes, Research Support; Becton, Dickinson and Company, Roche Diagnostics, Speaker's Bureau; Berlin-Chemie AG, Novo Nordisk, Sanofi.

Efficacy of a Workplace Intervention Program With Web-Based Online and Offline Modalities for Improving Workers' Mental Health

ObjectiveThis study aims to examine the efficacy of the Workplace Web-based blended psychoeducation mental health intervention program. Of particular interest is the short-term effect of the intervention on workplace burnout, stress, quality of life, and the mental health literacy of workers.Methods and MaterialsThe study focused on employees (n = 456) in specific industries with high levels of work-related stress, adopting a phase III wait-listed cluster randomized controlled trial. Work-related burnout was assessed by the Maslach Burnout Inventory (MBI) and stress was measured using the stress subscale of the Depression, Anxiety, and Stress scale (DASS). Quality of Life was evaluated by the European Quality of Life-5 Dimensions (EQ-5D-5L) and Mental Health Literacy was assessed using the Australian National Mental Health Literacy and Stigma Survey. Data were analyzed as a trial with intention-to-treat analysis and adjustment for the clustering effect of work sites.ResultsSignificant differences between intervention and control groups were found on all outcome measures except the self-rated quality of life. The intervention group displayed a significant reduction in the weighted mean score of about 1.0 units (s.e. = 0.4) on the stress scale (p = 0.015) and an increase in the weighted mean score of 1.9 units (s.e. = 0.9) in the professional accomplishment domain of the MBI (p = 0.035). Significant increases were found in the weighted mean scores in the intervention group for correct recognition of the mental problems, help-seeking, and stigmatization, in comparison to the control group who scored 0.2 (s.e. = 0.1), 0.9 (s.e. = 0.2), 1.8 (s.e. = 0.4), respectively.ConclusionsThe results obtained from a comparison of the outcome measures between the intervention and control groups were statistically significant, indicating that the intervention group performed better on most measures. The study demonstrates that, in the short term. the on-and-offline modalities of the Web-based blended psychoeducation intervention program is efficacious in reducing workplace burnout and stress and promoting mental health literacy at the workplace.

The burden of nicotine-dependent smokers in China: The role of primary healthcare providers

The burden of nicotine-dependent smokers in China: The role of primary healthcare providers

Relationship between socioeconomic, demographic, health and social characteristics and ability to access reliable information on herbal and food supplements: analysis of Thai Health Literacy Survey 2019

BackgroundThe consumption of herbal and food supplements attributing to health expenditures in Thailand has been increasing over the years. However, information on herbal and food supplement products can make it difficult for some people with limited health literacy to use. Evidence from previous studies outside Thailand shows that SES disadvantaged groups are more likely to have limited health literacy compared with their counterparts with advantaged SES. The present study adds to this body of knowledge through an exploration of health literacy competencies related to herbal and food supplement consumption to determine what competency would be most problematic among Thai people. The study also investigated the influences of demographic and socio-economic factors on the most problematic health literacy competency on herbal and food supplements.MethodsThe THL-S used a stratified three-stage-sampling to draw a sample of Thais aged 15 years and above. Participants were interviewed with a questionnaire of 34 items measuring health literacy and 8 items measuring behavioural practices. Responses to questions on accessing, understanding, communicating, and making decisions related to herbal and food supplement consumption were analysed. A logistic regression model was used to explore the association between having difficulties in accessing information and participant’s socio-economic factors.ResultsLevels of difficulties the participants experienced varied among their health literacy competencies. Accessing reliable information was found to be the most problematic health literacy competency faced by respondents (48%), followed by asking healthcare providers about herbal products and food supplements (41%). Significant differences in the ability to access reliable information on herbal and food supplements were found to be based on differences in: education, income levels, occupation, insurance scheme coverage, age, sex, reading ability, writing ability, chronic diseases, wearing eyeglasses or lenses, hearing impairment, and having a community leading role.ConclusionsAccessing reliable information on herbal and food supplements has been found to be the most difficult health literacy competency among respondents to the survey, particularly vulnerable consumers in the society such as people with hearing impairment or having limited overall literacy competencies. Therefore, health literacy programs might be developed to build health literacy competencies and empower vulnerable consumers for reasonable use of herbal and food supplements.

Factors affecting intention to screen after being informed of benefits and harms of breast cancer screening: a study in 5 European countries in 2021

BackgroundParticipation in mammography screening comes with harms alongside benefits. Information about screening provided to women should convey this information yet concerns persist about its effect on participation. This study addressed factors that may influence the intention to screen once a woman has been informed about benefits and harms of participation.MethodsA cross-sectional survey of women from five countries (Belgium, France, Italy, Spain, and the United Kingdom) was performed in January 2021. The survey contained a statement regarding the benefits and harms of mammography screening along with items to measure cognitive variables from the theory of planned behaviour and health belief model and the 6-item version of the European Health Literacy Survey Questionnaire (HLS-EU-Q6). Logistic regression and mediation analysis were performed to investigate the effect of cognitive and sociodemographic variables.ResultsA total of 1180 participants responded to the survey. 19.5% of participants (n = 230) were able to correctly identify that mammography screening carries both benefits and harms. 56.9% of participants (n = 672) responded that they would be more likely to participate in screening in the future after being informed about the benefits and harms of mammography screening. Perceived behavioural control and social norms demonstrated were significant in predicting intention, whereas, the effect of health literacy was limited.ConclusionsInforming women about the presence of benefits and harms of in mammography screening participation did not negatively impact upon intention to be screened. Information should also address perception on implementation factors alongside messages on benefits and harms. Overall, screening programme managers should not be discouraged by the assumption of decreased participation through increasing efforts to address the lack of knowledge on benefits and harms.

Differences in college students' occupational dysfunction and mental health considering trait and state anxiety during the COVID-19 pandemic.

BackgroundDue to the COVID-19 pandemic, university education has shifted from face-to-face classes to online and distance learning. Effects of exposure may manifest in terms of psychological, cognitive, or musculoskeletal impairments that affect an individual’s daily functioning and quality of life. There is a dearth of studies exploring anxiety states, occupational dysfunction, and mental health associated with the new standard of increased telecommunication. Accordingly, the present study aimed to identify the differences in occupational dysfunction, health literacy, positive and negative emotions, and stress response considering the anxiety states of college students during the COVID-19 pandemic. Another purpose is to identify relationships among the parameters such as occupational dysfunction and mental health.MethodsThis cross-sectional study included 358 students (average age: 18.5 years, age range: 18–29 years). Five tools were used: the State-Trait Anxiety Inventory (STAI), Classification and Assessment of Occupational Dysfunction (CAOD), European Health Literacy Survey Questionnaire (HLS-EU-Q47), Profile of Mood States 2nd Edition (POMS-2), and Stress Response Scale-18 (SRS-18). Based on the cutoff value of state and trait anxiety of the STAI, the participants were classified into four groups and compared using one-way analysis of variance and multiple comparison tests. The relationship between all parameters was analyzed using Pearson’s correlation coefficient.ResultsThe group with high trait anxiety and high state anxiety had the highest CAOD total score, Total Mood Disturbance score on the POMS-2, SRS-18 score, and scores on many sub-items of the three parameters. The prevalence of occupational dysfunction was 47% for university students, and there was a variation of from 19 to 61% in each group. The correlation coefficients of the state and trait anxiety scores of the STAI, Total Mood Disturbance score, and SRS-18 ranged from .64 to .75. Additionally, the correlation coefficient between the CAOD total score and these parameters ranged from .44 to .48.ConclusionThe prevalence of occupational dysfunction was highest in the group with high trait anxiety and high state anxiety, and occupational dysfunction, negative emotions, and stress responses were strongest in this group. Our findings point to potential areas for targeted support and interventions.

Health literacy in former Soviet Union immigrants in the US: A mixed methods study

BackgroundPeople with limited health literacy may have trouble finding, understanding, and using health-related information and services and navigating the healthcare system. PurposeThe purpose of this study was to assess the health literacy of immigrants from the former Soviet Union (FSU) using the Health Literacy Survey (HLS19-Q12 in Russian) and explore associated socio-demographic factors. MethodThis mixed methods study recruited adult immigrants through social networks and social media and included data from online survey and follow-up interviews. Variance in health literacy was explained using multiple linear regression. Qualitative data were analyzed through modified Grounded Theory approach. FindingsSurvey respondents (n = 318) were primarily female college-educated FSU immigrants aged 20–74 from 14 of the 15 FSU countries and distributed across 33 US states. Forty percent scored at or below predefined cut-offs for inadequate or problematic health literacy levels. Social status, social support, and English proficiency were significant variables in explaining variance in health literacy scores while controlling for age, gender, and education. Interviews (n = 24) identified eight themes: English proficiency, social support, health insurance, experience with health care, complexity of the US healthcare system, relevant health information, health beliefs/practices, and trust. DiscussionThere is a need to distribute health-related information in the native language (e.g., Russian), potentially through social media and immigrants' social networks. Health providers should be aware of the prevalence of inadequate and problematic health literacy among FSU immigrants and consider associated social factors.

Health Literacy among Pregnant Women in a Lifestyle Intervention Trial.

Health literacy plays a crucial role during pregnancy, influencing the mother’s health behavior which in turn affects the unborn child’s health. To date, there are only few studies that report on health literacy among pregnant women or even interventions to promote health literacy. GeMuKi (acronym for “Gemeinsam Gesund: Vorsorge plus für Mutter und Kind”—Strengthening health promotion: enhanced check-up visits for mother and child) is a cluster-randomized controlled trial, aimed at improving health literacy in pregnant women by means of a lifestyle intervention in the form of brief counseling. The women in the intervention group receive counseling on lifestyle topics, such as nutrition and physical activity, during their regular prenatal check-ups. The counseling is tailored to the needs of pregnant women. Demographic data is collected at baseline using a paper-based questionnaire. Data on health literacy is collected using the Health Literacy Survey Europe with 16 items (HLS-EU-16) at baseline and the Brief Health Literacy Screener (BHLS) questionnaire at two points during the pregnancy by means of an app, which was developed specifically for the purpose of the project. The results of the study indicate that around 61.9% of the women participating in the GeMuKi study have an adequate level of health literacy at baseline. The regression analyses (general estimating equations) showed no significant effect of the GeMuKi intervention on general health literacy as measured by the BHLS (ß = 0.086, 95% CI [−0.016–0.187]). However, the intervention was significantly positively associated with pregnancy specific knowledge on lifestyle (ß = 0.089, 95% CI [0.024–0.154]). The results of this study indicate that GeMuKi was effective in improving specific pregnancy related knowledge, but did not improve general health literacy.

Public perceptions of the association between drug effectiveness and drug novelty in France during the COVID-19 pandemic

ObjectivesDuring the coronavirus disease 2019 (COVID-19) pandemic, public debates overtly addressed the promises of new innovative drugs. Many of these debates pitted those who advocated for the development of new drugs by pharmaceutical companies against those who favored the repositioning of existing drugs. Our study explored perceptions of the association between drug novelty and effectiveness as well as perceptions of the role of the pharmaceutical industry in drug development.MethodsData were collected in January 2021 from a quota sample of the French population aged 18–75 years (n = 1,000) during the second round of the “Health Literacy Survey 2019” (HLS19).ResultsWe tested the hypothesis that individuals with a high level of familiarity with the health care system and those with a high level of trust in institutions are more likely to agree that new drugs are more effective than old ones and that drug development should be driven by the pharmaceutical industry. A quarter (25%) of respondents agreed that new drugs are always more effective than old ones. Agreement with this statement was stronger among respondents with a high level of familiarity with the health care system (as measured by the navigational health literacy score, OR 3.34 [2.13–5.24]). Respondents with a low level of trust in pharmaceutical companies or politicians were two times less likely to agree that new drugs are always more effective than old ones (OR 0.63 [0.42–0.95] and OR 0.68 [0.49–0.94], respectively). A high level of trust in pharmaceutical companies was reported by 42% of respondents, and 43% agreed that drug development should be driven by the pharmaceutical industry.ConclusionOur study shows that the perceived effectiveness of innovative drugs is associated with familiarity with the health care system and trust in institutions.

Prevalence of tobacco dependence and associated factors in China: Findings from nationwide China Health Literacy Survey during 2018–19

SummaryBackgroundTobacco dependence is the key barrier to successful smoking cessation. However, little is known about its prevalence, sociodemographic characteristics and determinants. We aimed to estimate the prevalence, associated factors and burden of tobacco dependence in China.MethodsDuring 2018–2019, the nationally representative 2018 China Health Literacy Survey (2018 CHLS) invited 87,708 participants to participate using a multistage stratified sampling method from 31 provinces (or equivalent) in mainland China, and 84,839 participants aged 20–69 with valid data were included in the analysis. We diagnosed tobacco dependence based on international criteria (ICD-10, DSM-4) and tailored to Chinese population according to China Clinical Guideline for Tobacco Cessation (2015 version). The prevalence of tobacco dependence was estimated overall and by sociodemographic factors. The Logistic regression was conducted to estimate odds ratios (OR) and 95% confidence intervals (CIs) for tobacco dependence and success of smoking cessation (being ex-smokers), with different levels of adjustment. These were used to estimate the total number of adults who were tobacco dependent in China.FindingsIn China, the estimated prevalence of current smoking was 25.1%, significantly higher in men than in women (47.6% vs 1.9%). The prevalence of current smoking varied approximately 3-fold (12.9% to 37.9%) across 31 provinces of China. Among general population aged 20–69 years, the prevalence of tobacco dependence was 13.1% (95% CI:12.2–14.1). Among current smokers, the prevalence of tobacco dependence was 49.7% (46.5–52.9%), with no difference between men and women (49.7% vs 50.8%). The prevalence of tobacco dependence was associated significantly with smoking intensity, defined by pack-years (1.62 [1.54–1.70] per 10 pack-years), cigarettes smoked per day (2.01 [1.78, 2.27] per 10 cigarettes), and smoking starting age (0.93 [0.90, 0.97] per 5 years). Given smoking intensity, the prevalence of tobacco dependence also varied by age, gender, certain socioeconomic status and regions. Compared with those without tobacco dependence, ever smokers with tobacco dependence were less likely to be ex-smokers (2.88, 2.59–3.21). In China, 183.5 (170.4–197.4) million adults (177.5 million were men) were tobacco dependent in 2018.InterpretationIn China, tobacco dependence is highly prevalent, with approximately half of current smokers being addictive, highlighting the need for coordinated effort to improve awareness, diagnosis and treatment of tobacco dependence.FundingChinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), National Key R&D Program of China (grant no 2017YFC1309400), and National Natural Science Foundation of China (grant no 81720108001).NoteChinese translation of abstract is available in appendix section.

Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study)

IntroductionLow health literacy is common in people with cardiovascular disease and may be one factor that affects an individual’s ability to maintain secondary prevention health behaviours following myocardial infarction (MI)....

Mental health literacy survey among Cambodia's urban and rural populations: Results from a vignette-based population survey.

BackgroundAlthough there are effective methods for the treatment and management of various mental illnesses, some individuals still do not seek psychiatric treatment. Various factors could affect this reluctance toward treatment, one of which is the public’s lack of mental health literacy. This survey aimed to measure and compare mental health literacy in Cambodia’s urban and rural areas.MethodTours were held to hold seminars that provided information about mental health in the health centers around Phnom Penh (PP) and Siem Reap (SR), and a survey was conducted on mental health literacy for the participants before the seminar at each location. Anthony Jorm’s vignette of psychosis (young adult) and Angermeyer’s questionnaire were used. After the participants were classified into the “agree group” and “disagree group” for each item, the answers for each item given by the participants in PP and SR were compared using the chi-square test and the odds rate was calculated.ResultsThe participants in SR were more likely to give reasons such as inherited causes, economic problems, stress at work, or family problems as the cause of schizophrenia. The percentage of these beliefs about schizophrenia was relatively lower in PP than in SR. Regarding attitudes toward schizophrenia, the participants in SR were more likely to have negative views and predict negative prognoses than the participants in PP. As for participants’ feelings about schizophrenia, the participants in SR reacted more strongly than those in PP. Even though the participants in SR reacted more negatively, they were sympathetic toward individuals with schizophrenia.ConclusionOverall, the participants in the SR group were more likely to have negative attitudes toward schizophrenia than those in the PP group. These results support our hypothesis that mental health literacy represents the maturity of community mental health in a targeted area.

The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases.

This study aimed to evaluate health literacy in patients (n=395) with systemic autoimmune diseases (SAD) and analyze their relationships with health-related quality of life (HRQoL), attitudes and beliefs about Covid-19 and vaccination, and perceptions of changes in medical care during the pandemic. This study was cross-sectional and the majority (81%) of particpants resided in Spain. An anonymous online survey was distributed to an online SAD association. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the SF-36 tool was used to assess HRQoL. More than half of patients (57.7%) have inadequate health literacy and the mean health literacy level was 9.63(5.66). Patients with inadequate health literacy levels presented the lowest HRQoL scores in all SF-36 domains (p < .001). Health literacy scores were positively correlated with all SF-36 domains (p < .001). The reservations to get vaccinated against Covid-19 were linked to health literacy level (p = 0.024). There are high levels of inadequate health literacy among patients with SAD and it is associated with worse HRQoL and risk attitudes about Covid-19 vaccination and medical care during the pandemic.

The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019.

Vaccines are among the most important public health achievements of the last century; however, vaccine awareness and uptake still face significant challenges and the COVID-19 pandemic has only exacerbated this phenomenon. Vaccine Literacy (VL) is the ability to find, understand and judge immunisation-related information to make appropriate immunisation decisions. A cross-sectional study on a sample of 3500 participants, representative of the Italian adult population aged 18+ years, was conducted in Italy in 2021. A validated questionnaire, including sections on health literacy (HL), sociodemographic characteristics, risk factors, and lifestyles of respondents, was used. VL was measured by four items (item 19, 22, 26 and 29) of the HL section. While 67.6% of the respondents had a “good” (47.5%) or “sufficient” (20.1%) level of VL, 32.4% had “limited” VL levels. Although the overall VL level was quite high, many participants reported difficulties in dealing with vaccination information, particularly those with a lower educational level, those living in southern and insular regions of Italy, those with greater financial deprivation and those with a migration background. Improving VL in Italy should be a top priority in the political agenda, with special regard to socially and geographically disadvantaged communities.

Health literacy among older adults in Switzerland: cross-sectional evidence from a nationally representative population-based observational study.

Despite being widely regarded as a major cause of health inequalities, little is known regarding health literacy and its association with certain personal characteristics among older adults in Switzerland. To fill this gap, this study assesses health literacy and its associations with individuals' social, regional, and health characteristics in a nationally representative sample of adults aged 58 years and older in Switzerland. We use data of 1,625 respondents from a paper-and-pencil self-completion questionnaire (cooperation rate: 94.3%) that was administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The scale includes 16 items whose dichotomised responses allow the construction of different indices and sub-indices aimed at measuring various aspects of health literacy. We use multivariable regressions to explore how respondents' sociodemographic characteristics are independently associated with health literacy. Overall, 6.8% of the respondents had inadequate health literacy, 24.6% problematic health literacy, and 68.6% sufficient health literacy. There were significant associations between health literacy and individuals' gender, education, economic situation, and self-rated health. Women had higher levels of health literacy than men (p <0.001). Moreover, a higher education level (p <0.001), fewer financial difficulties (p<0.01), and higher self-rated health (p <0.001) were positively correlated with adequate/higher levels of health literacy. One-third of older citizens have difficulties managing health-related issues in Switzerland. Individuals with low education, financial difficulties, and bad self-rated health are particularly at risk of being disadvantaged due to their inadequate health literacy level. These findings call for targeted interventions, such as using simplified health or eHealth information tools, improved patient-provider communication and shared decision-making, promoting lifelong learnings activities and health literacy screening for older patients to increase low health literacy and mitigate its consequences, thereby alleviating remaining social health inequalities in the Swiss population.

Prevalence of Limited Health Literacy in the Philippines: First National Survey.

Background:Health literacy (HL) is the ability to access, understand, appraise, and apply health information across the three domains of the health continuum: health care, disease prevention, and health promotion. It is needed for people to effectively manage their health. Information on population HL level is useful for crafting appropriate and targeted interventions to improve HL.Objective:The aim of this study was to describe the HL level of Filipino people at the national and subnational levels.Methods:A cross-sectional survey was conducted between 2018 and 2019 with 2,303 randomly selected Filipino people age 15 to 70 years, using an adapted Asia version of the European Health Literacy Survey Questionnaire-47. Prevalence estimates for limited HL and the corresponding 95% confidence interval (CI) were computed at the national and subnational levels.Key Results:The nationwide prevalence of limited HL was 51.5% (95% CI, [49.5%, 53.6%]), while sub-national prevalence estimates ranged from 48.2% to 65.4%. The prevalence varied across HL dimensions, with difficulty in access to information having the highest level. Similarly, prevalence across domains was variable; health care-related HL had the highest prevalence of limited HL. The HL levels for different dimensions and domains also varied across subnational groups.Conclusion:Many Filipino people had limited HL, and prevalence estimates varied across HL dimensions, HL domains, subnational groupings, and sociodemographic characteristics. The results highlight the need for targeted interventions focusing on subgroups with limited HL and on dimensions and domains where Filipino people have limited HL. [HLRP: Health Literacy Research and Practice. 2022;6(2):e104–e112.]Plain Language Summary:The National Health Literacy Survey is the first nationwide survey on the prevalence of HL in the Philippines, involving 2,303 randomly selected Filipino residents age 15 to 70 years. Many Filipino people have limited HL, and the prevalence of HL varies across the components of HL, subnational groupings, and sociodemographic characteristics, highlighting the need for targeted interventions.

Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019-2021.

Health literacy entails the knowledge, motivation, and competencies to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning health care, disease prevention, and health promotion to maintain or improve quality of life throughout the life course. It has become an essential concept in public health. It is considered a modifiable determinant of health decisions, health behaviors, health, and healthcare outcomes. Prior studies suggest highly variable levels of health literacy across European countries. Assessing and monitoring health literacy is critical to support interventions and policies to improve health literacy. This study aimed to describe the process of adaptation to Portugal of the short-form version of the Health Literacy Survey (HLS19-Q12) from the Health Literacy Population Survey Project 2019–2021, also establishing the health literacy levels in the Portuguese population. The sample comprised 1247 valid cases. The survey consisted of a brief questionnaire on the determinants of health literacy, plus the HLS19-Q12 questionnaire and the specific health literacies packages on digital health literacy, navigational health literacy, and vaccination health literacy. The results suggest that 7 out of 10 people in Portugal (mainland) have high health literacy levels and support the results of other studies concerning the main socioeconomic determinants of general health literacy. Furthermore, the results suggest that “navigation in the health system” tasks are the most challenging tasks regarding specific health literacies. The overall data suggest the HLS19-Q12 as a feasible measure to assess health literacy in the Portuguese population. Thus, it can be used in Portugal to assess the population’s needs and monitor and evaluate policies and initiatives to promote health literacy by addressing its societal, environmental, personal, and situational modifiable determinant factors.

Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations-International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA.

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS19-Q) developed within the Health Literacy Survey 2019–2021 (HLS19) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS19-Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS19 protocol and “team approach” method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS19-Q questions to each country’s healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS19-Q into different languages and can serve as an example of international collaboration towards this end.