Health Literacy Research Articles

Health literacy challenges of young adults with rheumatic diseased in the transition to adult care

Abstract Background For young people living with a chronic illness (such as rheumatic diseases), transitioning from youth to adult care is a challenging process requiring adequate health literacy (HL). Insight into the specific HL-challenges of young people with rheumatic diseases could contribute to preventing loss to follow-up, and improving medication adherence, health outcomes, and social participation. Methods A mixed-methods study was conducted among young adults (16-25 years old) living with rheumatic disease in the Netherlands. Participants were recruited at two clinics and through social media of patient initiatives. Quantitative data were digitally self-reported using the Health Literacy Questionnaire (HLQ) and Medication Adherence Report Scale (MARS). Qualitative data were collected through semi-structured interviews. Hierarchical cluster analysis of HLQ-data was used to identify health literacy profiles, uncovering strengths and weaknesses. Interview transcripts were analysed using content analysis and used to explore health literacy needs and confirm the HLQ results. Results Sixty-two participants completed the questionnaire and ten participants were interviewed. Six HL-profiles were identified, representing diverse strengths and weaknesses. Having sufficient information, social support, and critical appraisal were challenging across profiles. Some participants (particularly in profile 3) reported difficulties in taking medication. The interviews confirmed the quantitative findings and unveiled HL needs across seven categories, particularly the need for in-depth information and support, with a focus on (social) aspects of having a chronic illness as a young person. Conclusions HL-challenges of young adults with rheumatic diseases are similar to adult populations, but age-specific needs exist. The results can inform development of HL-responsive rheumatology services, for example during consultations or at the transition clinic.

Health literacy in adult cardiac surgery patients; a multi-site Australian study

Abstract Background Almost 60% of Australians report low levels of health literacy (HL). International evidence indicates limited comprehension of the risks and benefits of cardiac surgery, in addition to understanding the basic elements of informed consent. Purpose The aim of this study was to explore HL in adult cardiac surgical candidates. Methods We recruited consecutive English speaking adult patients from a major public (Site 1), major private (Site 2) and regional hospital (Site 3) in Victoria, Australia. Prior to discharge, a Registered Nurse conducted a semi-structured interview using the Health Literacy Questionnaire (HLQ). The HLQ is a multidimensional validated instrument comprised of 9 independent scales. Data were analysed using descriptive statistics, t-tests and ANOVA. Results We recruited 164 (29.5%) eligible participants from; Site 1 (63, 32.1%), Site 2 (49, 19.3%) and Site 3 (52, 49.5%) respectively. Average age was 64.6 (SD 11.8), most participants were male (n = 134, 81.7%), few lived alone (n = 28, 17.1%), 122 (74.4%) identified as being Australian 5 (4.1%) of whom were indigenous and 9 (5.5%) spoke a language other than English at home. The majority of participants highest level of education was aligned with a trade certificate (n = 48, 29.3%) or not completing high school (44, 26.8%) and most were retired (n = 68, 41.5%), working full time (n = 51, 31.1%) or part time (n = 24, 14.6%). Less than half had private insurance (n = 72, 43.9%), more than half had presented to emergency (n = 87, 53.0%) in the previous 12 months and a history of cardiac complaints (n = 137, 83.5%) was as expected. In this study participants felt understood and supported by healthcare providers (Scale 1 M 3.32, SD 0.26), had sufficient information to manage their health (Scale 2 M 3.13, SD 0.35), proactively managed their health (Scale 3 M 2.98, SD 0.39), had strong social supports (Scale 4 M 3.31, SD 0.36), could appraise health information (Scale 5 M 2.88, SD 0.49) and were proactively engaged (Scale 6 M 4.00, SD 0.50). More challenging was their ability to advocate on their own behalf (Scale 7 M 3.80, SD 0.60), to explore information (Scale 8 M 3.70, SD 0.60) and to understand all written information (Scale 9 M 3.90, SD 0.60). Site 2 participants were highly educated, less likely to live alone, more likely to have private insurance, had fewer emergency presentations and higher scores on scales 6 to 9 (p < 0.05) that measure health care interactions, than those from Site 1 or 3. Conclusions There was a high level of HL in this cohort and findings indicate patient strengths in relation to HL differed according to site. In measuring individual skills and experience of participants interacting with services, systems and the health care environment this study provides valuable insight into HL levels in cardiac surgery candidates.

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Predictors of infectious disease-related behaviors among adolescents in Armenia

Abstract Background We explored the behaviors related to infectious diseases (ID) and its predictors among 15-17 years old adolescents in Armenia. Methods We surveyed adolescents from public and private high schools in Yerevan and one province in 2023. The instrument explored ID-related behaviors, health literacy (HL), interest in health, and socio-demographics. ID-related behaviors were measured with five Yes/No questions about sharing a toothbrush, covering their mouth when coughing or sneezing, and washing hands with soap and water - before eating, after using the bathroom, and when coming home. HL was assessed with ten questions on a scale from ‘Strongly disagree’ to ‘Strongly agree’. Summative scores were calculated for ID-related behaviors and HL. Multivariable regression analysis explored factors associated with ID-related behaviors. Results Overall, 366 students completed the survey, most of them being females (64.4%). The majority were interested in health issues (80.7%). Almost all respondents reported not sharing a toothbrush with other persons (97.9%) and usually covering their mouth when coughing or sneezing in public places (94.1%). Somewhat lower percentages reported washing hands with soap and water before eating (82.0%), after using the bathroom (89.2%), and when coming home (86.6%). The mean behavior score was 4.52 out of 5 (SD = 0.92) and the percent score was 90.4%. The average HL score was 17.41 out of 30 (SD = 4.47). In the regression analysis, being female vs. male, being interested in health vs. not, studying in private vs. public schools, and having higher HL were independent significant predictors for higher score of ID-related behaviors. Conclusions Armenian adolescents reported high levels of compliance with ID-related behaviors. Improving health literacy and fostering interest in health can help further enhance the performance of preventive behaviors. Interventions targeting public schools and male adolescents are particularly pertinent. Key messages • Being female, studying in private schools, having higher interest in health issues, and better health literacy independently positively influence infectious disease-related behaviors. • Promoting health literacy and fostering interest in health in high schools have the potential to further enhance infectious disease prevention behaviors among adolescents.

2.K. Scientific session: Promoting organizational health literacy in healthcare organizations and beyond in Europe

Abstract Organizational health literacy (OHL) has been defined as the degree to which healthcare organizations equitably enable/empower people, through organizational structures, policies, and processes, to find, understand, appraise, and use information and services to make health-related decisions and actions for themselves and others. By adopting an OHL approach, healthcare organizations enhance health service delivery by simplifying interaction with health systems by making information and services more comprehensible. An OHL approach not only reduces health literacy demands of patients, but also of workforce and the resident population of the community that they serve. The workshop focuses on two theory-based initiatives that focus at promoting OHL in Europe: (1) the Organizational Health Literacy for All (OHL-ALL) initiative, which developed a practice-oriented OHL approach for organizations promoting equity explicitly to support people in vulnerable positions with or at risk for diabetes or other non-communicable diseases, and (2) the World Health Organization (WHO) Action Network on Measuring Population and Organizational Health Literacy (M-POHL) which aims at initiating and facilitating the (self-) assessment of OHL in healthcare organization by developing, providing, and disseminating OHL assessment tools. Both initiatives strive to support organizational change and workforce responsiveness. While the first initiative goes beyond health literacy responsiveness of healthcare organizations intending to offer guidance for organizations on how to give all individuals the best possible opportunities to achieve their optimal health and well-being, the second initiative specifically focuses on OHL in healthcare organizations using a settings approach with a focus on health care, prevention, and health promotion. The initiatives enrich and complement each other. The workshop consists of five short presentations, followed by a discussion among the presenters and the audience. The first presentation focuses on the development of the theory-informed and coherent OHL approach of the OHL-ALL initiative. The second presentation provides an overview of the M-POHL initiative and its innovative tools. Then three presentations will showcase results, experiences, and outcomes from European countries on assessing OHL in different healthcare settings. Expected impact: Theory-based guidance for implementing organizational development will be provided. Results from the M-POHL initiative will contribute to greatly needed insights into OHL needs and opportunities of healthcare organizations. The insights from these real-world assessments and implementation can inform future public health practice, policy, and research. Key messages • An OHL approach contributes to better equity. It helps meet health literacy needs of patients, health and care workforce and the resident population of the community that are served. • New tools have been developed to support management and health and care workforce in assessing and improving OHL responsiveness, to better serve patient communities.

Co-creation of migrant health interventions in Portugal: Insights from the VO(I)CES project

Abstract Background International migration is increasing both globally and in Europe, highlighting the need for responsive interventions that cater to the diverse needs and strengths of migrants. Although genuine involvement of stakeholders in the design and implementation of interventions is vital to enhance their relevance, responsiveness, and ownership, co-created migrant health interventions remain limited. This study aims to address this gap by collaboratively developing health literacy interventions with meaningful involvement from migrants and professionals from both the social and health sectors. Methods As part of the VO(I)CES project, twelve idea-generation workshops were conducted in Portugal, applying the Ophelia (Optimising Health Literacy and Access) process, engaging over 70 stakeholders (migrants, social and healthcare professionals). To guide discussions, these workshops used case vignettes developed from 16 health literacy profiles that were identified in a previous study among 1,126 migrants. The discussions aimed at eliciting detailed insights into the potential actions that are responsive to migrants’ challenges. Results Several key interventions were identified by the stakeholders, including the enhancement of cultural and linguistic training for healthcare providers, the use of community health agents/mediators to improve service delivery and community engagement, and the creation and dissemination of multilingual, multi-format health information materials. Specific interventions for groups experiencing increased vulnerabilities such as pregnant women were also proposed, alongside suggestions for creating citizen spaces and improving digital skills among healthcare staff. Conclusions The co-creation approach facilitated the development of tailored context-specific interventions that are anticipated to enhance health literacy, improve healthcare accessibility, and promote health equity for migrants. Key messages • Ideas Generation Workshops provide a platform for a wide range of groups to have their say and know their voice is being heard. • Co-creation tailors interventions to diverse needs, avoiding a one-size-fits-all approach.

Vaccination health literacy: cultural validation and pilot testing of the HLS19-VAC instrument

Abstract Introduction Vaccinаtion health literacy (VHL) is considered an extremely important aspect of health literacy. HLS19-VAC questionnaire is a 14-item ‘subjective’ perception-based instrument used for measuring VHL in the M-POHL Health Literacy Survey 2019-2021, which Serbia was not part of. Aim Translation and cultural validation of the HLS19-VAC questionnaire and using the validated Serbian version (HLS19-VAC_RS) for pilot study research. Materials and methods The English version of HLS19-VAC was translated using a systematic approach; three forward and one back-translations were synthesized and compared by an expert committee. Thereafter, cognitive interviews with 11 participants produced a version that was culturally validated by an expert panel. We conducted a cross-sectional pilot study using a HLS19-VAC_RS, on a convenient sample of the general population in Serbia. VHL was assessed by calculating the score for 4 out of 14 questions. Additional data were collected through a general questionnaire with 30 questions. Descriptive and inferential statistics were used. Results Cognitive interviews showed some problems in wording, and cultural adaptation resulted in minor refinements to eight out of 14 items. The instrument was pretested by 11 experts who adjusted it accordingly to produce culturally validated HLS19 -VAC_RS. Of 439 respondents in a pilot study, 15% had problematic VHL, while the levels of sufficient and excellent VHL were nearly the same (38.5% and 35.1%, respectively). There was difficulty in deciding whether to receive the flu vaccine (15.0%) and to find information about recommended vaccines (12.3%). There was a significant statistical difference in responses to VHL and monthly income and alcohol consumption. Most of the respondents contacted pharmacists as primary sources of information about medication (42.7%). Conclusions HLS19 -VAC_RS could be implemented in a local context as culturally appropriate. Further testing on a population level is needed. Key messages • HLS19-VAC_RS Questionnaire is culturally appropriate for assessing vaccination health literacy in Serbia. • Majority of respodents had sufficient or excellent vaccination health literacy.

Psychometric evaluation of a COVID-19 health literacy scale applying Rasch analysis

Abstract Background Assessing health literacy in times of the COVID-19 pandemic is vital, since health literacy has been highlighted as a personal resource for managing health information. The HLS-Covid-Q22 questionnaire was developed to measure self-reported COVID-19 health literacy in adults. It has been used and validated, mainly using confirmatory factor analysis, in some studies with different target groups. However, several comprehensive validation studies are needed to ensure the feasibility of a novel measurement tool. In the current study, Rasch analysis has been chosen, as this analysis transforms the categorical responses of the items of the HLS-Covid-Q22 into linear measures. Methods The psychometric properties of the HLS-Covid-Q22 were evaluated in a sample of 2187 German adults applying Rasch analysis. The data is from the German COVID-HL school survey that was generated by employing an online survey in school principals during the third infection wave from March to April 2021 in four federal states. Applying the Partial Credit Model for polytomous data, the responses to the HLS-Covid-Q22 items were transformed into linear measures, unidimensionality was tested and several indices to assess the quality of the measurement tool were computed. Results Unidimensionality of the questionnaire could be confirmed. The rating scale steps worked as intended. Participants used every rating category. Item fit could be verified. High reliability indices were found with a person separation index of 3.41, person reliability of .92, item separation of 20.08 as well as item reliability of 1.0. Conclusions The HLS-Covid-Q22 appeared to be a reliable and valid questionnaire which has not been validated by applying Rasch analysis before. Even though Rasch analysis is already a well-established validation method in other disciplines, it should be used to evaluate other health literacy questionnaires more often to gain comprehensive insights into the intended functioning of measurement tools. Key messages • The HLS-Covid-Q22 questionnaire appears to be a valid and reliable measurement tool. • Rasch analysis is an appropriate method to evaluate the psychometric properties of likert-type rating-scale questionnaires.

Health literacy in pregnant women facing prenatal screening: a short report from “SaperePer” project

Abstract Advancements in health promotion and prenatal medicine have made noninvasive prenatal testing (NIPT) a common practice during pregnancy, but understanding prenatal health information becomes crucial not only for the well-being of the mother but also for that of the unborn child. Analyze health-related information during pregnancy is fundamental, and this work fits perfectly with this topic, reporting preliminary results from the pilot study “SaperePer”. A health-related questionnaire was administered to 358 women in the first trimester of pregnancy, aiming to study different outcomes: 1.level of knowledge of NIPT; 2.number of screening tests undergone; 3.willingness to undergo a diagnostic test with a high outcome risk of screening test; 4.willingness to end the pregnancy following a diagnosis of pathology. The questionnaire was divided into 3 sections: personal characteristics and lifestyle habits, prenatal health behavior scale (PHBS), and knowledge of NIPT. Preliminary results showed that the level of knowledge of NIPT was higher in older, atheist, working, wealthy highly educated, and preliminary informed women, as well as the higher number of screening tests undergone and the propensity to undergo an invasive diagnostic test after a high-risk screening result (KS and MW tests p < 0.05). On the contrary, women with lower education, faithful and, even more, not preliminary and appropriately informed during prenatal counseling showed lower knowledge of NIPT, lower number of tests undergone, and meager chances to undergo an invasive diagnostic test or to end the pregnancy after a positive diagnosis of pathology (KS and MW tests p < 0.05). In conclusion, this study evaluated health-related information during the first but crucial stages of pregnancy, opening a new understanding of how health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women, particularly in those women with lower cultural tools. Key messages • Health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women. • Understanding prenatal health information becomes crucial both for maternal and prenatal well-being.

The Impact of Health Literacy on Diabetes Control

Abstract Introdution People with diabetes have a significant impact on treatment outcomes through their daily decisions. Therefore, health literacy (HL) is crucial for effectively managing the disease and maintaining overall health. This study aimed to explore the relationships between different dimensions of health literacy, self-care behaviors, and Diabetes Control (HbA1c). Methods HLwas assessed using the Health Literacy Questionnaire. 706 individuals with diabetes participated in the study, the majority of whom were male (60.2%), had more than 9 years of schooling (84.7%), and over half were employed (52.4%). To examine the relationship between dimensions of HLand HbA1c, multiple linear regression analysis was conducted. Results The study revealed a significant association between higher levels of HLand lower HbA1c levels. There is a statistically significant positive linear correlation between adherence to general nutrition and HLdimensions. In terms of physical activity, a positive correlation was also found with HLdimensions, and blood glucose monitoring showed a positive correlation with health literacy. Greater adherence to nutrition was linked to a decrease in HbA1c levels, while higher adherence to self-monitoring and medication was associated with an increase in HbA1c levels Conclusions This study emphasizes the importance of HLin managing diabetes. It underscores the impact of HLin diabetes compensation. The results reveal that higher levels of feeling understood and supported by healthcare professionals, having sufficient information to manage health, actively managing health, and appraising health information among people with diabetes lead to better adherence to blood glucose self-monitoring. Based on these findings, a crucial aspect of effectively managing diabetes will involve empowering individuals with the necessary skills for self-management of their condition, overall health, and treatment regimen. Key messages • The present research reinforces the importance of health literacy for diabetes compensation and self care activies. • One critical success factor in dealing with diabetes will be investing of health literacy of people with diabetes and health care providers responsiveness.

Can ChatGPT affect health literacy?

Abstract Background ChatGPT is a large language model based on artificial intelligence, which nowadays finds application in various fields, including medicine. Objectives To investigate the usefulness of ChatGPT related to health literacy and to highlight its potential limitations. Methods We searched PubMed/MEDLINE for published research and articles that reviewed ChatGPT in the context of health literacy, written in English over the past five years with free full text access. All original articles were screened. Results A total of 53 publications were found. Twenty-five publications met the inclusion criteria and were included in the review. Most of the works presented a positive opinion towards the use of ChatGPT. The authors of six articles believe that ChatGPT generates more readable papers, while four of them believe the opposite. In four articles authors found out possibility to simplify text. The negative sides relate to the possibly insufficient education of users, the accuracy of the information, potential bias, dependence on the outdated data, and the ethical problem of the real authors not being cited, and therefore not recognized for their work. Conclusions According to the conducted research, ChatGPT represents an opportunity to improve health literacy by generating accessible and comprehensible information about health. It has also been shown to improve the readability and accessibility of public education materials on selected health topics. Furthermore, while AI models like ChatGPT can serve as a reliable source of health information, they should be used as an addition to professional medical consultation, and not as a standalone advice service. Key messages • ChatGPT represents an opportunity to improve health literacy. • AI models like ChatGPT can serve as a reliable source of health information, but they should be used as an addition to professional medical consultation, and not as a standalone advice service.

Involving children in health literacy research

Abstract Background The range of health literacy research related to children has not normalised children’s involvement as advisors in health literacy research about them. While research with children can be difficult to facilitate, the principles of involvement and engagement should guide all health literacy work. This presentation shares learning from convening a Children’s Advisory Group to consult children about health literacy research priorities, ethics and methods. Methods Children (n-8) aged 7-11, referred by adults whose networks included children, joined a Children’s Advisory Group as Child Advisors. Consultations focused on a proposed study of how children’s critical health literacy could be supported in a community setting. Child Advisors piloted methods for rapport-building and data collection to be adapted for use with child participants later. Child rights-informed evaluation forms captured children’s reflections on their involvement. Results Consulting with a Children’s Advisory Group has challenges and benefits. Despite equity-focused strategies, e.g. introductory phonecalls and postcard updates, seldom-heard children remained less involved and the extent of parent/caregiver support varied. Child Advisors valued independent consultations led by their interests. Contributions included child-friendly consent documents, livestreamed draw-and-describe inspired by favourite influencers, and a novel Interview to the Alien protocol designed to appeal to middle childhood. Conclusions Taking an equity-focused approach is relevant for research with children focused on critical health literacy. Consulting with Child Advisors provides a way to involve children in health literacy research that holds adult researchers accountable for acting on children’s contributions. It is important to offer Child Advisors more than one option to get involved in research so that their insights can be foregrounded in future health literacy research with children.

4.K. Scientific session: The realm of the information ecosystem and its public health impact

Abstract Workshop background As a field of science, study, practice, and policy, infodemic management has emerged during the Covid-19 pandemic but has since been emancipated and can be translated to any topic where information ecosystems play a vital role. In particular relevant to public health, infodemic managers have grown in the ranks of institutes of public health, academic institutions, UN agencies and civil society organizations, tackling outbreaks and public health issues as wide as mpox, Marburg, teen mental health, chronic diseases, seasonal influenza, Ebola and routine immunization. Aiming at improving public health strategies, they are responsible for exploring and investigating personal and organizational (health) information ecosystem, generating evidence, identifying patterns of communication and information flow, tackling the onset and distribution of circulating mis- and disinformation, better understanding information voids, and respond to citizen needs concerning information demands around emergencies. In this workshop, we will focus on several common challenges associated with implementing whole-of-society interventions and strategies for resilience to health misinformation. Solving these challenges, which often are too big just for the health system to solve, will sometimes require creativity, out-of-the-box thinking as well as cross-disciplinary perspectives and new partnerships. Infodemics are also a global challenge that can easily cross borders, which is why country-to-country discussions of experiences by participants is encouraged-while no previous infodemic management experience is required. Workshop objectives The workshop will be organized as a research symposium with five speakers from infodemic management, health information, and health literacy. They will provide a solid introduction to infodemic management from different perspectives and angles. (i) The first presentation will introduce a study on health information seeking and health literacy in midwife-led care and the modern information environment. (ii) The second presentation will discuss how fact-checking organizations can partner within public health for a healthier internet. (iii) The third presentation will focus on unravelling misinformation by investigating the associations between health literacy and resilience. (iv) The fourth presentation will present a novel web-platform for credible health information and tackling misinformation. (v) The fifth presentation focuses on the impact of misinformation on social media in the context of natural disasters. The format of this workshop will be 5x8-minute presentations, including Q&A with the audiences, followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • Infodemic management seeks to quickly understand the public’s information and health needs improve future public health responses, especially during emergencies. • Whole-of-society approaches are needed to address and mitigate harms caused by infodemics by developing closer partnerships and understanding between health systems and the public.

Implementation of organizational health literacy depending on school characteristics in Germany

Abstract Background Children and adolescents are important target groups for health promotion measures to sustain a healthy upbringing. Organizational health literacy in schools is a promising environmental intervention to strengthen health literacy in school children. This study examines the relationship between school characteristics and the implementation of organizational health literacy. Methods School principals in Germany were invited to complete a 20-minute online survey between November 2022 and July 2023. An 8-item self-report tool was used to measure organizational health literacy in schools (OHLS-Q-SF) that comprehends eight different areas within schools to become health literate. A hierarchical cluster analysis was carried out to identify groups according to the composition of the socioeconomic status of the student body. Descriptive statistics, Mann-Whitney-U tests, and Kruskal-Wallis tests were performed. Results 598 school principals (73.6% female, Ø 52.3 years old) who worked at primary schools (49.1%), secondary schools (37%), and special education schools (13.9%) completed the survey. Cluster analysis revealed two groups. The first one (36.8%) contains schools with mainly students with lower socioeconomic status, and the second group (63.2%) contains schools with more students from middle or higher socioeconomic status. The socioeconomic status of students within the schools showed no significant results for any area of organizational health literacy, whereas all eight areas are more likely implemented if the schools already participate in a school health promotion program or network (p < 0.001). Conclusions Participating in a school health promotion program was associated with higher levels of implementation in all areas of organizational health literacy in schools. This finding highlights the importance of those programs. Integrating organizational health literacy into those interventions can be a beneficial approach to sustaining health literate schools. Key messages • Participating in a school health promotion program or network might facilitate schools to become health literate organizations. • In Germany, the socioeconomic status of the students within the schools is not associated with the implementation of organizational health literacy.

The association between health literacy and colorectal cancer screening uptake in Taiwan

Abstract Background Population-based cancer screening programs have been confirmed as a cost-effective strategy for early detection of colorectal cancer, leading to reduced mortality and morbidity. In Taiwan, the government has provided an immunochemical fecal occult blood test (iFOBT) every two years to all citizens aged 50 to 74 years since 2013. The study aims to determine the association between iFOBT uptake and health literacy (HL). Methods Data from the National Health Interview Survey (NHIS), a population-based cross-sectional survey conducted in 2021-22 in Taiwan, were applied. The European Health Literacy Survey Short Form (HLS-EU-Q16), self-reported iFOBT participation within the past 2 years, and covariates assessed by face-to-face interview. The present analysis included those age-eligible for screening (n = 3,871) and applied the survey-weighted multivariable logistic regression to estimate odds of iFOBT uptake between HL skill levels, controlling for age, education attainment, socioeconomic status, health status, and household urbanicity level. Results In general, 44.6% of participants had utilized the iFOBT, and 79.9% had adequate HL skills which reported higher iFOBT uptake rates (45.9%) than their counterparts (39.4%). Multivariable analysis showed that having adequate HL was associated with greater odds of iFOBT utilization (adjusted odds ratio [aOR] = 1.79; 95% CI: 1.29-2.49). Additionally, compared to those households registered in the township, participants in higher urbanicity levels had lower iFOBT uptake: city (aOR = 0.62; 95% CI: 0.47-0.82). Other predictors that contributed significantly were participants’ gender and having 2 or more chronic diseases. Conclusions Inadequate HL skills and urban residency may reduce participation in the CRC screening program, despite its free availability. More efforts should include literacy-friendly designed materials and the provision of tailored support in urban settings. Key messages • HL skills are significantly associated with the CRC screening uptake in Taiwan. Improving HL could have positive effects on people’s participation. • Urbanicity levels are also predictors associated with screening utilization. Disseminating health service information in localized ways should be a potential option.

The Effect of Parents Health Literacy Level on Attitudes Towards Childhood Vaccinations

Abstract While the importance of vaccination services increases day by day, WHO declared vaccine hesitancy as one of the 10 threats to global health in 2019 due to the decrease in vaccination numbers in recent years. Raising parents awareness about childhood vaccines with adequate and accurate information is likely to positively affect vaccination decisions.Although the level of knowledge on this subject depends on parents being able to obtain information using the right sources, this situation can also be associated with a sufficient level of health literacy.This study aimed to evaluate how parents health literacy level affects their attitudes towards vaccines. This cross-sectional study was conducted through a facetoface survey with 400 parents of children under the age of 18 who applied to the Istanbul Faculty of Medicine, ChildHealthDiseasesPolyclinic. Asdata collection tools, a survey form including general approaches to preventive health services and knowledge level about vaccines, as well as the TSOY-32 and PACV were used. As a result of our study, the average of the correct answers given by the participants to the questions regarding their vaccination knowledge levels was determined as 12.1±4.3. The average health literacy general index score was found to be 33.6±4.5. It was determined that 2.5% of the parents had insufficient health literacy levels, and 67.8% had problematic or limited health literacy levels. Parents received a total score of 30.2±23.7 (13 (1-83)) from the PACV scale. It was determined that 13.5% of parents were hesitant about childhood vaccines. It was determined that individuals with vaccine hesitancy had lower general health literacy and vaccine knowledge levels, and they used the media and neighbors as sources of information at a higher rate. Additionally, it was determined that low level of knowledge about the vaccine(OR 1.4 95%CI 1.3-1.6). and using the media(OR 2.3 95%CI 1.0- 4.9) as a source of information poses a risk for vaccine hesitancy. Key messages • Providing community-based training to increase the health literacy level of parents will also create positive changes in vaccine hesitancy. • Community-based studies should be carried out regarding misconceptions about vaccines, especially those acquired from the media, and individuals should be made aware.

Effect on comprehension of an AI patient-friendly hospital discharge letter: a quasi-RCT

Abstract Background During transition from hospital to home care, discharge letters serve as a bridge of information between hospital physicians, general practitioners, and patients. However, the complexity of these letters often hinders patient comprehension, leading to medication errors and adverse outcomes. We assessed the effect on patients’ comprehension and satisfaction of using AI to transform discharge letters into patient-friendly versions. Methods An online quasi-randomized controlled parallel-group trial was conducted in Italy. A synthetic discharge letter for a chronic obstructive pulmonary disease patient was drafted. GPT-4 rephrased the letter into an easier-to-understand version. Participants were assigned to receive either the original or AI-generated letter and completed comprehension assessments and satisfaction survey. Results Out of 460, 166 participants received the original letter, and 175 the AI version. The AI group showed significantly higher comprehension scores (median 4;IQR 2-4 vs. 2; IQR1-2, p < 0.001) and outperformed the control group in understanding diagnosis, medications, and antibiotic instructions. Perceived satisfaction was higher in the AI group across all measures (p < 0.001). Health literacy was a good predictor of comprehension in both arms (p = 0.013; p = 0.015). Subgroup analysis revealed the AI letter nearly bridged the comprehension gap between non-healthcare individuals and healthcare professionals receiving the original letter. Conclusions AI-optimized discharge letters improved patient understanding, and satisfaction compared to traditional letters. The study underscores the influence of sociodemographic factors like healthcare experience and health literacy on comprehension, advocating for adaptive communication strategies. These findings contribute to discussions about integrating AI in healthcare to develop patient-centered communication approaches. Key messages • AI-generated patient-friendly discharge letters significantly improved comprehension and satisfaction compared to traditional letters. • Integrating AI in healthcare communication can help bridge comprehension gaps and promote patient-centered care.

Predictors for psychosocial consequences of screening for liver diseases in Germany: a LASSO approach

Abstract Background Medical screening is extensively used across various disciplines for early disease detection and prevention of severe progression aiming to reduce disease-specific burden, improve quality of life and promote health. However, screening is debated due to unclear evidence of its overall benefits from a public health perspective. Screening is associated with improved health behavior and cost-effectiveness. However, studies identified adverse effects of screening like psychosocial burden. Most results originate from cancer screening and it is unclear whether they are transferable to other contexts. Within a research program, a systematic screening procedure to detect patients with liver cirrhosis at early stage in an asymptomatic general population was evaluated. In this study, we aimed to identify patient characteristics that predict and explain variance in psychosocial outcomes of screened patients. Methods This study analyzed data from 523 participants who underwent a systematic liver disease screening in Germany from Jan 2018 to Feb 2021. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on the outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ). The constructs measured by the PCQ are social, physical and emotional dysfunction associated with screening. Results We identified lower severity of comorbidities, higher subjective social status, stronger social support, older age, better critical health communication skills and higher health literacy as relevant predictors of lower psychosocial dysfunction, indicating their protective role in preventing psychosocial burden of screening. Conclusions From a public health perspective, medical screening offers should take into account patients’ individual context regarding their subjective social status, health impairments, personal social networks and health literacy skills to reduce post-screening psychosocial burden. Key messages • Social support, age, health literacy and higher subjective social status were positively associated with lower psychosocial consequences of liver screening. • The findings indicate that liver screening should be carried out, taking into account the individual’s situation and resources available.

Health literacy & somatic education: a salutogenic self-resource critical health intervention

Abstract Issue Non-communicable diseases (NCDs), such as musculoskeletal conditions, cause severe functional limitations. Therapeutic practices in this field have employed a theoretical-practical framework with a pathogenic and mechanistic bias. However, the causes of these NCD’s are also related to biopsychosocial factors. Therefore, a critical theoretical-practical approach, such as Somatic Education, becomes relevant as it introduces a subjective experience to an educational praxis, modifying the meaning processes in human movement experience in a complimentary approach to the pathogenic perspective. Description of the problem There is a perceptual poverty in movement experience, which dissociates doing from feeling. Somatic practices aim to foster movement awareness (perception) and autonomy (self-regulation), placing the individual as a valuable resource, strengthening the capacity for understanding, reflection and habitus change. This presentation will focus on the following research questions: Can Somatic Education, as a critical intervention of the body, contribute to increased levels of health literacy? Can somatic practices contribute to sustainable health development? Is it possible to create a new meaningful process in human movement experience through this practice incrementing its salutogenic emphasis? Results/Effects Somatic practices foster integrative approaches of health, promoting subjective bodily experience (interface between doing, thinking and feeling). Integrative progress can urge the embodiment of health literacy, encouraging more active and awareness of individuals related to their well-being, contributing to sustainable health development. Moreover, subjective bodily experience transforms the process of meaning in movement experience. Lessons Somatic practices enhance NCDs prevention and education, increasing health literacy rates through innovative conceptual foundations.

Organizational health literacy responsiveness in community pharmacies in Serbia

Abstract Background The Faculty of Pharmacy at the University of Belgrade conducted a pilot study at community pharmacies in Serbia in 2023 in the framework of the M-POHL organizational health literacy (OHL) project. Community pharmacies in Serbia are considered relevant settings where people’s health can be promoted within the organization. Methods The validated and culturally adopted Serbian version of the International Self-Assessment Tool for Organizational Health Literacy in Primary Health Care Services (OHL-PHC) was used. We recruited employees from 3 pharmacy chains with pharmacists from different units. A preparatory workshop was organized to explain the procedure and the concept of OHL. First, the self-assessment was performed in a small group of 5 persons individually, and then the results were discussed in a joint assessment. The self-assessment was based on the degree of fulfillment of 4 categories offered for each indicator: not fulfilled (0-25%), predominantly not fulfilled (26-50%), predominantly fulfilled (51-75%), and completely fulfilled (76-100%). The same scale was applied for the indicators, sub-standards and standards and the final score was the mean of the individual scores (min. 0, max. 4). Results The overall score of the OHL on the sample level was 1.93±0.86, with the highest score for providing of easy access to primary care service and facilitating navigation (2.3±0.5). The least fulfilled standards were related to promotion of digital health literacy and promoting health literacy with the same score values of 1.7±1.0. Out of 69 indicators 1 had been self-assessed as not fulfilled and 15 reached low consensus (SD ≤ 1), and needed to be discussed further. Conclusions Improvements in OHL in the piloted institutions are necessary for successful healthcare and health promotion and could be tailed in further usage of the OHL-PHC on a broader scope. More pilot studies are needed in other healthcare settings at primary level in Serbia.