Health Literacy Research Articles

Factors associated with over-the-counter drug misuse among young people: a narrative review

Abstract Background Over-the-counter (OTC) medications are sold directly to customers without requiring a doctor’s prescription. Misuse of OTC drugs is higher in adolescents and young adults than in the general population. This review is the first to narratively synthesize the factors associated with OTC drug misuse among adolescents and young adults (14-25 years old). Aim To identify the factors that are associated with OTC drug misuse among adolescents and young adults (14-25 years). Methods A comprehensive search of three electronic databases, including MEDLINE, PsycINFO and Web of Science, was conducted to retrieve publications between 1 January 1997 and 31 July 2023. The AXIS tool was used to aid critical appraisal. Papers were analysed using thematic analysis. Results Eight studies were eligible for inclusion in this narrative review We identified four key themes: motivational factors; health literacy; illicit drug use and socioeconomic status. Sensation-seeking and using OTC drugs for recreational purposes were associated with OTC misuse. Limited health literacy and lack of understanding of OTC drugs were significant factors for misusing OTC drugs. Greater use of OTC drugs at the same time as alcohol and other illicit drugs represented that they were at increased risk for misusing OTC drugs. Finally, adolescents and young adults with low income, from rural areas and with lower educational attainment were most likely to misuse OTC drugs. Conclusions Although over-the-counter medications (OTCs) encourage self-medication, their rising misuse has led to a public health problem to which nations worldwide are responding. Therefore, education and awareness among OTC drug users policy will be helpful further on strategies to prevent the misuse of OTC drugs. Key messages • This review identifies some of the factors for misusing OTC drugs, and education and awareness among OTC drug users policy may be helpful further in strategies to prevent the misuse of OTC drugs. • This review also identifies that changing the user habits and availability of OTC drugs policy may also be helpful in further strategies to prevent the misuse of OTC drugs.

Development and Implementation of Health Education Tools for Excluded Areas in the Czech Republic

Abstract Background Reducing health inequalities among population groups is imperative, however, health communication strategies tailored to ethnic minorities remain under-researched. To address this issue, various health communication strategies were developed and tested within the 3 year Saste Roma project, focused on improving health literacy and disease prevention in the excluded Czech Roma population. Methods A planning group comprising of doctors, sociologists, psychologists, NGOs and community health workers was established to create tailored health communication tools. The tools were developed with consideration of the sociocultural specifics of the Roma community, using focus groups, in-depth interviews, and the Delphi method. A PR agency was hired to implement the tools. Reach, engagement and Price Per Click = PPC were measured for online tools; feedback on offline tools was collected via surveys and interviews. Results From April 2021 to March 2024, 12 online and offline tools addressing 10 diseases were developed for various age groups and implemented. These tools, such as health literacy brochures and leaflets (78,500 pcs distributed), music videoclips (viewed 150,000 times), a mobile application (with over 500 users), social media profiles dedicated to health (with 140 followers), preventative events, school-based e-learning modules (implemented in 86 elementary schools in excluded areas), online campaigns (reaching 556,337 people; PPC of 0.85 EUR in case of in-house campaign Vs. PPC of 3.21 EUR by PR agency) or poster campaigns (engaging 3,046 individuals) focusing on excluded areas. Lessons This project represents the first extensive use of diverse communication tools targeting the Roma population. The involvement of community representatives (patients, artists, actors, and residents) in tool development is crucial. Training and support for health community workers are essential to achieve effective engagement with the community. Key messages • Tools must be delivered in a culturally sensitive and comprehensible manner by members of the communities. • Commercial PR agencies failed with this specific campaign. Cooperation with Roma artists and influencers is essential.

Barriers and facilitators to healthcare services of people with mental ill-health in Europe

Abstract Background People with mental ill-health (PMIH) have higher cancer mortality rates than the general population. Barriers to healthcare service access may be a contributing factor. The EU-funded CO-CAPTAIN project aims to reduce health inequalities by improving overall health and reducing cancer burden by adapting and implementing the Patient Navigation (PN) Model targeted at PMIH. This qualitative study explored healthcare system experiences of PMIH in Austria, Greece, Poland, and Spain. Methods Eighty-one participants (22-76 years old), including 34 PMIH, 10 caregivers, 14 care team members, 12 mental health organization representatives, and 11 service manager representatives, were recruited. Semi-structured interviews focused on awareness of cancer risk factors, healthcare system experiences, and perspectives on PN as an intervention. Interviews were transcribed verbatim and analyzed using thematic analysis. Results Three major themes emerged: (1) somatic health relevance and preventive services utilization and (2) barriers / (3) facilitators to preventive services access. Knowledge of cancer prevention services varied greatly. Participants were aware of associations between risky health behaviors and health. Burden of mental health problems and discrimination, insufficient access to information, and lack of service flexibility were noted as barriers. Considerations of individual circumstances, social support, and empowerment were named as facilitators. Conclusions Tailored interventions involving healthcare professionals and PMIH in development of supportive environments and health literacy have the potential of overcoming identified barriers to the use of healthcare services. Key messages • People experiencing mental ill-health are faced with significant structural barriers when accessing somatic health services. • Understanding people’s needs in terms of access and utilization of health care allows us to define guidelines for future personalized healthcare solutions.

9.X.2. Activating the ASPHER-WHO Public Health Core Curriculum: Interprofessional Skills

Abstract The updated ASPHER-WHO Public Health Core Curriculum builds on ASPHER’s previous work on Competencies for Public Health Professionals (2006-2020), reflects the changing needs of our population and planet and public health professionals. The key objectives of this workshop are to: - Share the updated ASPHER core curriculum for public health; - Illustrate examples of public health challenges that young professionals have championed for inclusion; - Share the Faculty of Public Health (UK)’s work on Fair training as a case study on operationalising public health leadership on equality, diversity and inclusion and demonstrating the core competencies in action. A curricular content survey of member schools and programmes yielded responses from 60 schools, with > 500 submissions of detailed. subject curricula. These have been compiled into 36 Subject Areas in four Domains, namely: (1) Core Subject Areas in Public Health: (2) Subject-specific Areas in Public Health;(3) Core Cross-curricular Subject Areas; and (4) Core Interdisciplinary Professional Skills in PH. The development process was guided and grounded by the expertise and passion of young public health professionals. They are helping us make the core curriculum fit for purpose for the near future and provide them with the skills required to be a competent member of a supportive public health team in an ever changing world. This Workshop will profile selected Subject Areas from each Domain using real life challenges facing WHO European Region to show how the core curriculum integrates research, theory and practice to help build those essential interdisciplinary skills. The examples will focus on Economics in Public Health (Domain 1); Public Health and Criminal Justice; (Domain 2); Health Literacy and Infodemiology, Mental Health and Wellbeing (Domain 3); and Integrative Learning in Action; Communication Skills; Advocacy, Negotiation; Collaborations and Partnerships; and Leadership, Management and Implementation Science (Domain 4). Discussions for each of the Subject Areas will be led by an expert in the area. We will also illustrate an example of these competencies in action, how they are helping shine a light on the challenges we face in creating that supportive team and environment and how the potential for collaboration helps us to capitalise on the expertise available in some schools and programmes for the benefit of all. Key messages • Learning interdisciplinary skills are essential for effective public health analysis, advocacy and action. • Collaboration across countries, schools, professions and generations can create transformational change. Speakers/Panelists Mary Codd University College Dublin, Dublin, Ireland Karl F Conyard University College Dublin, Dublin, Ireland Jenny Houston University of Edinburgh, Edinburgh, UK Samia Latif Faculty of Public Health, London, UK Olalekan Popoola ASPHER, UCD, Dublin, Ireland

Slaintécare Healthy Communities: Engaging with evidenced based best practice to promote health literacy in Ireland

Abstract This workshop will include a blend of presenters from both practice and research, with tangible examples of how the needs analysis was conducted, how meaningful partnerships were developed, and how we suggest these suggestions can be brought to life. This opening presentation will set the scene, detailing the role of Sláintecare Healthy Communities, the rationale for a focus on health literacy, the incredible value of adopting a meaningful participatory approach, and learnings from collaborating with a research team/project.

Health coaching: the node of health literacy & health promotion

Abstract Introduction To achieve sustainable health behaviors and outcomes to move from a precarious health situation to good health, people need to be supported in health literacy in behavior change that ensure interventions’ success. As a non-clinical approach, health coaching aims to increase a person’s levels of self-efficacy, confidence and resilience, by promoting the sense of coherence. This communication aims to identify the benefits that health coaching as a salutogenic approach can trigger. Methods The work is structured in a narrative review of literature and the lived experience of the authors in health coaching. Results The published research on health coaching and the systematic professional experience of the authors highlight: (1) the anchoring of health coaching in the salutogenic model and in the person-centered approach focused on individual characteristics and needs in driving healthy behaviors; (2) health coaching as a collaborative relationship with chronically ill people and people at risk of developing illness; (3) the role of health coaching as a sense of coherence (SOC) promoter; (4) health coaching as a new profession in the healthcare ecosystem (e.g. NHS, UK), cooperating with multidisciplinary teams. Discussion From A.Antonovsky’s model approach to health, the SOC stands out and constitutes one of the basic theories in health coaching interventions, by strengthening the person’s capabilities of comprehensibility, manageability, and meaningfulness. As an emerging profession, with ethical and a growing research foundation, it is facilitated by trained professionals in managing and monitoring health behavior change. Conclusions Health coaching aims to bring relevance, meaning and strategy to a person’s behavioral change. Health coaching demonstrates positive effects on several health parameters by supporting the implementation of health literacy development and empowering people to trigger sustainable changes that lead to healthier lifestyles.

Risk communication with asylum-seekers: Insights from the COVID-19 Pandemic experience in Munich

Abstract Background The COVID-19 pandemic has created a ‘double crisis’ for asylum-seekers, whose lives were already in crisis. Many reports indicated the syndemic consequences on asylum seekers’ health, underscoring the need for their inclusion in risk communication (RC) and community engagement (CE) and infodemic management (IM) actions. This study aims to describe RCCE experience with asylum seekers in Munich during the COVID-19 pandemic from an expert perspective and thus gain a thorough understanding of the requirements for inclusive RCCE. Methods Our qualitative study involved people who conducted COVID-19-related RCCE for asylum-seekers. Volunteers/workers of civil society organizations and health professionals were interviewed using purposeful sampling. After reviewing international guidelines, an interview form was created. The content analysis resulted in themes and categories. Results Four of the interviewees were health managers, while 8 were working in civil society organizations. The first category of the results describes the context in which RCCE occurs; syndemic factors (uncertainty; social exclusion and stigma; precarious housing; limited access to healthcare and unmet mental health needs) and pandemic management. The second category includes determinants of RCCE from both the asylum-seeker (trust; risk perception; health literacy; language; culture and gender) and RCCE member (competences; overburden; continuity) standpoint. The third category focuses on various RCCE-IM measures, including their effectiveness and consequences. Conclusions Syndemic factors hampered the effective implementation of RCCE for asylum seekers in Munich. RCCE determinants show that pre-crisis actions are necessary for an effective response and individual interactions should accompany community-level activities, particularly for female and marginalised migrants. This study’s scope will be expanded by incorporating the IM component.

Key requirements for achieving EU-wide programme change

Abstract Issue Across the world, thousands of projects aim for equitable improvement in health for people who are experiencing ongoing avoidable stigma, discrimination and disadvantage however very little change is often achieved. Description of the problem In this presentation we explore key requirements for project-level change to ensure EU-wide programme change is achieved. Results The two most common causes of project failure are a) the innovation is not suitable, needed or wanted (also called theory failure) or b) implementation failure. This presentation shares strategies to mitigate risks of project failure through co-design processes and communication, drawing from 30 years of experience from the entire implementation process from ideation to scale up. These experiences include projects from over 30 countries, including partnerships with the World Health Organization, governments and industry focused on health literacy, self-management, care pathways, workplace health, hospital services redesign, First Nations health and migrant health. Common success factors include balancing top-down needs with co-designed inputs and with previous preferred or good practice (which may have come from controlled trial evidence generated in different contexts). The intervention must co-implemented to serve stakeholder’s needs at all levels, from citizens to decision makers. Lessons The United Nations (UN) and private sector apply system-wide approaches to affect large scale change. This knowledge is valuable for large public health programmes aiming to integrate equity and diversity in project processes to minimize implementation failure.

Digital health literacy in schools: empirically navigating novel data from students and teachers

Abstract With the introduction of the Digital Competence Framework (DigComp+) by the European Commission, European schools have committed to promoting digital and media literacy systematically. DigComp+ shares several intersections with health literacy, e.g., information management, using digital tools, and taking action on the digital and commercial determinants of health, making it an ideal curriculum to teach digital health literacy in schools. However, internationally, not much is known about digital health literacy in schools. The aim of this study is to present data from a representative school study of students and teachers in 16 federal states in Germany. Data was collected using an online survey from a representative sample of N = 1,448 students (9-18 years) and a convenient sample of N = 1,600 teachers. With SPSS, descriptive statistics, chi-square tests, and internal consistency were calculated. Cronbach’s alpha indicated good internal consistency for both tools. Low digital health literacy was reported by 52,9 of students and ∼39,3% of teachers. In students, low digital health literacy linked with younger age (X2 (2)=34.69, p = <.001), family affluence (X2 (4)=24.16, p = <.001), and parental education (X2 (2)=8.26, p=.016). In teachers, it was linked to age (p < .048), school position (p < .001), and their own digital health literacy DHL (p < .001). More than 45% of teachers reported not teaching digital health literacy in schools, while on average, 55% of students indicated they would not learn it in schools. Based on the first digital health literacy in schools study, results suggest DigComp+ is almost not used to teach digital health literacy and both students and teachers have significant deficits in their digital health literacy. Teachers should be trained in digital health literacy so that they can include it in their classroom teachings to promote the digital health literacy of students.

Organizational health literacy in hospitals and primary health care - developing innovative tools

Abstract Background Organizational health literacy (OHL), particularly in health systems, is vital for supporting public health. Self-assessment tools (SAT), critical for quality assessment/improvement and for empowering relevant stakeholders, could support hospitals and primary healthcare services to promote their role in health literacy responsiveness, and support organizations in identifying strengths and areas of improvement. Methods The SAT for OHL in hospitals (OHL-Hos) and in primary healthcare (OHL-PHC) were developed via a participatory process, based on the “Vienna Concept of a Health Literate Healthcare Organization”. Piloting of the tools in European countries shed light on the tools’ depth and the need for revision. The development of short versions followed a Delphi process with experts from ten to thirteen European countries, respectively, from December 2023 - April 2024. Healthcare service diversity within and between countries was taken into consideration as well as cultural/language adaptation. Shortening OHL-Hos followed four steps: 1) prioritization of the most relevant indicators, 2) considering additional resources, 3) consensus process, 4) refinement of the tool and wording. Results The SATs for both healthcare settings are now established. The SAT for OHL-Hos includes a matrix model of eight standards, 21 sub-standards and 75 indicators. The SAT for OHL-PHC includes seven standards, 19 sub-standards and 69 indicators, covering OHL in organizational structures and processes for staff, patients and the community served with specific focus on navigation, communication, and participation. Both SATs are accompanied by a guide to direct organizations through in the self-assessment process. Conclusions The process of identifying OHL needs and opportunities in the health system, facilitated by participatory methods for tool development, led to innovative SATs for OHL which are currently ready for piloting and implementation in European countries.

Characteristics predisposing to the utilization of Internet websites offering e-prescriptions

Abstract Background The introduction of e-prescriptions in the Polish healthcare system was accompanied by the emergence of websites offering easy access to medication without adequate medical assessment. This study aimed to analyze the characteristics of Polish users of such services. Methods The analysis presented here is based on the online survey conducted in June 2023 among 1661 adult Internet users. The multivariable logistic regression model (MLRM) was developed for the variable reflecting the use of e-prescribing web services (EPWS). Sociodemographic variables, self-assessed health status, the presence of chronic disease (CHR) and disabilities (DIS), the frequency of Internet (IU) and social media use (SMU), and finally, digital health literacy (DHL) were included in MLRM as independent variables. Results The percentage of respondents who used EPWS was equal to 18.2% (n = 303). MLRM revealed that age, vocational and income status, CHR, SMU, and DHL were significant predictors of EPWS use. Older respondents were less likely than younger ones to use EPWS (odds ratio (OR), 95% confidentiality interval (95%CI): 0.97, 0.97-0.99. Persons suffering from the chronic disease, when compared to those without such disease, used EPWS less frequently (OR, 95CI: 0.59, 0.43-0.80) and unemployed when compared to employees (OR, 95%CI: 0.53, 0.32-0.88). A higher likelihood of using EPWS was observed among respondents with the highest income in comparison to those from the group with the lowest income (OR, 95%CI: 1.52, 1.02-2.52) and among more frequent social media users (OR, 95%CI: 3.88, 1.90-7.93). Finally, the increase of DHL score by 1 unit was associated with the increase of the likelihood of EPWS use by 9% (OR, 95%CI: 1.09, 1.05-1.12). Conclusions A significant number of adult Internet users utilize EPWS in Poland. Lower age, unemployment, and chronic diseases are negative predictors of EPWS use. More intense SMU and unexpectedly higher DHL predispose to the use of such services. Key messages • Even persons with high e health literacy are inclined to use web portals offering e-prescriptions. • The high prevalence of the utilization of e-prescribing websites requires awareness campaigns warning about related potential risks.

Automated digital counselling promotes therapeutic change in mental health in patients with chronic heart failure or chronic kidney disease: ODYSSEE-vCHAT study

Abstract Background The efficacy of digital programs to improve the management of chronic heart failure (CHF) and chronic kidney disease (CKD) is not established. Building on related studies in digital health, behavioural counselling, and social support, we evaluated whether an automated digital counselling program with social network support (ODYSSEE-vCHAT) could improve mental health and health-related quality of life in patients with CHF or CKD. Purpose The primary objective was to examine whether engagement with ODYSSEE-vCHAT was associated with a minimal clinically important difference for improvement in the Mental Component Summary (MCS) of the SF-36 at end-of-study. Secondary outcomes included: ENRICHD Social Support Index (ESSI), Patient Health Questionnaire for Depression (PHQ-9) Godin-Shephard Leisure Time Physical Activity Scale (GSLTPAQ), and an index of the frequency to which patients engaged in goal-directed activities for living well (EUROIA). Methods ODYSSEE-vCHAT was a multi-centre, single group, open label study with assessments at baseline and end-of-study (approximately 11 months). Inclusion criteria were: ≥18 years of age, diagnosis of CHF (reduced ejection fraction (EF) ≤ 40%, mid-range EF, 41-49%, or preserved EF ≥ 50%); or CKD diagnosis (>10% risk for dialysis using the 4-variable, 2-year Kidney Failure Risk Equation, or on dialysis). Exclusion was based on inability to participate due to co-morbidities. The digital counselling protocol taught self-care skills to improve mental health, quality of life, and adherence to medications, exercise, diet, and smoke-free living (Figure 1). Patient engagement with ODYSSEE-vCHAT was defined as Not Engaged (0 logon minutes) vs. Engaged (> 0 logon minutes). The primary outcome was a minimal clinically important difference for MCS change: ΔMCS ≥ 3.8 or MCS ≥ 65 at baseline and study endpoint. It was assessed using multivariable binary logistic regression, controlling for exposure to COVID-19 and health literacy. Secondary outcomes were assessed using multivariable linear regression analyses with the same covariates. Results 215 patients were enrolled. There were 7 deaths and 34 withdrew. In our sample of 174 patients, mean age = 54.4 years (95% Confidence Interval, CI, 25, 81), gender identity as women, n = 68 (39%), ethno-racial group other than White, n = 83, (48%), primary diagnosis, CHF, n = 68 (39%), and CKD, n = 106 (61%). Duration of enrolment to end-of-study: median = 352 days, (95% CI, 159, 496). Engagement with ODYSSEE was associated with therapeutic change on the MCS (for both CHF and CKD patients, and CHF patients alone), GSLTPAQ, and EUROIA, but not the PHQ9 or ESSI (Figure 2). Conclusions Automated digital counselling with social network support promotes improvement in indices of mental health for patients with CHF and CKD. These findings support a follow-up randomized controlled trial.Figure 1.ODYSSEE-vCHAT Study ProtocolFiFigure 2.ODYSSEE-vCHAT Study Outcomes

Joint Action JACARDI: a context analysis on CVDs and diabetes policies and practices

Abstract Issue/problem Non-communicable diseases are the leading cause of death and disability in Europe, with 63 million people living with cardiovascular diseases (CVDs) and 32 million with diabetes (DM) in 2019. The EU-co-funded Joint Action on CVDs and diabetes (JACARDI), with 76 partners from 21 countries, aims to reduce CVDs and DM burden at European level through 142 pilot projects. Description of the problem For an effective and tailored pilots’ implementation, a preliminary step is to assess the current state of strategies and services for CVDs and DM prevention and management in Europe. We adopt the Gap Analysis methodology aiming to evaluate the gap between the current and the ideal state, the latter defined according to scientific evidence, best-practices, guidelines, and expert’s opinions. For this purpose, 12 questionnaires, one for CVDs and one for DM for six different thematic areas, were developed through a participatory approach that fostered the collaboration between the scientific coordination team and the project members. Results Questionnaires were sent to National Focal Points for health covering 29 European countries. We anticipate receiving responses from each country covering aspects related to the legal and strategic framework, the intersectoral and equity-oriented approaches, the funding and the service delivery and capacity for CVDs and DM. This information will be collected across each of the six thematic areas corresponding to six technical Work Packages (WP): health literacy, data, screening, integrated-care pathways, patients self-management, labour participation. The survey will be completed by June 2024, and results by WP and country will be presented. Lessons The context analysis, based on the Gap Analysis methodology, allows to identify gaps between the current and ideal state in CVDs and DM prevention and management. This will guide JACARDI’s pilots to address gaps and serve as a roadmap to inform European policy-makers. Key messages • The context analysis will provide an invaluable overview of the current European state of CVDs and DM prevention and management. • The context analysis will support JACARDI’s pilots in addressing identified gaps and policy-makers in shaping public health responses.

Empowering youths through citizen science to address health inequalities in adolescence

Abstract Citizen Science (CS) stands as a beacon of hope in the fight against inequalities in adolescent health, revolutionizing scientific research by involving individuals from diverse backgrounds. Unlike traditional methods, CS transcends academic boundaries, fostering inclusivity and collaboration irrespective of age, nationality, or social status. This approach has gained momentum in adolescent health research, empowering young people as co-researchers from project inception, thereby reducing disparities in health knowledge and access. Studies demonstrate its efficacy in enhancing empowerment and health literacy among participants. YouthChronic is an example of how CS can mitigate health inequalities among adolescents. The project ensures active participation in every research stage by engaging adolescents with chronic conditions as citizen scientists. Open-ended questions facilitate detailed responses, while participation in analysis and dissemination enhances their research involvement and sense of ownership. Through initiatives like YouthChronic, CS is reshaping the research landscape, making it more relevant and impactful to bridge the inequality gap. Young Citizen Scientists’ views on their participation: “As part of YouthChronic, we felt like our experiences with chronic conditions were finally being heard. The researchers were cool-they listened to us, let us be flexible with our participation, and even taught us some research skills. Learning from other peers’ experiences made us feel less alone and gave us new insights. But it’s frustrating that we’re limited by resources. We have big ideas, like running an advocacy campaign, but we need funding to make them happen”. In conclusion, by actively involving adolescents in the scientific process through CS initiatives like YouthChronic, we can reduce inequalities in adolescent health, empower marginalized voices, and pave the way for a brighter, more inclusive future in scientific exploration and discovery.

Food and nutrition literacy in Austria - results of a representative study

Abstract Background A healthy diet is a key factor in people’s long-term health. The nutritional health literacy and food literacy of the population play a crucial role in this. In 2021, comprehensive data on these competences were collected for the first time in Austria. Methods Almost 3,000 people were surveyed online. Nutrition health literacy was assessed with the newly developed Nutrition Health Literacy Scale (NHLS) and food literacy with the Self-Perceived Food Literacy Scale Short-Form (SPFL-SF). Scores and subscores were calculated. Associations between socio-demographic and socio-economic factors and the competences surveyed were assessed using t-tests, variance analysis, correlations, and multivariate regression models. Results In terms of nutritional health literacy, respondents score an average of 60 out of 100 points, with judging (51 points) and applying (60 points) nutritional information being the most difficult. In the area of food literacy, respondents score an average of 62 out of 100 points. The most challenging areas are ‘healthier choices’ (44 points), ‘healthy snacking’ (52 points) and ‘healthy eating in exceptional circumstances’ (54 points). In both areas, men and people with less formal education score lower. In the case of nutritional health literacy, people aged 65 and over have greater difficulties. Conversely, this group performs better in the area of food literacy. Differences by income can only be seen for nutritional health literacy, to the detriment of low-income groups. Conclusions Possible options for action include the provision of quality-assured and target-group-specific information, the implementation of appropriate tools to facilitate the assessment of foods, and measures to strengthen assessment skills, digital health literacy, food and nutrition skills. Key messages • The survey showed that there is potential for improvement in both nutritional health literacy and food literacy. • The biggest challenge is to evaluate and use nutritional information and to stick to a healthy diet without making exceptions.

The adoption of a place-based framework to inform municipal health strategies

Abstract Background Health is a place-based issue. Research shows that inequalities in health are significantly influenced by social, economic, and environmental factors, making local policies related to these domains critical determinants. Yet, place-based health planning remains underutilized by local practitioners, not receiving adequate attention from policy-makers. Departing from the Municipal Health Strategy of Coimbra, this presentation aims to showcase the framework used for guiding municipal health planning, addressing multidimensional factors, geographic analysis, intersectoral collaboration and participatory approaches. Methods The conceptual and methodological framework followed a population health approach with a geographic lens, looking at how the health outcomes and health determinants were geographically distributed across the municipality (data disaggregated at sub-municipal level), as well as the extent to which policies from multiple sectors can address them. The planning cycle followed an iterative seven-stage process based in five key actions: 1 - Assess (Health Profile), 2 - Prioritize (Priorities), 3 - Plan (Objectives and Strategies), 4 - Implement (Action Plan) and 5 - Monitor (Targets and Measures, Monitoring Plan). Participatory processes were conducted involving local stakeholders and citizens to identify needs, establish priorities and actions. Results The framework for action integrates 14 goals and 94 actions across six policy domains: Sustainable Mobility and Public Places, Safe and Adequate Housing, Accessible Healthcare, Social Cohesion and Participation, Education and Health Literacy and Intersectoral and Collaborative Leadership. Conclusions Adopting a place-based framework to health planning, involving a geographical and multidimensional health assessment as well as the participation of local stakeholders and citizens, was considered effective in turning evidence into practice. Key messages • Municipal health strategies should be developed with a place-based perspective, prioritizing health as the focal point across various intersectoral municipal policies. • The integrated framework shed light on the experience of co-creation to inform health-oriented planning, ensuring that actions address specific needs of localities.

InfoQ: Certifying credible providers of digital health information

Abstract Background Access to accurate health information is crucial. Despite the abundance of information online, sorting through it can be overwhelming, especially with the spread of misinformation. This poses a threat to public health and challenges health literacy. Efforts to combat misinformation are struggling due to the rapid growth of available information. We need complementary strategies, such as promoting trustworthy information sources. An initiative by Bertelsmann Stiftung, aims to counter misinformation by promoting health information from credible sources. Methods In 2021, the U.S. National Academy of Medicine outlined principles for identifying credible health information sources, endorsed globally by the WHO and embraced by the social media industry. However, these principles lack operationalization, leaving indicators for credibility undefined. To address this gap, Bertelsmann Stiftung, in collaboration with German experts, conducted workshops in 2023 to draft evaluation criteria. Their ongoing work, alongside initiatives by the Careum Foundation and Gesundheit Österreich GmbH will be presented. Results The criteria focus on structure (e.g., the expertise of providers) and process (e.g., methods for identifying relevant evidence) rather than outcome (i.e., the quality of each piece of information), and are based on the domains science-basis, transparency and legitimacy. Mandatory and complementary criteria allow a two-step approach to identify health information providers of good quality (meeting all mandatory criteria) and excellent quality (meeting all criteria). Conclusions These criteria build the basis of the establishment of an international certification system and represent a crucial measure to combat misinformation and promote population health literacy. Various international partners and social platforms have already reached a strong consensus on the relevance of the project goals and expressed their willingness to deepen their efforts in this regard.

Digital Health in Croatia: Key stakeholders’ perspective of societal and institutional readiness

Abstract Background According to the literature, digital health brings an innovative approach to healthcare and an inevitable transformation and disruption. The potential of digital technologies is far-reaching, from preventive medicine to addressing public health challenges. However, the implementation also significantly depends on the social & cultural context. Methods To research Croatia’s expectations, challenges, and readiness for implementing digital health, interviews were conducted with physicians, patients, hospital managers, policymakers, jurists, and engineers (n = 75). Following identifying key themes, a survey was conducted among Croatian medical students (n = 775) at the end of 2022. Results Key stakeholders believe implementation preparedness is demonstrated through institutional and societal readiness. Prominent characteristics of societal readiness include appropriate infrastructure and legal and financial frameworks. Societal readiness is assessed through digital and health literacy and existing social practices within Croatian society. Only 4.6% of medical students believe Croatia’s healthcare system is ready to implement digital technologies. They perceive the highest readiness regarding digital education (63.7%) and the digital literacy of physicians (60.9%) while negatively evaluating healthcare infrastructure, financial resources, and patient literacy. The results highlight numerous aspects that must be addressed for successful implementation, many of which have been neglected in previous periods. Conclusions The research identifies critical aspects of the social context and presents valuable implications for the digital health transformation. Key stakeholders assess that institutional and societal readiness is not at the level required for the sustainable implementation of digital health, thus necessitating specific actions, ranging from governmental bodies and international organisations to the health system, education system, and media. Key messages • It’s crucial to align digital health implementation with the social & cultural context and capabilities. • The prerequisites for successful implementation necessitate engagement across various societal domains beyond the healthcare system.

Development and validation of a tool for assessing breast cancer health literacy among Chinese women

Abstract Background Breast cancer (BC) is a major malignancy that seriously threatens women’s health. No unified, evidence-based, standardized assessment tools for BC literacy are available in China yet. Objectives We sought to develop an assessment tool to measure BC health literacy among Chinese women and to test the tool’s reliability, validity, and feasibility. Methods Group discussion, expert consultation, and small-sample pilot investigation were conducted to develop an initial assessment tool. A multi-stage stratified random-sampling process was used to select women aged 18-64 years in Yichang City, Hubei Province, China, for an onsite survey. Project analysis and exploratory factor analysis were used to screen the questions to create a formal assessment tool, which was further evaluated by feasibility analysis and the measurement of reliability and validity. Results The official version of the assessment tool for Chinese female BC health literacy includes 32 items. Nine common factors (policy knowledge, uncorrectable risk factors, modifiable risk factors, identification of early warning signs #1 and #2, screening methods, breast self-awareness and examination behaviors, timely seeking of medical help and standardized treatment, and rehabilitation) were extracted through exploratory factor analysis with factor loadings of 0.511-0.873 and a cumulative explained variance of 65.989%. Confirmatory factor analysis revealed χ2/df = 1.61, CFI = 0.91, TLI = 0.90, RMSEA = 0.04, and SRMR = 0.06. The overall Cronbach’s α coefficient was 0.875, and the split-half reliability was 0.770 (both >0.700). Conclusions An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. The application of this tool can help to promote BC prevention and control in China and may also benefit other countries. Key messages • An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. • The application of this tool can help to promote BC prevention and control in China and may also benefit other countries.

Measuring communicative health literacy – a revision of the HLS19-COM-P scale

Abstract Background Communicative health literacy (COM-HL) is important for patients being able to actively participate in communication with health care professionals, such as physicians. The HLS19-COM-P scale was developed for measuring COM-HL in the M-POHL HLS19 survey. However, two items under-discriminated according to the Rasch model and the item set did not sufficiently capture the aspect of appraising health information. Consolidating both a long and short version into a single scale was deemed appropriate. Hence, this study aimed to develop a revised version of the COM-HL scale. Methods The revision and development of new items followed a Delphi process. Items that worked well psychometrically in the six-item version of the HLS19-COM-P were kept, and new items concerning appraising information were developed. The revised version of the scale has so far been translated into nine languages (BG, CZ, DE, FR, HU, IT, NO, SK, UA). Challenging translation terms underwent multiple discussions to ensure language consistency. The interpretability of items has been explored in cognitive interviews in six countries (AT, CZ, HU, IT, SK, and UA) so far. Items that were difficult to understand were revised and tested in new interviews. The evaluation of the scale’s psychometric properties is scheduled for May and June 2024. Results The revised scale consists of eight items - two items for each of the cognitive domains of accessing, understanding, appraising, and applying health information. One item in each of these domains focuses on the interactive aspect of communication. An instruction for translation of terms that were challenging to translate has been developed. Overall, the revised HLS19-COM-P was well accepted in the cognitive interviews. Results from the quantitative testing will be presented. Conclusions The adapted HLS24-COM-P scale developed for the M-POHL Health Literacy Survey 2024-2026, is a short and conceptually sound instrument for measuring COM-HL.