Higher Levels Of Health Literacy Research Articles

Association among therapeutic adherence, health literacy, and engagement in care: How to increase health-conscious management of HIV disease.

In the context of People Living with HIV (PLWH), poor health literacy (HL) seems to be linked to poorer health outcomes and reduced engagement in care. Additionally, the level of HL can affect HIV knowledge and may impact adherence to antiretroviral therapy (ART). This research explored the connection between ART adherence, HL, and engagement in care in a cohort of 250 PLWH receiving ART in Italy. A questionnaire was given to PLWH at Policlinico Gemelli in Rome to assess their health literacy and adherence to therapy. The Brief Health Literacy Screening (BHLS) and the Newest Vital Sign (NVS) were used to evaluate subjective and objective HL. Adherence levels were self-reported as poor, good, or excellent, and the assessment included the Patient Health Engagement Scale (PHE-S). Notably, the majority of the sample comprised male individuals (67.9%), with 69.2% reporting a 10-years or longer duration between their HIV diagnosis and their initiation of ART. It was found that PLWH with poor adherence had low schooling, had been living with HIV for 1-5years, were HCV co-infected, had a viremia >50copies/mL, poor health status, poor engagement in care, and poor HL (p = <0.001). They exhibited lower mean scores on the subjective HL scale and lower CD4 T-cell counts and nadir CD4 T-cell counts (p < .001). Our study demonstrated a positive correlation between higher HL levels and improved disease management, treatment adherence, and overall physical and mental well-being. Enhanced HL capabilities are paramount in bolstering health management and treatment adherence.

Health literacy and individuals’ perception regarding Heart Failure management: patient perspective

Abstract Background Heart failure (HF) is a multidimensional disease that has a significant impact on the quality of life of people with this condition and the person’s level of health literacy is a key element in disease management. Therefore, this analysis aims to assess the correlation between the level of health literacy of people with HF and their level of concern about managing the disease, their perception about quality of life, and access to healthcare. Methods Cross-sectional study conducted through a survey among adults with HF, residents, and healthcare consumers in Portugal. The survey comprised 6 questions on health literacy (HLS-EU-Q6); 9 dimensions of concerns in HF management (4-level scale ranging from “not concerned” to “very concerned”); quality of life and access to healthcare perceptions (5-level scale ranging from “very bad” to “very good”). Concerns global score was calculated based on 9 dimensions of concerns about HF management. The statistical analysis included Spearman’s and Pearson’s correlations. Results A total of 428 responses were analysed. Respondents had a mean age of 70 years, 52.1% were men and 67.9% have secondary education. 47.0% of respondents perceived their access to healthcare as “good”, 63.3 % perceived their quality of life as “reasonable” and 61% have low levels of health literacy. Individuals with a higher health literacy level tended to have lower levels of concerns regarding HF management (r=-0.133; p = 0.006); individuals with a higher level of health literacy tended to have a better perception of their access to healthcare (ρ = 0.145; p = 0.003) and quality of life (ρ = 0.220; p &amp;lt; 0.001). Conclusions The findings reinforce that overcoming health literacy obstacles must continue to be a focus of healthcare systems and institutions to enhance healthcare access, quality of life, and chronic disease management. These efforts may result in better health outcomes, promote health equity and general well-being in this population. Key messages • Individuals with Heart Failure with higher levels of health literacy report less concerns about the management of their condition. • Individuals with Heart Failure and lower levels of health literacy have a worst perception of their access to healthcare and quality of life. Health literacy promotion must continue to be a priority.

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 &amp;lt; 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.

WeCare – Mental healthcare for health professionals

Abstract Issue/Problem Health professionals face physical and mental stressors (risk factors) due to challenging working conditions. Description of the Problem Despite high levels of health literacy among healthcare workers, maintaining healthy habits is challenging due to variable shifts, including nights, high workloads, and intense emotional and mental demands. Adopting a healthier lifestyle requires personal changes that can be difficult to implement, particularly in nursing and caregiving. This is critical, as retaining and attracting new staff in these fields is essential for the healthcare sector. Results/Effects/Changes To address these challenges, it’s crucial to boost intrinsic motivation and provide healthcare workers with practical tools to support their well-being and encourage them to remain in the sector. The WeCare project offers a mobile app designed as a ‘pocket coach,’ accessible at any time. Healthcare professionals can use the app to assess their current mental well-being through self-evaluation. With built-in assessments and predefined thresholds, the app tracks stress levels and quality of life. Depending on the outcomes, users are automatically guided to appropriate information, gamified activities, and exercises tailored to their specific needs. The project, running from 2022 to 2024, is co-funded by the European Union’s Erasmus+ programme. Lessons The app is beta-tested during 2024 in five countries: Germany, Austria, Serbia, Poland, and Italy, with local language support. The test group will consist of healthcare professionals and related professions. The results, including user engagement and motivational factors are analyzed. As the project concludes in autumn, comprehensive recommendations and lessons learned will be compiled and presented at the European Public Health (EPH) Conference. This will also include sharing the app and its solution with the broader healthcare community. Key messages • The WeCare app supports healthcare workers’ mental health with a mobile “pocket coach” that provides personalized exercises. Through gamification, it promotes healthy habits and boosts job motivation. • It is critical to support healthcare workers, as retaining and attracting new persons is essential for the healthcare sector.

The role of health literacy in adherence to the Mediterranean diet

Abstract Background Health literacy has emerged as a crucial concept in public health. It is considered a modifiable determinant influencing health-related decision. One such decision is the adoption of specific dietary patterns. The Mediterranean diet has garnered recognition as one of the healthiest diets. This study aims to explore the association between health literacy levels among adults in socially vulnerable contexts and their adherence to the Mediterranean diet. Methods This study is part of a cluster-randomized trial conducted in primary schools from socially vulnerable contexts. A total of 469 parents of school-aged children agreed to participate. Health literacy was assessed using the Health Literacy Survey Questionnaire. Adherence to the Mediterranean diet was evaluated using the MEDAS questionnaire. Anthropometric and sociodemographic variables were self-reported via questionnaire. Parental BMI was calculated using weight/height^2. Education level was categorized into two groups (less than higher education and higher education), while professional status was classified based on the occupational categories of collar color. Generalized linear models were utilized for the analysis. Results Individuals with higher levels of health literacy present a greater odd to adhere to the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035), even after adjusting for potential confounders (B = 0.019, 95% CI 0.006-0.032). Conclusions Health literacy emerges as a crucial factor influencing individuals’ dietary choices, as evidenced by its association with higher adherence to the Mediterranean diet. These findings underscore the importance of implementing policies and initiatives aimed at promoting health literacy, particularly among individuals from socially vulnerable contexts. Enhancing public health interventions to bolster health literacy should be prioritized to foster better dietary decision-making. Key messages • Health literacy plays an important role in the adoption of Mediterranean diet among adults from socially vulnerable contexts. • Implementing policies to aim the promotion of health literacy, particularly among individuals from socially vulnerable contexts are necessary.

The influence of health literacy on health outcomes and behaviors in fourth-graders in Germany

Abstract Background For the adult population, evidence suggests that a high level of subjective health literacy is associated with a number of favorable health outcomes and behaviors. However, for younger populations, particularly children, little evidence is available. This study investigates the relationship between subjective health literacy, health outcomes, and health behaviors in children. Methods We conducted a representative survey of 4th-grade students (age 8-11) in North Rhine-Westphalia, Germany, between Oct. 2022 and Feb. 2023. Subjective health literacy was measured with the HLS-Child-Q15 questionnaire. For mental and physical well-being, the KINDL-R was used. For health behaviors, we asked about the frequency of (1) brushing teeth, (2) eating fruit and (3) vegetables, (4) exercising, (5) consuming sweetened drinks, and (6) wearing a helmet when riding the bike. Regression analysis was used to determine the impact of health literacy on outcomes, controlling for a number of sociodemographic indicators (birthplace, home language, sex, age), as well as the tendency to give socially desirable responses. Health behaviors were rated on a Likert scale and where dichotomized for ordinal regression. Results n = 1085 students are included with a mean age of 9.5 years (SD=.6). 50.3% are female. While controlling for a number of variables, health literacy was a significant predictor (p&amp;lt;.05) for every indicator except the frequency of (1) brushing teeth, (4) exercising, and (5) consumption of sweetened drinks. For mental well-being, health literacy was the strongest predictor. Conclusions Our findings highlight the potentially enabling role of subjective health literacy regarding favorable health outcomes and health behaviors. However, because this is a study among younger children, further research is needed on the interplay of individual subjective health literacy, social contexts (e.g., parental health literacy and health behaviors), and children’s health outcomes and behaviors.

The influence of beliefs and health literacy on medication-related outcomes in older adults: A cross-sectional study

BackgroundOlder adults often manage multiple chronic diseases which necessitates the use of multiple medicines. Nevertheless, they also face an elevated risk of harm when medicines are used inappropriately. Studies indicate that socioeconomic disadvantage, beliefs, and health literacy may correlate with non-adherence and inappropriate medicine use. However, older adults are underrepresented in the current body of literature. ObjectiveTo investigate the influence of beliefs and health literacy on medication-related outcomes in older adults. MethodsParticipants ≥65 years living in the community were invited to complete a survey. Participants were asked to report demographics, medicines and complete three questionnaires: Self-Efficacy for Appropriate Medication use Scale (SEAMS), Beliefs about Medicines Questionnaire (BMQ) and Health Literacy Questionnaire (HLQ). Descriptive statistics, regressions and correlations were calculated. ResultsA total of 154 participants were included in the analysis (35.7 % male, age range 65–110 y). Mean SEAMS score was 33.2 out of 39 (standard deviation (SD) = 8.0), reflecting high self-efficacy for adherence. Mean HLQ scores were high across the four scales measured in the survey (scales 1, 5, 6, and 9). Sixty-two participants (44.0 %) were using five or more medicines (polypharmacy) and 18 (15.4 %) reported use of a potentially inappropriate medicine. Regarding beliefs, mean BMQ-specific scores were as follows: necessity score 17.5 (SD = 5.1) and concern score 12.0 (SD = 4.0), indicating strong beliefs in the necessity of medicines and few concerns. Results of the regression analysis indicated that where the BMQ-Necessity scores were employed as the independent variable, there was statistical significance with polypharmacy (p < 0.001). Additionally, moderate positive correlations were identified between (1) necessity beliefs and both polypharmacy (r = 0.401, p < 0.001) and adherence (r = 0.477, p < 0.001), and (2) adherence and HLQ scale 5 (r = 0.343, p < 0.001), scale 6 (r = 0.326, p < 0.001) and scale 9 (r = 0.320, p < 0.001). ConclusionOlder adults who perceive their medicines as necessary are more inclined to report use of multiple medicines, leading to polypharmacy. Additionally, older adults with stronger beliefs in the necessity of medicines and higher levels of health literacy demonstrate greater self-efficacy for adherence. Health professionals should consider evaluating necessity beliefs in older adults to manage potential non-adherence, reduce the risk of polypharmacy, and thereby mitigate the risk of suboptimal medicine use.

Association Between Cancer Screening Patterns and Carer Literacy in Individuals With Cognitive Decline: An Observational Study.

The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors in this population. We conducted a postal follow-up survey, associated with the National Center for Geriatrics and Gerontology-Life STORIES of People with Dementia, that targeted primary carers to assess their reports regarding patient attendance at regular cancer screenings recommended by the Japanese Ministry of Health, Labor and Welfare, over the preceding 2 years. Screening rates were compared between the memory clinic cohort and the national average, and the influence of carer health literacy level on screening was analyzed. Among the 826 total individuals analyzed, the memory clinic cohort exhibited lower breast cancer screening rates, at 11% among female patients aged 65-74 years versus the national average of 32%. Higher health literacy among carers was significantly associated with increased screening. For female patients, carers with high levels of communicative health literacy were more likely to ensure that patients attended screenings for gastric (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.03-3.04), colorectal (AOR, 1.70, 95% CI 1.08-2.70), and breast cancers (AOR, 3.08; 95% CI, 1.40-6.76). Among the male patients, high communicative health literacy was associated with increased lung cancer screening attendance (AOR, 1.82; 95% CI, 1.11-2.99). Our research highlights a notable gap in cancer screening attendance between individuals with cognitive impairment and the general population, potentially arising from the intricate nature of screening procedures and the extensive burden on carers. More informed decisions and increased screening rates can be achieved through patient-centric communication strategies that accommodate the cognitive abilities of patients, ensuring the comprehensibility and accessibility of health-related information.

Health Literacy and Health-Related Quality of Life in Older Adults with Mild Cognitive Impairment

ObjectivesHealth literacy is considered crucial in health status outcomes, but little is known about the association among cognitively impaired persons. This study investigated the association between health literacy and health-related quality of life (HRQoL) in older adults with mild cognitive impairment (MCI). We further examined whether the association between health literacy and HRQoL depends on age, sex, and educational attainment. DesignA cross-sectional study was conducted between January and December 2022. Setting and ParticipantsThe study population was 233 older adults with MCI who visited the Veterans Health Service Medical Center in Seoul, Republic of Korea. MethodsThe diagnosis of MCI was confirmed by a physician based on clinical and neuropsychological assessments. The European Health Literacy Survey Questionnaire and EuroQol Five Dimensions Questionnaire were used to measure the health literacy and HRQoL of the participants. ResultsHRQoL was significantly correlated with health literacy (R = 0.25, P ≤ .001) and its 3 subdomains (R = 0.27, P ≤ .001 for healthcare; R = 0.19, P = .004 for disease prevention; and R = 0.18, P = .005 for health promotion). After adjustment for potential covariates, older adults with higher levels of health literacy were significantly associated with better HRQoL: β = 0.02 (P = .0021) for health literacy, β = 0.07 (P = .0001) for healthcare, and β = 0.04 (P = .0443) for disease prevention. The interactions between HRQoL and health literacy with the specific variables of age, sex, and education demonstrated a statistical significance (β = 0.02 with age, β = 0.03 with sex, and β = 0.06 with education). Conclusions and ImplicationsThere was a significant association between health literacy and HRQoL among older adults with MCI. This finding suggests that improving health literacy of older adults with MCI may enhance HRQoL. An education intervention is recommended to reduce the existing health disparities due to low health literacy.

Relationship between Attitude Toward Aging, Health Literacy, and Utilization of Healthcare Services among Older Adults in Suburban Areas in Iligan City

Background and Aim Health literacy and attitudes towards aging have become increasingly important problems, especially as they relate to health care. This study focused on exploring the relationship between attitudes toward aging, health literacy, and utilization of healthcare services among older adults.  Methods Using quantitative, descriptive-correlational design, data were collected from 150 older adults through structured questionnaires.  Results Older adults agreed that the services are being provided adequately. The study found a positive correlation between having adequate knowledge to manage health and the accessibility of healthcare services, and it also indicated that providing adequate information to the public can increase their knowledge about health services and facilities provided. Providing adequate information to the public can increase their knowledge about the health services and facilities provided.  Conclusion These results highlight the need for intervention that increases the utilization of healthcare services among older adults. The overall attitude towards aging is positive. High levels of health literacy are essential to enhance their ability to access and improve utilization of healthcare services. A positive attitude toward aging correlates to the accessibility of healthcare highlighting the importance of considering attitudes in the healthcare concept. There was a significant relationship between attitude toward aging, health literacy, and utilization of healthcare services among older adults.

Abstract P185: Patient Portal Access, Health Literacy, Patient Trust in Health System, and Shared Decision Making Among US Adults with Hypertension: A National Cross-Sectional Study

Background: Shared decision-making (SDM) is increasingly recognized as central to delivering patient-centered care and improving hypertension control. However, there is limited understanding of the association between patients' access to patient portals, health literacy, trust in the health system, and involvement in SDM. Objectives: This study investigated the associations between patients' access to patient portals, health literacy, trust in the health system, and patients’ involvement in SDM among adults with hypertension in the United States (US). Methods: This cross-sectional study utilized data from the 2022 Health Information National Trends Survey (HINTS 6) conducted among US adults. The exposure variables were patient portal use, health literacy, patients' trust in health systems, and whether the participant was offered access to patient portals by healthcare providers. The outcome of interest was whether patients were always involved in SDM (Yes/No) during the past 12 months. Analyses were weighted according to HINTS 6 methodology. We performed three weighted sequential multivariable logistic regression models (Fig. 1, Models 1-3). The fully adjusted model included demographics, clinical characteristics, and social determinants of health and resources for implementing SDM and was stratified by age (&lt;65 and ≥65 years). Results: We included 1703 adults with hypertension (mean age of 61.6, SD 13.9 years; 52.5% male; and 64.9% White adults). About 86.4% of participants were offered online access to patient portals by their healthcare providers. In the fully adjusted model (Fig. 1, Model 3), adults who were offered access to patient portals (adjusted odds ratio [aOR] 1.90, 95% CI 1.03-3.49), with higher health literacy levels (aOR 2.18, 95% CI 1.42-3.34), and with higher trust in health systems (aOR 3.08, 95% CI 2.26-4.21) were more likely to engage in SDM than their counterparts. These associations were similar among adults &lt;65 years (Fig. 2). However, among adults ≥65 years, offering online access to patient portals was not associated with involvement in SDM; while those who used the patient portal 6-9 times during the past 12 months were more likely to engage in SDM than those who never used it (aOR 2.26, 95% CI 1.06-4.83). Conclusion: Offering access to patient portals may enhance SDM among US adults with hypertension, especially for adults with higher health literacy levels and greater trust in health systems. These associations differed by age.

Acceptance level of advance care planning and its associated factors among the public: A nationwide survey

BackgroundAdvance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model.MethodsA total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP.ResultsOn a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00–83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP.ConclusionsThis study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges.

The Effect of Health Literacy on Health Status in Patients with Heart Failure: A Path Analysis.

Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention. This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data. The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2±19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status. Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers.

Physical Education Teachers' Health Literacy: First Evidence from Lithuania.

Promotion of health literacy is an important goal in the context of promoting whole school health. Physical education teachers are of particular importance in achieving this goal. However, very limited empirical studies have addressed the health literacy of physical education teachers. This research aimed to test the structural validity and reliability of the HLS19-Q12, to measure health literacy among physical education teachers, and to evaluate associations of health literacy with health- and lifestyle-related indicators. We conducted a cross-sectional study of Lithuanian physical education teachers. The participants completed a self-administered online survey that collected information on socio-demographics and health literacy (HLS19-Q12 for general health literacy and the optional package HLS19-DIGI to measure digital health literacy) as well as health behavior. A total of 332 participants completed the survey. The HLS19-Q12 demonstrated acceptable internal consistency (Cronbach's α of 0.73 and McDonald's ω of 0.75) and satisfactory structural validity (CFI = 0.924, TLI = 0.917, RMSEA = 0.081). Participants had an average score of 85.09 (SD = 17.23) when using the HLS19-Q12, with 19.3% and 48.8% displaying excellent and sufficient levels of health literacy, respectively. Regression analyses revealed that a higher level of health literacy was significantly associated with better health evaluation (β = 0.15, p < 0.01), but no significant association was found with other health behavior and lifestyle indicators. Overall, the results suggest that teachers' general health literacy is relatively high. Our findings highlight the importance of conducting more in-depth studies to pursue the understanding of the whole school teachers' health literacy.

Subjective health literacy skills among Greek secondary school students: results from a national-wide survey

Abstract Health literacy is a significant element of education and is inextricably linked to children’s and adolescents’ growth and prosperity. It is critical to monitor students’ health literacy on a nationwide scale and identify the factors that influence it in order to create policies that advance it. The purpose of this study was to determine the health literacy level of Greek secondary school students and to correlate it with possible determinants such as personal and family characteristics, social support and personal and/or family illness experiences. A representative sample of 2749 seventh-, ninth-, and tenth-grade students was involved. Results showed that a higher motivation to learn about health topics and having positive social interactions and support were strongly associated with a higher level of health literacy. Gender, high academic achievement, absence of learning disabilities, gender, preference for biology and informatics and primary source of health information were also found to influence the skills’ level. In order to enhance health literacy, the Greek educational system should take measures to include health literacy skills development goals in their curricula.

Association of symptom severity, anxiety, and health literacy with portal usage among patients with cancer.

1567 Background: Patient portals within electronic health records (EHR) have become increasingly essential in promoting patient-centered oncology care. They offer opportunities for completing symptom surveys that can aid in symptom management, facilitate patient-clinician communication, and enable health monitoring. As part of the Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT) study, we examined the relationship between symptom severity, anxiety, health literacy, and shared decision-making with usage of three common features in the patient portal (portal). Methods: This study included adults diagnosed with cancer in the NU IMPACT study. Participants completed baseline surveys on socio-demographics, health literacy (Single Item Literacy Screener), anxiety (Patient-Reported Outcomes Measurement Information System; PROMIS), with high anxiety scored as ≥60 vs &lt;60, shared decision-making (CollaboRATE), and symptom severity (Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events; PRO-CTCAE). Portal activities one year following enrollment were extracted from EHRs. Portal usage patterns of patient-initiated messages, portal lab and clinical note views were counted as number of days the activity was used over the year and categorized as tertiles. Multivariable ordinal logistic regression models were used to examine associations between survey measures and ordered tertiles of patient portal activities. Results: Participants (N=3,464) were mostly female (66%), White (85%), with a mean (SD) age of 61(13) years old. The frequency ranges of patient-initiated messages over a year were 0-163 days, labs viewed were 0-350 days, and clinical notes viewed were 0-103 days. Participants with at least one severe or very severe symptom on the PRO-CTCAE were more likely to be in higher tertiles of patient-initiated portal messages (OR: 1.37, 95% CI: 1.17-1.61), lab views (OR: 1.48, 95% CI: 1.26-1.74), and clinical note views (OR: 1.19, 95% CI: 1.01-1.40). Participants with higher levels of anxiety were more likely to be in higher tertiles of patient-initiated portal messages (OR: 1.54, 95% CI: 1.28-1.85), lab views (OR: 1.22, 95% CI: 1.01-1.46), and clinical note views (1.42, 95% CI: 1.18-1.71). Participants with higher health literacy were more likely to be in higher tertiles of patient-initiated portal messages (OR: 1.38, 95% CI: 1.09-1.74) and lab views (OR: 1.34, 95% CI: 1.06-1.69), but not note views (OR: 1.03, 95% CI: 0.82-1.30). Shared decision making was not associated with portal usage. Conclusions: Patients with greater symptom severity and anxiety may turn to the portal for symptom management. Certain features within the portal may demand a higher level of health literacy for engagement. Understanding the factors that promote and impede portal usage can help optimize cancer care delivery.

Digital health literacy, vaccine information sources, and vaccine acceptance among parents in Ontario: Quantitative findings from a mixed methods study.

Parents make important vaccination decisions for their children and many variables affect parents' decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents' digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across the continuum of vaccine hesitant to vaccine accepting is reported. An online survey of parents of young children living in Ontario, Canada was conducted in 2022. Multiple linear regression determined predictors of vaccine acceptance. 219 participants completed the survey and on average reported adequate digital health literacy skill. Healthcare providers were reported as the most commonly used source of vaccine information. Two models were retained that predicted vaccine acceptance, both models predicted about 50% of the variability in vaccine acceptance. Model A identified that trust predicted parent vaccine acceptance and model B identified that digital health literacy, and the vaccine information sources healthcare providers, family and friends, and alternate healthcare providers predicted vaccine acceptance. Family and friends and alternate healthcare providers negatively predicted vaccine acceptance. Most parents in our study had high levels of digital health literacy. Opportunities exist for further research and policy change focused on trust at a systemic public health level. While clinical level implications included the importance of healthcare providers as a vaccine information source and adequate digital health literacy to facilitate parental vaccine decision making. Continued efforts to develop awareness on the importance of digital health literacy among the public and healthcare providers is needed, including further research on the digital health literacy levels of Canadians.

Antecedents and Consequences of Health Literacy among Refugees and Migrants during the First Two Years of COVID-19: A Scoping Review.

Supporting refugee and migrant health has become a critical focus of healthcare policy. Developing and designing health literacy interventions that meet the needs of refugees and migrants is core to achieving this objective. This literature review sought to identify antecedents and consequences of health literacy among refugees and migrants during the first two years of the COVID-19 pandemic. We systematically searched nine electronic databases and numerous grey literature sources to identify studies published between December 2019 and March 2022. The antecedents (societal and environmental determinants, situational determinants, and personal determinants) and consequences of health literacy among refugees and migrants were mapped to a validated integrated health literacy model. Social and environmental determinants (n = 35) were the most reported antecedent influencing health literacy among refugees and migrants during the first two years of COVID-19. Language (n = 26) and culture (n = 16) were these determinants' most frequently reported aspects. Situational determinants (n = 24) and personal determinants (n = 26) were less frequently identified factors influencing health literacy among refugees and migrants. Literacy (n = 11) and socioeconomic status (n = 8) were the most frequently reported aspects of personal determinants. Media use (n = 9) and family and peer influence (n = 7) were the most cited situational determinants reported. Refugees and migrants with higher levels of health literacy were more likely to use healthcare services, resulting in better health outcomes. The findings of this review reveal personal and situational factors that impacted health literacy among refugees and migrants during COVID-19 that require attention. However, the inadequate adaptation of health literacy interventions for linguistic and cultural diversity was a greater problem. Attention to this well-known aspect of public health preparedness and tailoring health literacy interventions to the needs of refugees and migrants during pandemics and other public health emergencies are paramount.

The Role of Parental Health Literacy in Establishing Health-Promoting Habits in Early Childhood.

In early childhood, children are extremely susceptible to the acquisition of habits and the establishment of health-promoting habits. Therefore, the patterns, routines, and rules transmitted and expected by the adults surrounding the child are of paramount importance and can correlate with the level of their health literacy. Our cross-sectional, quantitative, exploratory study aimed to examine the relationships between parental health literacy and preschool children's health-related habits, using simple, non-random sampling (n = 598). In addition to the sociodemographic characteristics, the measuring tool we compiled included the standardized European Health Literacy Survey Questionnaire (HLS-EU-Q16), as well as a set of questions containing 30 statements suitable for exploring children's habit systems. The health literacy of the parents involved in our study proved to be more favorable than that of the general population. Regarding children's habit systems, we found significant differences in several areas by age group (p < 0.05) and gender (p < 0.05). The levels of parental health literacy (0.003 ≤ p ≤ 0.048) and parents' education (p < 0.05) show a correlation with the children's health-related habit systems: the indicators of children with parents who have a higher level of health literacy and a higher level of education are more favorable in terms of established habits. In the long term, the formation of health-promoting habits may facilitate the internalization of favorable health behavior motives for the future, contributing to the establishment of positive physical, mental, and social health in adulthood.

Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12–18 in China: a cross-sectional study

The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12–18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12–18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12–18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.