Improve Health Literacy Research Articles

The relationship between health literacy and problematic internet use in Chinese college students: The mediating effect of subject well-being and moderating effect of social support

BackgroundThe issue of problematic Internet use (PIU) amongst college students is emerging as a major concern for mental health. Factors such as health literacy, subjective well-being and the extent of social support may be critical in preventing PIU. However, the complex relationship between these factors has not been extensively explored in research. MethodsA national cross-sectional study based on multistage random sampling was conducted in China in 2022. The subjects for this study were 7669 college students who completed a set of questionnaires assessing their health literacy, subjective well-being, PIU and social support. A structural equation model (SEM) was utilised for exploring the mediating effect of subjective well-being, and the PROCESS macro was used to test the moderating effect of social support. ResultsAfter controlling for demographic factors, a significantly negative correlation was found between health literacy and PIU, and subjective well-being partially mediated this relationship. In addition, social support was negatively related to PIU and could moderate the relationship between health literacy and subjective well-being and between subjective well-being and PIU. LimitationsThis is a cross-sectional study, and the results cannot inform the causality between these variables. ConclusionResults revealed that the relationship between health literacy and PIU was partially mediated by subjective well-being in college students. The correlation between health literacy and subjective well-being and between subjective well-being and PIU were moderated by social support. Thus, future interventions for college students' PIU should be facilitated by improving health literacy, subjective well-being and social support.

Childbirth preparation and its facilitating and inhibiting factors from the perspectives of pregnant and postpartum women in Tabriz-Iran: a qualitative study

BackgroundThe World Health Organization recognizes childbirth preparation as an essential component of antenatal care, as it plays a crucial role in reducing maternal mortality and improving women's childbirth experience. Countries worldwide have implemented various interventions to assist women in preparing for childbirth, based on their own resources. This study was conducted with the aim of exploring the perspectives of pregnant and postpartum women on childbirth preparation and the facilitating and inhibiting factors, in Tabriz, Iran.MethodsThis qualitative study was conducted with 25 participants, selected purposively among pregnant women in weeks 37 to 40 of gestation and postpartum women within 10 days to 6 weeks after childbirth. Data collection was done through semi-structured, in-depth individual interviews using an interview guide. The data was analyzed using content analysis method with conventional approach.ResultsThe perspectives of pregnant and postpartum women regarding childbirth preparation revealed that factors such as maternal health during pregnancy, having an antenatal care plan, improving health literacy, and developing a birth plan were identified as crucial elements for effective childbirth preparation. Additionally, mental and emotional preparation, support, financial planning, participation in preparation classes, and awareness of childbirth methods were recognized as facilitators. On the other hand, insufficient mental and emotional preparedness, inadequate support, weak antenatal care, information deficiencies, insufficient physical activity, and a lack of a birth plan were identified as barriers.ConclusionThe findings highlight the multifaceted nature of childbirth preparedness, necessitating the involvement of families, the healthcare system, and the entire community. Utilizing the study results in strategic planning for pre-pregnancy, during pregnancy, and inter-pregnancy care can enhance childbirth preparedness and contribute to achieving Iran's population rejuvenation policy goals.

Identifying Health Literacy Strengths and Needs Among Jordanian Acute Myocardial Infarction Patients.

Acute myocardial infarction is a significant health issue, particularly in Jordan where ischemic heart disease is the leading cause of death. Effective management of acute myocardial infarction is essential to mitigate its consequences. Although health literacy is crucial for the successful management of acute myocardial infarction, research about the strengths and needs of health literacy among acute myocardial infarction patients is still limited. This study was conducted to identify the health literacy strengths and needs of Jordanian acute myocardial infarction patients using cluster analysis. A cross-sectional design was used to conduct this study in a sample of acute myocardial infarction patients in Jordan (N = 114). A demographics questionnaire and the Health Literacy Questionnaire were used to collect the data. Data analysis was performed using hierarchical cluster analysis using Ward's method. Seven distinct clusters of acute myocardial infarction patients were identified, each characterized by unique health literacy profiles and sociodemographic characteristics. Cluster 7 had the highest health literacy scores across all nine Health Literacy Questionnaire scales. Sociodemographic factors such as age, education level, and gender influenced health literacy levels, with female, younger, more educated patients exhibiting higher health literacy. Through identifying the specific strengths and needs, this research provides a foundation for developing targeted health literacy interventions for acute myocardial infarction patients. Improving health literacy among acute myocardial infarction patients can enhance their ability to manage their health and potentially reduce the complications associated with acute myocardial infarction.

Integrating a Strategic Framework to Improve Health Education in Schools in South Tyrol, Italy.

This narrative review addresses the integration of health education into school curricula in South Tyrol, an Italian province with significant cultural and linguistic diversity. This review's objective is to analyze current health education initiatives and propose a strategic framework to enhance school-based health education, aiming to improve student well-being post-pandemic. The review synthesizes global examples and recent local studies, highlighting the importance of comprehensive teacher training, mindfulness-based interventions, culturally sensitive health education, and community engagement. The key findings indicate that current health education programs in South Tyrol are insufficient to meet immediate public health needs, such as low vaccine uptake and mental health challenges exacerbated by the COVID-19 pandemic. The proposed strategic framework seeks to align educational strategies with the diverse needs of South Tyrol's student population, thereby improving health literacy and behavior and strengthening the region's public health infrastructure.

Patient and carer experiences of cancer cachexia and its management.

To explore the contributions of recent qualitative literature in progressing understanding of the experiences of cancer cachexia, and its management, from the perspectives of patients and unpaid/family carers. Challenges with conducting everyday activities, maintaining independence, and continuing usual roles within the family are sources of distress. Patients and carers value individualization, flexibility, and carer involvement in physical activity/exercise interventions. In psychosocial/educational interventions that were positively perceived, the opportunity to talk about cachexia was appreciated, leading to improved health literacy, awareness about nutrition, and relationships with food. However, the general patient and carer experience around clinical acknowledgement and management of cachexia remains poor. Eating-related distress and conflicts, lack of understanding about cachexia, and the visibility of weight loss remain recurring themes amongst literature on experiences of cancer cachexia. Studies exploring preferences for, and experiences of, interventions have primarily focused on physical activity or exercise. Psychosocial/educational and physical activity/exercise interventions are valued and perceived to alleviate some of the key quality of life issues amongst patients with cancer cachexia and their unpaid/family carers.

International medical graduates as untapped resource for community health and wellness

ObjectivesThis study examines the potential of International Medical Graduates (IMG) in contributing to the health and wellness of a community, particularly through transdisciplinary knowledge engagement or mobilization in diverse settings. We aimed to gather IMGs’ perspectives on potential non-physician roles to enhance community health and wellness using a qualitative descriptive approach. MethodsEight focus groups were conducted among IMGs in Canada between June and August 2020 (n = 42), followed by a thematic analysis of the verbatim transcripts. Two independent reviewers carried out inductive coding of the data. Emergent themes and sub-themes were identified. Through an iterative process incorporating insights from community partners, themes were refined to capture the lived experiences of IMGs in this context. ResultsWe sought to engage this population in discussions to capture their perspectives on contributions to health and wellness. Participants suggested various alternative contribution pathways such as knowledge mobilization, research generation, and supportive community roles. They also identified individual and systemic challenges. Finally, strategies for change were proposed on personal, professional, and organizational levels. ConclusionThe IMGs put forward various ideas and insights regarding their potential contributions to community health and wellness. They can be valuable assets in promoting health and improving health literacy. It is important to recognize that IMGs are eager to take on significant roles in the community and that they are currently an underused resource for enhancing community health and wellness.

Literacy on Pregnancy Complications: Causal Factors and Prevention

Purpose: This study investigates the role of maternal health literacy in preventing pregnancy complications and evaluates the effectiveness of various educational interventions designed to enhance health literacy. Research Design and Methodology: Utilizing a quantitative design, this research involved pre-and post-tests to measure changes in knowledge, skills, and attitudes among diverse demographic participants. Participants were divided into control and experimental groups. Educational interventions were implemented, including prenatal classes, online courses, and community workshops. Data were collected through surveys and analyzed using statistical methods. Findings and Discussion: The study revealed a significant correlation between increased health literacy and reduced pregnancy complications such as pre-eclampsia, gestational diabetes, and preterm labor. This positive correlation underscores the potential for improved maternal and child health outcomes. Educational interventions significantly enhanced health literacy, with different models showing varied effectiveness based on accessibility and engagement. These findings align with the Health Belief Model and Self-Determination Theory, reinforcing the positive impact of health literacy on maternal and child health outcomes. Implications: The research underscores the importance of tailored educational interventions in promoting maternal and child health. Policymakers and healthcare providers should prioritize developing comprehensive, accessible, culturally sensitive health education programs. Addressing socio-economic disparities and providing continuous support is crucial to ensuring that all mothers and children have equal access to healthcare and can benefit from improved health literacy. Future research should explore long-term impacts and innovative educational technologies to enhance maternal health outcomes further.

Examining the relationship between health literacy and quality of life in patients with coronary heart disease: a quantitative study at a cardiology clinic

Coronary Heart Disease (CHD) is the leading cause of death worldwide and is rising, annually. Improved health outcomes require early treatment and self-monitoring, which need health literacy. This study examined how health literacy affects CHD patients’ Quality of Life (QoL) at the Hospital’s Cardiology Clinic. This quantitative, descriptive correlation study was cross-sectional. The sample was 164 respondents, sampled consecutively. Patients must be willing to participate, diagnosed with CHD, and attend cardiology outpatient follow-up appointments. Health literacy was measured with the HLS-EU-SQ10 and QoL with the Seattle Angina Questionnaire. This study used chi-square to analyze the relationship between two ordinal scale variables in a contingency table. The average age was 58.07 years, according to research. Of the respondents, 59 (36.0%) had graduated high school. Health literacy was assessed in three QoL domains: physical limitation (P=0.024), angina frequency (P=0.570), and QoL (P=0.338). Service agencies should be able to use pamphlets to improve health literacy and provide rehabilitation to acute coronary syndrome patients to improve QoL.

Harnessing the power of empathy, visual art and patient narratives to improve health literacy: An exploratory study.

Health-related information can often be overwhelming for consumers, frequently infused with complex medical terminology that is difficult to understand and apply. Historically empathic connection, art and narratives have played key roles in communicating with diverse populations however collectively have received little recognition as a modality to improve health literacy. This study aimed to investigate the empathetic connection between art and patient narratives with a view to improve health literacy in the wider community. Nine recently discharged patients and one carer from a regional hospital were paired with 10 tertiary visual arts students for interview. Each narrative was transformed into visual art and exhibited at a community art gallery. The Empathy Quotient (EQ), Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and self-completed questionnaires assessed empathy and functional well-being. Health literacy was evaluated through community response surveys post-exhibition exposure. Student artist participants' EQ Cognitive Empathy (EQ-CE) scores were associated with 'Emotional Reactivity' (EQ-ER) (p = .038). SF-36 scores revealed that role limitations due to physical health and emotional problems had the greatest impact on patient/carer participant's life at the time. The SF-36 General Health domain was associated with the EQ-ER total score (p = .044). Exhibition surveys revealed that 96.9% of observers had learnt something new about illness or injury. SO WHAT?: Although a relatively small study, our findings suggest patient/carer narratives and visual art is a simple yet effective modality for health service organisations to facilitate affective learning and improve health literacy when engaging with consumers.

Commonalities and differences in injured patient experiences of accessing and receiving quality injury care: a qualitative study in three sub-Saharan African countries

ObjectivesTo understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries.DesignA qualitative interview study. The interviews were audiorecorded, transcribed...

National mixed methods evaluation of Adult and Youth Mental Health First Aid

ObjectiveMental Health First Aid (MHFA) is an international, early intervention, public education program that teaches participants to identify, understand, and respond to signs of mental health and substance use challenges. Until now, all evaluations on MHFA courses in the United States have been performed externally, which have limits in generalizability and the ability to address insights in a timely manner. Additionally, few evaluations have assessed the newest versions of MHFA courses. Therefore, this evaluation aimed to understand key outcomes and participant responses to Adult and Youth MHFA courses in a nationwide sample, spanning nearly a year of real-world implementation. MethodsAn internal, mixed methods program evaluation was performed on the second edition of the in-person versions of Adult and Youth MHFA. Pre- and post-course evaluation data from 3,586 Adult and 2,314 Youth MHFA participants trained between October 2022 and July 2023 were used in this evaluation. Key quantitative constructs, such as mental health literacy, intentions to perform MHFA skills, and confidence to use MHFA skills, were analyzed using paired sample t tests. Rapid thematic analysis methods were used to analyze participants' qualitative responses to the course. ResultsSignificant increases in mental health literacy, intentions, and confidence were observed in both Adult and Youth MHFA participants from pre- to post-course. Qualitative analyses revealed key themes in participant responses, including the helpfulness of the activities, materials, and the MHFA action plan. Adjustments to materials, the length or pace of the course, and other specifics were noted as opportunities for improvement. These findings will be used to inform the future practice, implementation, and revisions of MHFA. ConclusionCompletion of Adult or Youth MHFA by adults in the United States led to improvements in mental health literacy and intentions and confidence to assist someone in need. Both programs may benefit from implementation and content-related changes to enhance participant experience.

Heart Foundation’s clinical glossary goes live – a tool to improve health literacy

Heart Foundation’s clinical glossary goes live – a tool to improve health literacy

Evaluation of YouTube Videos on Defibrillation Applications in Cardiopulmonary Resuscitation: A Comprehensive Analysis.

In the realm of healthcare, particularly after the COVID-19 pandemic, there is a rising trend of sharing videos on YouTube. The increased popularity of these videos among Internet users can be attributed to the captivating nature of visual and auditory data compared to written information. This study aims to assess the content, accuracy, reliability, and quality of YouTube videos focusing on defibrillation applications-a critical component of cardiopulmonary resuscitation (CPR). On October 17, 2022, a video search was conducted using the keyword "defibrillation" on the YouTube platform, sorted in order of interest. Various parameters, including views, view rate, duration, comments, total likes and dislikes, target population, JAMA, DISCERN, and GQS scores, were recorded. In addition, content information was evaluated by Emergency Medicine specialists. The average video duration was 263.95 seconds, with an average of 90,574.6 views, 587.4 likes, and 19.1 comments. The mean DISCERN score was 35.9 (poor), modified DISCERN score was 1.7, GQS score was 2.7, and JAMA score was 2. The mean score regarding the scope and detail of information in the videos was calculated as 6.1. Deficiencies in the accuracy and reliability of Internet information were observed, mirroring the findings in our study. Supervision in this regard was often found to be inadequate. We advocate for the evaluation of video appropriateness before sharing on the Internet. We believe that platforms ensuring easy access to accurate information about crucial interventions such as CPR will significantly contribute to improving health literacy.

Qualitative Evaluation of a Health Literacy Program for Older Adults Who Live in a Community Dwelling in Brazil.

To address current gaps in health literacy research and practice in low-resource settings, the 'Alfa-Health Program' was designed to improve health literacy in older adults who live in a community dwelling in a socioeconomically disadvantaged community in North-East Brazil. In this longitudinal qualitative study, participants were interviewed before and after participating in the group-based program that was delivered November 2017 to December 2017 in the Primary Care Health Unit. Semi-structured interviews were guided by a previously validated health literacy instrument, translated and adapted for use in Brazil. Data was analyzed using Framework analysis. Of the 21 participants, the majority were age 60 to 69 years with a median of 4-years of school education. Our analysis identified self-reported improvements in health knowledge, behaviors, and skills that matched program content and indicated that participants were supported to manage their health conditions more autonomously. Other themes reflect the distributed nature of health literacy and the potential for group-based health literacy programs to facilitate feelings of social support and cohesion through co-learning. However, age-related deficits in memory and external and structural factors remained important barriers to program participation. This study provides insight into developing health literacy in low-resource settings with older adults, where health literacy is compounded by social determinants and cognitive and sensory changes that contribute to health disparities. Although the targeted Alfa Health Program addresses calls to ensure that priority is proportionate to need by reaching and engaging population groups who are disproportionately affected by low health literacy, further work is needed to adapt the program for people who are unable to read or write. [HLRP: Health Literacy Research and Practice. 2024;8(3):e140-e150.].

Evaluating health literacy from an organizational perspective: A cross-sectional study of community health centers.

To investigate community health centers' (CHCs) health literacy. A cross-sectional study. A total of 374 CHCs were surveyed and 258 CHCs responded, with an effective questionnaire response rate of 69.0%. Data were collected by using a self-developed health literacy assessment tool to survey CHCs' health literacy throughout Taiwan from January to December 2019. The item of organizational health literacy (OHL) with the highest proportion of CHCs not implementing them was "Design of easy-to-use computer applications and new media" (47.3% not yet achieved), followed by "Involving target audiences in document and service development" (34.9% not yet achieved). CHCs located in northern Taiwan had higher health literacy achievement scores than those in other regions, and those in urban areas had higher health literacy achievement scores than those in general and remote areas. This study identified items with poor implementation of OHL and found regional differences in health literacy among CHCs. The findings can inform the development of targeted interventions to improve health literacy in underperforming CHCs and guide policymakers in allocating resources to regions and areas in need of.

Impact of Digital Media, School Problems, and Lifestyle Factors on Youth Psychosomatic Health: A Cross-Sectional Survey.

Post-pandemic psychosomatic complaints in children and adolescents have been underreported. This study investigated psychosomatic complaints in children and adolescents in Northern Italy in 2023, with the aim of identifying changes in predictors and vulnerable subgroups. Cross-sectional data representative of scholars from a northern Italian province were analyzed using the Health Behavior in School-aged Children (HBSC) checklist. The sum scores, count data, and dichotomized data were examined, and predictor effects were expressed using a linear regression model for the sum scores. Data from 4525 participants (aged 7-19 years, 50.5% girls) were analyzed. Psychosomatic symptoms remained unchanged after the pandemic. Significant gender differences were noted, especially in older age groups, with girls reporting more complaints. Factors such as children's health, digital media use, and school problems significantly influence psychosomatic outcomes. While migration background negatively affected girls' psychosomatic well-being, boys showed improvement through sports. The psychosomatic well-being of children and adolescents did not improve after the pandemic. These findings indicate the need for targeted interventions, improved health literacy, and ongoing monitoring to support the mental well-being of this vulnerable population. Reducing screen time remains a critical strategy for enhancing youth well-being.

A Theory and Evidence-Based Artificial Intelligence-Driven Motivational Digital Assistant to Decrease Vaccine Hesitancy: Intervention Development and Validation.

Vaccine hesitancy is one of the top ten threats to global health. Artificial intelligence-driven chatbots and motivational interviewing skills show promise in addressing vaccine hesitancy. This study aimed to develop and validate an artificial intelligence-driven motivational digital assistant in decreasing COVID-19 vaccine hesitancy among Hong Kong adults. The intervention development and validation were guided by the Medical Research Council's framework with four major steps: logic model development based on theory and qualitative interviews (n = 15), digital assistant development, expert evaluation (n = 5), and a pilot test (n = 12). The Vaccine Hesitancy Matrix model and qualitative findings guided the development of the intervention logic model and content with five web-based modules. An artificial intelligence-driven chatbot tailored to each module was embedded in the website to motivate vaccination intention using motivational interviewing skills. The content validity index from expert evaluation was 0.85. The pilot test showed significant improvements in vaccine-related health literacy (p = 0.021) and vaccine confidence (p = 0.027). This digital assistant is effective in improving COVID-19 vaccine literacy and confidence through valid educational content and motivational conversations. The intervention is ready for testing in a randomized controlled trial and has high potential to be a useful toolkit for addressing ambivalence and facilitating informed decision making regarding vaccination.

COVID-19 prevention education using interactive comic and animated videos on the health literacy of school-aged children: Implications for healthcare policy and management

Background: Amidst the COVID-19 pandemic, the proliferation of fake news and an infodemic has highlighted the necessity to enhance health literacy, particularly among school-aged children in the concrete operational phase of cognitive development. However, current health literacy studies predominantly focus on the adult population and overlook COVID-19 prevention protocols. Objective: This study aimed to evaluate the effectiveness of COVID-19 prevention education utilizing interactive comic and animated videos on the health literacy of school-aged children in Sleman Regency, Yogyakarta, Indonesia. Methods: The study employed a quasi-experimental research design with pretest-posttest nonequivalent control groups conducted from July to November 2021. Non-random sampling was utilized to select elementary schools and students, resulting in seventy-eight respondents. Health literacy was assessed using the modified 22-item Indonesian version of the Health Literacy Scale of COVID-19. Data analysis employed the Wilcoxon test. Results: Significant improvements in children’s health literacy were evident within the intervention group from pretest to posttest (p = 0.046, p <0.05). Conversely, no significant change was observed within the control group post-intervention. Furthermore, comparable pre-intervention health literacy levels were noted across both groups, with a modest increase post-intervention, suggesting the intervention’s potential to enhance health literacy, albeit to a limited extent. Conclusion: The research highlights the significance of focused health education for school children, particularly in preventing COVID-19. Incorporating interactive media such as animated videos and comics in school programs can improve health literacy. Policymakers need to invest in creating and sharing engaging health education materials working with schools, communities, and parents. Moreover, integrating artificial intelligence-driven personalized learning platforms may be possible to enhance information delivery, enabling children to confidently address health issues in the digital era. These findings may also guide post-pandemic health education approaches, ensuring children are informed and ready for future health challenges.

Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study

BackgroundMedical rehabilitation can be helpful for maintaining workers’ health and work ability. Its contribution to longer working lives is of high economic relevance in aging populations. In Germany, individuals must apply for rehabilitative measures themselves. Therefore, the subjective need for rehabilitation (SNR) is a prerequisite for rehabilitation access. A low education level is associated with poor health, lower health literacy and more frequent utilization of health services. In the present study, we investigated whether lower educational levels are also associated with a greater SNR and whether health literacy, past rehabilitation utilization and physical health play a mediating role in this path in older employees.Methods3,130 socially insured older employees (born in 1959 or 1965) who participated in the German prospective lidA (leben in der Arbeit) cohort-study in 2011, 2014 and 2018 were included. A causal mediation analysis with an inverse odds weighting approach was performed with the SNR as the dependent variable; educational level as the independent variable; and health, health literacy and past rehabilitation utilization as the mediating variables. Sociodemographic variables were adjusted for.ResultsThe SNR was significantly greater in subjects with a low education level, poor physical health, inadequate health literacy and those who had utilized rehabilitation in the past. For health literacy, past rehabilitation utilization and physical health, a significant partial mediating effect on the SNR was found for employees with low compared to those with high education levels. However, the combined mediating effect of all the mediators was lower than the sum of their individual effects. Among those with medium or high education levels, none of the variables constituted a significant mediator.ConclusionsThe path between a low education level and a high SNR is mediated by inadequate health literacy, past rehabilitation utilization and poor physical health; these factors do not act independently of each other. Promoting health education may lower the SNR by improving physical health and health literacy. While improving physical health is beneficial for individuals, improved health literacy can be economically advantageous for the health system by reducing inappropriate expectations of rehabilitation benefits and subsequent applications for rehabilitation.

Development of an Audiovisual Tool on Peripheral Arterial Disease and Preliminary Suitability Assessment

Background: Increasing health literacy in people with chronic illness is essential to prevent disease complications and to promote responsible and conscious decision-making. Therefore, an audiovisual tool was developed to promote literacy about peripheral arterial disease (PAD) in a hospital setting, and a preliminary evaluation of the tool’s suitability was carried out. Material and Methods: The tool was developed by a multidisciplinary team. The preliminary assessment of the suitability study of an audiovisual tool was carried out with a sample of 7 patients with PAD admitted to an Angiology and Vascular Surgery Service and with a group of four professionals specialized in the subject (health literacy and PAD). The design, elaboration, and production of the audiovisual tool were based on a literature review, an informal focus group with patients, a communication model, and an empirical model of behavioral change. Through this preliminary suitability assessment study, we identified the suitability characteristics of this audiovisual tool that can be transmitted in waiting rooms and vascular surgery hospitalizations. The Suitable Assessment of Material (SAM) was used by professionals and patients to obtain different appropriateness factors for each of the 11 videos. Results: The audiovisual tool developed and built for patients with PAD proved to be accessible, understandable, and attractive for people with low levels of education. The patients were satisfied with the audiovisual tool and highlighted positive points, also reporting some suggestions for changes. Health professionals evaluated the 11 videos with a high level of adequacy ranging from 82% to 93.05% adequacy. Out of 19 factors (from the SAM), the quality of the illustrations, the presence of tables and lists, and stimulation and incentive to learning were the two dimensions scored as least appropriate/used. Conclusion: The audiovisual tool developed to improve health literacy on PAD presented preliminary suitability characteristics that make it a high-quality material to be used in future studies that evaluate the effectiveness of the tool with this population.