This qualitative study aimed to explore the self-management dilemmas faced by patients with diabetes in Chinese primary care and collect suggestions for improvement. Qualitative methods are used in this study. Thematic analysis was used to analyse the transcripts. Four primary care communities in Beijing. The interviews were conducted between April and August 2025. This qualitative study used face-to-face, semi-structured interviews with 32 patients with type 2 diabetes. Data collection continued until information saturation was reached. Four core themes and multiple subthemes were identified. The first theme, 'Inadequate Disease Cognition and Health Literacy', showed that patients had a limited understanding of diabetes, often delaying diagnosis and only learning about complications after they appeared. Misconceptions about diet and a lack of medication management knowledge were also common. The second theme, 'Suboptimal Daily Management', highlighted that physical activity was unstructured, glucose monitoring was irregular and emergency response capabilities were poor. The third theme, 'Fragmented Healthcare Resources and Inadequate Family Support', revealed systemic barriers such as limited primary care competencies, homogeneous health education formats that failed to meet patients' needs and insufficient family support. The fourth theme, 'Limitations in Self-Management Decision-Making', demonstrated that patients' decision-making processes were predominantly experience-driven, relying on personal or communal anecdotes rather than scientific medical evidence. The self-management challenges among Chinese patients with diabetes in primary care are a complex interplay of inadequate individual cognition, suboptimal daily practices and fragmented support systems. The study suggests that future interventions should focus on enhancing general practitioner training, developing culturally sensitive health education and rebuilding family and community support networks to sustainably resolve these management dilemmas.

Inadequate health literacy (HL) is a critical factor contributing to fall risk among older adults. However, evidence on how HL relates to home environment and fall prevention behaviors in Asian community settings remains limited. This study aimed to assess HL levels and examine their associations with sociodemographic characteristics, home environment, and fall prevention behaviors. A community-based cross-sectional study was conducted among 177 community-dwelling older adults aged 60 to 79 years. Data were collected through structured questionnaires assessing sociodemographic characteristics, home environment, fall prevention behaviors, and HL using the European Health Literacy Survey Questionnaire (HLS-EU-Q47), which cover three subdomains: healthcare, disease prevention, and health promotion. Multiple linear regression analysis was performed to examine the associations between sociodemographic factors, home environment, fall prevention behaviors, and HL. The HL score among older adults was 34.50 ± 7.50 (54.2% limited HL). A total HL score was positively associated with regular exercise (β = 2.73, 95% CI: 0.71, 4.74) and a sitting toilet (β = 6.38; 95% CI: 3.83, 8.92) and marginally associated with wearing properly fitting shoes (β = 2.54; 95% CI: 0.22, 4.86). Therefore, the health promotion aimed at improving HL in this population may benefit from concurrently promoting regular exercise, home safety modifications, and safe footwear practices.

Background: Functional health literacy enables individuals to navigate health information and resources to make health decisions to choose and to use appropriate health services. It promotes self-health care management and to cope with crisis like Coronavirus disease 2019 (COVID-19). However, teachers’ functional health literacy about COVID-19 study was scant. This study aimed to measure teachers’ functional health literacy and its association with their socio-demographic characteristics. Methods: This study was cross-sectional survey conducted among since June 29 to August 28, 2023. Sample size was 732. Multi-stage cluster sampling was used. Tool was developed by modified Delphi technique. Firstly, items about access to and apply health information for preventive measures of COVID-19 were developed from guidelines about COVID-19 remaining under functional health literacy framework. Then school teachers, health, language experts, and supervision were consulted for improvement. Tool consisted of socio-demography, access to and use of health information about COVID-19 prevention. Tool was piloted and correlation coefficient was calculated. Tool was self-administered at leisure period after taking informed consent from school head teachers and teachers for data collection. Data were entered and analyzed in SPSS version 27. Both descriptive and inferential statistics like Chi-square test was used to analyze data at 5% level of significance. Study proposal was approved by school of medical science, Kathmandu University Results: Results showed that 59.2% of participants had adequate functional health literacy about COVID-19. Gender, ethnicity, and involvement in social health insurance were significantly associated with functional health literacy about COVID-19. Conclusion: This study revealed that teachers have inadequate functional health literacy about COVID-19. This study results suggest interventions from authority of school education and health sector focusing gender, ethnicity and economy to promote teachers’ functional health literacy and to make school and community resilient for future pandemic.

This study aimed to examine the health literacy (HL) levels of ministry employees, assess their risk of developing type 2 diabetes (T2D), and evaluate the relationship between HL and the risk of developing T2D. Conducted using a cross-sectional design, the study included data from 351 participants working at the Republic of Türkiye Ministry of Environment, Urbanization, and Climate Change between October 2020 and March 2021. Data were collected using the Turkish Health Literacy Scale (TSOY-32) and the Finnish Diabetes Risk Score (FINDRISC). The mean HL score of participants was 31.92±7.85, with 59% of employees classified as having problematic or inadequate HL. Regarding T2D risk, 9.4% of participants were categorized as “high risk” and 1.1% as “very high risk” for developing T2D within the next 10 years. Descriptive findings indicated that as HL levels decreased, the risk of T2D increased. However, multiple linear regression analysis showed that HL was not independently associated with T2D risk when variables such as age and perceived general health were controlled. These findings suggest that although HL is not a direct determinant of T2D risk, it remains an important factor to consider in diabetes prevention programs due to its association with preventive health behaviors. The high prevalence of low HL among employees highlights the need for systematic assessment and enhancement of HL in workplace diabetes prevention initiatives. Longitudinal studies are necessary to understand better the potential causal relationships between HL and the risk of T2D.

Abstract Aim This study examined data from a representative sample of Tuscan residents aged 18-69 years in order to investigate the relationship between health literacy (HL), other sociodemographic factors, and their influence on binge and consistent heavy drinking among the general population in Tuscany. Subject and methods The study examined data gathered from 2017 to 2022 from a subset of the Tuscan population within the Italian Behavioral Risk Factor Surveillance System known as PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia). Results Among the 12,953 respondents, 8.49% reported engaging in binge drinking, and 3.53% were classified as consistent heavy drinkers. Multivariate logistic regression analysis revealed that participants over 34 years of age, Italians, those with low educational attainment, and those with problematic or inadequate HL levels had higher odds of consistent heavy alcohol consumption. In contrast, females, individuals over 34 years of age, and those of foreign nationality were less likely to engage in binge drinking. While low health literacy was independently associated with consistent heavy drinking, it was not associated with binge drinking. Conclusion This study reveals distinct factors influencing alcohol consumption. Given that HL affects only consistent heavy drinking, it is advisable for policymakers to focus on HL initiatives tailored to this specific group. On the other hand, campaigns designed to enhance HL with the goal of curbing binge drinking are unlikely to significantly influence the population.

Background: This study aims to determine parents' cyberchondria and health literacy levels and examine how these levels affect parents' behaviors regarding their own and their children's health. Method: This descriptive cross-sectional study was conducted between January 1, 2023, and June 30, 2023. Survey forms were used, and the surveys were filled out face to face. Results: 619 parents participated in the study. The parents' Cyberchondria Severity Scale (CSS) score was 71.51±22.46 (medium-high), and the Turkish Health Literacy Scale (THLS-32) score was 21.37±6.60 (insufficient); 92.2% of the parents stated that they diagnosed themselves and 91.1% of their children via the Internet, 14.2% of parents and 12% of their children stopped taking their medication due to information they read on the Internet. Conclusion: Parental internet use for health purposes is very high. Inadequate health literacy and high levels of cyberchondria increase the risk of making wrong health decisions. Health professionals should prioritize efforts to increase parents' health literacy and reduce the severity of cyberchondria.

Background: Non-communicable diseases (NCDs), including hypertension, diabetes mellitus, and chronic obstructive pulmonary disease (COPD), remain significant public health challenges in Indonesia. Despite advances in clinical management, patients lived experiences, particularly regarding disease-related knowledge and self-care practices, have received limited scholarly attention. Methods: A qualitative phenomenological approach was employed using focus group discussions and in-depth interviews with 19 participants, including 12 patients with hypertension, diabetes mellitus, and COPD; five primary health workers from community health center; and two district health office staff. The research was conducted between February and June 2024. Data were analyzed using descriptive phenomenological methods. Results: Three interrelated themes emerged. First, participants described delayed symptom recognition accompanied by limited initial understanding of their disease. Second, deeply entrenched lifestyle-related risk factors, including smoking, high salt and sugar intake, and physical inactivity. Third, inconsistent self-management practices following diagnosis. Although some participants attempted to adhere to medical advice and adopt healthier behaviors, these efforts were frequently constrained by inadequate health literacy, low motivation, and barriers to healthcare access. Persistent misconceptions regarding disease etiology were evident, reflected in culturally embedded terms such as “sweet urine” for diabetes and “lung pain” for COPD. Family support and religious beliefs were found to exert a dual influence, functioning as both facilitators and barriers to treatment adherence. Conclusion: Improving chronic disease outcomes in Indonesia requires the integration of culturally responsive health education, patient-centered communication, continuous follow-up, and health literacy interventions that are aligned with the sociocultural context of affected communities.

BackgroundUncontrolled type 2 diabetes results in major complications that threaten patients’ life. Patients with uncontrolled type 2 diabetes often have inadequate health literacy, making them less motivated to perform self-management behaviors for glycemic control. Earlier health literacy interventions were effective in promoting self-management behaviors and reducing blood glucose, but evidence is lacking for those with uncontrolled type 2 diabetes.ObjectiveThis study aimed to investigate the effect of a health literacy program on self-management behaviors of patients with uncontrolled type 2 diabetes.MethodsThis two-group quasi-experimental study with pre-posttest design was done between September 2024 and June 2025. The participants were 64 patients with uncontrolled type 2 diabetes who lived in a community in a province in central Thailand selected using simple random sampling. The experimental group (n = 32) underwent the health literacy program with eight weekly sessions along with usual care while the control group (n = 32) was given usual care only. Data were collected using a Demographic Data Questionnaire, the Functional, Communicative and Critical Health Literacy Scale, the Self-Management Behavior Scale, and hemoglobin A1C (HbA1C) testing. Data analysis was performed with descriptive statistics, paired t-test and independent t-test.ResultsNo significant between-group differences were noted in baseline data. At post-test, the experimental group had a significantly higher mean score of overall health literacy (t = 3.720, Cohen’s d = 2.67), functional health literacy (t = 0.399, Cohen’s d = 2.43), communicative health literacy (t = 7.90, Cohen’s d = 1.76), and critical health literacy (t = 12.972, Cohen’s d = 3.14), and self-management behavior (t = 21.862, Cohen’s d = 2.84), and a significantly lower level of HbA1C (t = 3.436, Cohen’s d = -0.82) than before receiving the program and than the control group (all p <0.01).ConclusionThis study offers evidence for the program's efficacy in raising health literacy, which in turn improves self-management behavior and decreases HbA1C in patients with uncontrolled type 2 diabetes. Nurses can incorporate program activities in empowering patients for diabetes control by promoting their ability to seek and comprehend health information, communicate effectively during medical visits, and develop critical thinking abilities on diverse health determinants.Trial Registry NumberThai Clinical Trials Registry (TCTR20250624001)

Vaccine hesitancy refers to the reluctance or refusal to get vaccinated. This can be influenced by various factors, including concerns about vaccine safety, distrust of healthcare systems, misinformation circulating on social media, cultural beliefs, and inadequate health literacy. The aim of this study is to determine whether there is any relationship between vaccine hesitancy and health literacy of prospective science teachers. The sample of the study consists of 165 students studying at the faculty of education of a state university. It was observed that there was a low-level negative relationship between health literacy and vaccine hesitancy. The study shows that higher health literacy reduces vaccine hesitancy. Since teachers have responsibilities in improving the health literacy levels of society, the health literacy levels of teacher candidates need to be increased.

The availability of health information through media has raised public awareness of health literacy (HL). HL is essential for medication adherence and self-management in individuals with chronic diseases, and for those without chronic conditions, HL is important for promoting health and engaging in preventive behaviors. This study examined the role of having a regular physician in improving HL among Korean adults, both with and without chronic diseases. We conducted a retrospective, cross-sectional analysis using data from 8,322 participants in the 2021 Korea Health Panel Study. HL was measured with the 16-item European Health Literacy Survey Questionnaire. To identify factors associated with HL categories and to calculate adjusted mean HL scores, we used multiple logistic regression and weighted linear regression. Among participants with chronic diseases (n=4,627), 56.6% reported having a regular physician, with the largest group (42.7%) showing inadequate HL. After adjustment, age 75 years or older and lower education were significantly linked to lower HL levels, regardless of chronic disease status. Having a regular physician was significantly associated with higher HL levels in participants with chronic diseases (adjusted odds ratio, 1.94; 95% confidence interval, 1.42-2.63), but not in those without chronic diseases. Participants with chronic diseases who had a regular physician showed higher mean HL scores across all HL competencies and domains. Although access to health information has increased, the risk of encountering conflicting or misleading content has grown. These findings emphasize the importance of regular physicians in guiding patients and improving HL, especially among individuals with chronic diseases.

Health literacy (HL) is essential for individuals to effectively navigate health information and make informed decisions. Village Health Volunteers (VHVs) in rural Thailand are crucial in delivering health education and services, yet little is known about their HL levels, particularly following the COVID-19 pandemic. Understanding the HL of VHVs is crucial for enhancing health communication and the effectiveness of public health initiatives. This study aims to evaluate the HL levels of VHVs and explore the association between demographic factors and HL levels following the COVID-19 outbreaks. A web-based, cross-sectional, descriptive-analytic study was conducted with 840 adults (aged 18-85 years) in Nakhon Nayok, Thailand, using random cluster sampling. HL levels were assessed using a validated HL questionnaire. A multiple logistic regression model was employed to identify demographic factors associated with HL levels. The findings revealed that 0.4% of VHVs had inadequate HL, 4.8% had marginal HL, 65.5% demonstrated adequate HL, and 29.4% exhibited excellent HL. Multivariate logistic regression analysis identified several factors significantly associated with adequate HL. A positive attitude (AOR = 3.44; 95% CI: 1.37-3.57; p = 0.012), high levels of motivation (AOR = 4.56; 95% CI: 1.70-6.73; p < 0.001), and more than 10 years of experience as a VHVs (AOR = 3.63; 95% CI: 1.29-10.19; p = 0.014) were positively associated with adequate HL. In contrast, a monthly household income exceeding 9,000 THB was negatively related to adequate HL (AOR = 0.38; 95% CI: 0.15-0.93; p = 0.034). The current results indicate that the majority of VHVs demonstrated adequate HL followed by excellent HL. Positive attitudes, high motivation, and over 10 years of experience were key factors linked to better HL. To enhance HL levels, educational interventions should target VHVs with neutral attitudes, low motivation, and less than 10 years of experience.

Head and neck cancer (HNC) is rising globally and linked to poor clinical outcomes. Health Literacy (HL) could potentially have a role throughout the HNC pathway. Following PRISMA, this review assessed HL impact in HNC. Five databases and gray literature were searched for observational studies. Descriptive analysis and proportional meta-analyses were performed. Of the 70 studies, 11 met the inclusion criteria (2153 HNC patients), mostly from the USA (n = 7). The Brief Health Literacy Screen was the most used tool (n = 6). The post-treatment phase and quality of life (QoL) were the main outcomes studied. Inadequate HL (11.9%-47%) was more common among men, laryngeal cancer, and advanced HNC, reducing post-treatment adherence and delaying postoperative radiotherapy. Adequate HL was associated with higher education, better QoL, better health-promoting lifestyle, and shorter time to diagnosis. HL influences diagnostic timelines, overall QoL, and post-treatment phase. However, its role in prevention, screening, and survival remains understudied.

General-purpose large language models (LLMs) like ChatGPT are increasingly used for medical advice despite lacking medical training and frequently producing incorrect or unsafe output. Older adults’ health information-seeking behaviors using LLMs remain poorly characterized. We conducted a cross-sectional survey of 574 US adults aged 50+ recruited via Prolific, balanced by sex and race. Participants reported health information sources, ChatGPT and PubMed use, demographics, and health literacy. Most participants (92%) searched online for health information. All had heard of ChatGPT, and 63% used it for medical information, compared to 44% who had heard of PubMed and 39% who used it. Those with inadequate health literacy had higher odds of ChatGPT use for medical advice (AOR 2.36, 95% CI 1.30–4.52) versus those with adequate health literacy. In conclusion, with more than half of older adults using LLMs for medical advice, the development of safer, purpose-trained medical LLMs is warranted.

Despite Austria's highly ranked healthcare system, health literacy (HL) is lower than in other European countries, with Vienna falling below the national average in life expectancy and healthy life years. Following the 2016 WHO Strategy for Women's Health and Well-being, Austria introduced aWomen's Health Action Plan in 2017, which highlighted amajor lack of information about women's reproductive health. To date, data on reproductive health knowledge (RHK) and behavior (RHKB), and their relationship with HL remain scarce. The study aimed to examine these relationships among women in Vienna. An online cross-sectional survey was conducted in 2023 among women of reproductive age (18-49years) in Vienna. Collected data included information about sociodemographic characteristics, HL (HLS19-Q12-AT), RHK and RHKB (0-100% scale). Associations between RHK/RHKB and HL, alongside sociodemographic characteristics were examined using linear regression analyses. Among 386 participating women 41% had limited HL. Mean scores were 71% (SD = 21) for HL, 74% (SD = 16) for RHK, and 78% (SD = 14) for RHKB. The highest rate of incorrect responses concerned egg cell lifespan (61%), human papillomavirus (HPV) consequences (49%) and fertility age (40%). In univariate analyses RHK and RHKB were positively associated with older age and partnership and negatively associated with inadequate HL and certain religious affiliations. The RHKB was further associated with university education and parenthood. Multivariate analyses confirmed age and religion as significant factors. Our study identified RHK gaps among women in Vienna, showed associations between RHKB and HL and highlighted the importance of information sources. Findings underline the need for targeted interventions to improve reproductive HL.

Background: Health literacy is increasingly recognized as an essential determinant of health, readiness, and safety in the military, especially as health systems become more digitalized. However, evidence on general and digital health literacy in the armed forces remains limited. This study examined levels of general health literacy and digital health literacy among Lithuanian soldiers and explored their associations with sociodemographic, service-related, and health characteristics. Methods: A cross-sectional survey was conducted among 603 military personnel serving in the national armed forces. General and digital health literacy were measured with HLS19-Q12 and HLS19-DIGI. Data on sociodemographic and military characteristics, self-rated health, and self-reported long-term illnesses were collected. Descriptive statistics, correlation analyses, and multivariable regression models were used to analyze the data. Results: The sample was predominantly male (81.9%) with a mean age of 39.08 years (SD = 8.89). The mean general health literacy score was 80.1 (SD = 19.17), whereas the mean digital health literacy score was 67.81 (SD = 30.05). Overall, 45.0% of soldiers had excellent general health literacy, and 12.0% had inadequate general health literacy; 42.1% had excellent digital health literacy, and 35% had inadequate digital health literacy. Higher levels of health literacy were positively associated with better self-rated health and social status. No statistically significant associations were found between health literacy and gender, age, education, length of service, type of military service, and self-reported long-term health complaints. Conclusions: Military personnel in this study displayed relatively high general health literacy, yet digital health literacy was lower and more unevenly distributed, indicating a potential vulnerability for health outcomes as access to information, communication, and care increasingly relies on digital platforms. Given the cross-sectional design, causal inferences cannot be drawn. Military health services may build on existing health literacy strengths while considering strategies to address digital health literacy gaps (e.g., targeted training, tailored support, and user-friendly digital solutions, including service design), acknowledging that feasibility and implementation depend on organizational context and resources.

Examining the Relationship Between Surgical Fear and Health Literacy in Patients Undergoing Open-heart Surgery: A Multicenter Cross-sectional Study.

Predictors of health literacy among Deaf American Sign Language users.

Objective: The principal purpose of this study was to assess the health literacy level among people experiencing chronic musculoskeletal pain. A secondary aim was to analyze possible links between health literacy, kinesiophobia, and engagement in physical activity. Materials and Methods: In this cross-sectional study, participants aged 18 to 75 years with a history of musculoskeletal pain exceeding three months were consecutively selected from the Physical Medicine and Rehabilitation outpatient clinic. Health literacy was evaluated using the Turkish Health Literacy Scale-32 (THLS-32), physical activity level was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK). Results: A total of 113 individuals participated in the study, comprising 78 women (69%) and 35 men (31%). The mean age of the cohort was 58.07 ± 12.22 years, while the average THLS-32 score was 22.22 ± 10.23. Of all participants, 63.7% had inadequate, 15.9% limited/problematic, 15% adequate, and 5.3% excellent health literacy. Health literacy significantly decreased with increasing age ( 0.05). Conclusion: Inadequate health literacy is prevalent among individuals with chronic musculoskeletal pain and is often associated with advanced age and lower educational attainment. Strategies designed to enhance health literacy may contribute to reducing kinesiophobia and promoting better adherence to treatment.

Health literacy is a dynamic and multidimensional concept. Examining health literacy among higher education students and teachers is crucial for promoting informed health decisions and encouraging healthier behaviors. Our study aimed to measure health literacy among higher education students and teachers, assess the impact of sociodemographic variables, and compare health literacy levels between these groups. This study is a Portuguese Academic Health Literacy Network (RALS) project. Data were collected via a questionnaire, including the HLS-EU-Q16 and sociodemographic and health information-seeking behavior items. The statistical analyses involved descriptive statistics and binary logistic regression. The executive boards of the participating universities and polytechnic institutes were initially informed about the objectives of the study and the prior approval obtained from an ethics committee. We then requested that the institutions use their official email databases to distribute invitations to students and teachers to complete the online questionnaire. The sample consisted of 5,798 students and 1,823 teachers. The majority were women, with students predominantly aged 20-30years and teachers mostly over 40years. Compared with students, teachers presented higher health literacy levels (p < 0.001). Specifically, 45.0% of the students and 31.5% of the teachers had inadequate or problematic health literacy. Graduate students and PhD-holding teachers had superior literacy scores (p < 0.001). Economic sufficiency (highest OR: students 2.708; teachers 3.310) and self-health perception positively influenced health literacy (highest OR: students 1.974; teachers 2.284), whereas nonhealthy fields decreased the likelihood of positive health literacy (lowest OR: students 0.583; teachers 0.456). For students, age and educational level were significant factors for positive literacy levels, whereas for teachers, professional background in health was key. Sex and chronic disease presence were not significant for either group. The study highlights a meaningful portion of students with inadequate health literacy (45%). Socioeconomic factors, including education and economic resources, significantly influence health literacy. Additionally, involvement in health-related fields and better self-assessed health correlate with higher health literacy. These findings underscore the need for targeted interventions and training to enhance health literacy across the academic community.

After decades of relative stability, syphilis rates among reproductive-age women in the United States have sharply increased, with maternal cases tripling between 2016 and 2022. This surge has also contributed to a concerning rise in congenital syphilis. Gaps in healthcare access and stigma surrounding sexually transmitted infections have compounded the problem. Focused public health initiatives are needed to strengthen prevention, screening, and treatment efforts. We conducted a national survey to assess health literacy and syphilis knowledge among 643 women aged 18 to 49. Participants completed validated measures, including the Brief Health Literacy Screener and a syphilis knowledge assessment. Recruitment was conducted online to achieve geographic diversity across 48 states, with intentional oversampling of Michigan participants to support future region-specific analyses. Overall, 120 (18.7%) screened positive for inadequate health literacy and 523 (81.3%) did not. Among those who screened positive, 72.5% (87/120) were syphilis-knowledgeable versus 89.1% (466/523) among those who did not screen positive. In logistic regression, syphilis knowledge was associated with nearly three times the odds of not screening positive for inadequate health literacy (AOR = 2.99, 95% CI: 1.71-5.22; p < .001). Education was not associated with health literacy (p = .802). Age and race were significant predictors of health literacy, but neither age nor race predicted syphilis knowledge in adjusted models. This study highlights the connection between health literacy and syphilis knowledge. It emphasizes the need for integrated health education that targets knowledge and literacy, especially among younger and marginalized groups. Incorporating health literacy and syphilis education into sexual health strategies could improve prevention and reduce disparities in syphilis rates among women of reproductive age and racially marginalized populations.