Incorporating Health Literacy Research Articles

An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial.

Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting. A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415. RR2-10.2196/20534.

Conceptual Framework for Health Literacy Instruction in Malaysian International School Libraries

The study is anticipated to assist school libraries in creating and managing an effective programme to promote health literacy throughout the community. School libraries can better promote health literacy and healthy living by participating in these programmes. The research will adopt a mixed-methods strategy, combining qualitative and quantitative techniques. Expanding school library services to incorporate health literacy promotes their vitality and well-being. Furthermore, by integrating significant works of literature, a framework may be developed to guide the research and act as a reference for a library for developing health-related activities or programmes.

Health Literacy Implementation Principles

Background As part of the course requirement for a postgraduate acute care pediatric nurse practitioner program, a patient/family education project was presented using health literacy principles to support the materials developed. The project represents previously implemented materials for a newly developed pediatric colorectal program; this is a retrospective synthesis. Purpose Understanding and including the population served when designing, implementing, and evaluating health information and services are imperative in emerging health literacy foci. Previously health literacy focused on patients and their skills or deficits that were then linked to health outcomes. Later, the focus shifted to the clinician's rigor and skill in communication. New developments in health literacy shift the focus from skills, public, and staff to an emphasis on the interplay of the environment, which either limits or facilitates health literacy. Methods Pediatric colorectal care gap analysis from 2018 to 2021 for the state where the program was created provides a needs assessment of the population of interest. A descriptive narrative of the process for designing, implementing, and evaluating health literate services is presented. Information on current literature and materials to integrate health literacy principles is explored. Conclusion This article contributes to a need for more available literature on developing health literacy in pediatric colorectal program development and care. The findings challenge clinicians to incorporate health literacy best practice attributes in healthcare environments and monitor and use quality improvement methods that address health disparities.

The role of health literacy in simulation education: needs assessment and call to action

Understanding health literacy is crucial to improve health and reduce disparities. Simulation is an effective active learning strategy to teach health literacy. Our aim was to perform a needs assessment of health literacy education using simulation, to guide faculty development for simulation educators. Utilizing Kern’s curricular development process, problem identification, general and targeted needs assessments were performed. PubMed, CINAHL and PsycINFO searches were conducted using terms for health literacy and ‘prioritized health literacy competencies’ (PHLCs). Abstracts and full texts were screened. Simulation events that could feasibly incorporate health literacy were included. Data were collected regarding learners, type of event and incorporation of PHLCs. A targeted needs assessment used electronic survey to identify knowledge, attitudes and beliefs of local simulation educators regarding health literacy. Health literacy components of local simulation events (2018–2019) were assessed using a tool developed by the investigative team. Literature search identified 614 published articles, and 67 were included in analysis. ‘Avoidance of jargon’ (14/67) and ‘patient-centred approaches’ (11/67) were the most commonly cited PHLCs. No articles mentioned ‘delivery of information in 1–3 need-to-know elements’. Of the 57/881 local simulation events that could feasibly incorporate health literacy, 17/57 did so. ‘Jargon’ and ‘patient-centred’ care were the PHLCs most often present in learning objectives. Survey response rate was 77%. Only 18% (3/17) of local simulation educators demonstrated ‘comprehensive understanding’ of health literacy. Educators reported understanding ‘using universal precautions in written and oral communication’ (mean Likert 3.3) and ‘need-to-know/need-to-do concepts’ (3.4) least well. The majority felt including health literacy was important in simulation and believed they did this. There is a critical need to formalize and standardize language used when creating and studying simulations involving health literacy. An interprofessional faculty education program may assist faculty understanding of PHLCs when designing focused simulations for future healthcare providers.

A Practical Approach to Health Literacy: A Primer for Athletic Training Educators

Context The Commission on Accreditation of Athletic Training Education has an educational standard to address the need for competence in health literacy. Objective The purpose of this paper is to introduce foundational health literacy knowledge and evidence-based tools to apply in athletic training and present examples of assignments to instruct and assess health literacy from a model professional athletic training program. Background Health literacy is “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”1 Most patients will experience moments of poor health literacy; therefore, clinicians should use health literacy universal precautions to improve patient decisions and outcomes. These health decisions range from practicing health promotion behaviors, understanding when and how to use health services, and participating in shared decision-making about treatments or procedures. These same health decisions apply to athletic training patient populations. Athletic trainers (ATs) should demonstrate effective health literacy skills; therefore, professional athletic training programs must instruct athletic training students on essential concepts and tools. Description Examples of how one professional athletic training program instructs and assesses health literacy across the curriculum are discussed; including didactic lessons, rubric criteria development, a comprehensive health literacy project, and learning objectives for simulation-based experiences. Clinical Advantage Education drives clinical practice. Incorporating health literacy through didactic presentation and assessment of application may develop health literacy competence and prepare athletic training students to provide optimal care when transitioning to practice. Conclusion Health literacy universal precautions are recommended for all health care professionals to provide quality care. Introducing and assessing these concepts during education will prepare future ATs for successful integration of health literacy into clinical practice. Furthermore, these concepts and tools should be shared with preceptors to reinforce during student clinical experiences.

Health Literacy and Radiation Therapy: a Current State Assessment of Patient Education Materials.

In order to mitigate low levels of health literacy among patients, there is need to evaluate patient education (PE) materials and to ensure that the information is readily accessible to patients. The quality and comprehensiveness of radiation therapy materials were evaluated at fourteen cancer centres. To assess quality, PE leaders independently conducted readability, actionability and understandability assessments of materials. To evaluate comprehensiveness, an assessment was conducted of the scope of symptoms covered in extant materials, and the modality they were produced in (e.g. pamphlet, video). A total of 555 PE materials were reviewed for comprehensiveness and modality and seventy underwent evaluation against health literacy best practice standards. Most materials (n = 64, 91%) had a reading grade level above the recommended grade 6 ([Formula: see text] = 9, range = 4-12). Under half (n = 34, 49%) scored at or above the 80% threshold for understandability ([Formula: see text] = 74%, 33-100%) and just over half (n = 36, 51%) scored at or above the 80% target for actionability ([Formula: see text] = 71%, 33-100%). Only two cancer centres (n = 2/14, 14%) had PE materials covering the breadth of symptoms related to radiation therapy and the vast majority of materials were pamphlets (89%). Findings indicate that most radiation therapy PE materials used in cancer centres do not meet health literacy best practices, and there is a disparity between cancer centres in the topics that are available to patients and family. This evaluation highlights the need to better incorporate health literacy best practices into the development of radiation therapy PE materials and strategies to improve accessibility of such health information.

Degrees of separation: health literacy education in speech language pathology programs

Objectives: To explore how Speech Language Pathology (SLP) leaders implement HLE within higher education SLP programs. Introduction: Adequate health literacy skills are a vital aspect of an individual’s quality of life and well-being. Low health literacy is related to low life expectancy and higher prevalence of disease and illness. Historically however, healthcare providers, such as SLPs have overlooked the health literacy skills of their clients. Currently, there is minimal data exists on whether SLP leaders are incorporating health literacy education (HLE) into their programs and student training. Methods: An electronic survey was emailed to SLP leaders (i.e., administrators and/or faculty), who were members of SLP higher education programs accredited through the American Speech-Language Hearing Associations’ (ASHA) Council on Academic Accreditation, questioning their implementation of HLE health and health literacy strategy (HLS) use. Results: More than half (56%) of participants implemented HLE within their SLP programs. Only 4% always teach students why health literacy is important and 75% never instruct students to encourage clients to ask questions. Although HLE and HLS occurred in SLP programs, use of each varied greatly. Conclusion: SLP leaders are implementing HLE; however, there is a lack of consistency in the HLS being taught. National SLP curriculum standards should be mandated to increase HLE instruction and consistency of HLS use. Future researchusing qualitative data is needed to gain a better understanding of how SLP leaders integrate HLE into their programs and why they value doing so. This could include how SLP leaders define and describe health literacy, how it is being taught and assessed, and why they believe HLE is important for their clients.

Patient satisfaction with a consumer codesigned lower limb cellulitis leaflet.

Objective This study evaluated whether a consumer codesigned leaflet about the common skin infection cellulitis would improve patient satisfaction. Methods A patient information leaflet was codesigned with consumers incorporating health literacy principles and attached to a new adult lower limb cellulitis management plan launched in three regional Victorian health services. Health service staff were educated to provide the leaflet during hospital care. Patients discharged with a diagnosis of cellulitis in an 8-month period were followed-up via telephone between 31 and 60 days after their discharge. Each patient was asked to provide feedback on the utility of the leaflet (if received) and their overall satisfaction with the information provided to them using a five-point scale (with scores of 4 or 5 considered to indicate satisfaction). Results In all, 81 of 127 (64%) patients (or carers) were contactable, consented to the study and answered the questions. Of these, 27% (n = 22) reported receiving, accepting and reading the leaflet. The proportion of patients who were satisfied with the information provided to them about cellulitis was 100% for those who received the leaflet, compared with 78% for those who did not receive the leaflet (95% confidence interval 4.8-34%; P = 0.02). Conclusion The provision of a consumer codesigned leaflet increased patient satisfaction with the information received about cellulitis. Real-world strategies to embed the delivery of such resources are required to ensure that more patients receive the benefit. What is known about the topic? There are known deficiencies in the information provided to patients about the common skin condition cellulitis. There is little published evaluation of strategies to address these knowledge deficiencies. What does this paper add? This study evaluated a simple strategy to address patient knowledge deficiencies on cellulitis. It highlights that pertinent information delivered in an accessible way can significantly increase patient satisfaction with the information provided to them. What are the implications for practitioners? These findings are a timely reminder for practitioners that even a simple intervention, such a providing a hard copy information leaflet, can improve patient satisfaction. A national repository of similar consumer codesigned materials would be valuable and could minimise existing duplication of effort in resource development across health sectors. Real-world strategies to embed the delivery of such resources is required to ensure that more patients receive the benefit.

Dissonances in communication with sexual health consumers in an inner-Sydney sexual health clinic in relation to health literacy: A mixed-methods study.

This study examined the navigation of health care interactions by health consumers attending Sydney Sexual Health Centre (SSHC), an inner-city sexual health clinic in Sydney, Australia. We aimed to assess the accessibility and appropriateness of communications between SSHC and patients in the context of health literacy. We conducted 20 semi-structured interviews with health consumers, assessed health literacy using the Short Health Literacy Assessment for English-Speaking Adults (SAHL-E) and conducted a focus group with clinical staff. We identified dissonances around assumed knowledge in communications between health professionals and health consumers, which were most apparent when lack of knowledge about sexual health, HIV and pre-exposure prophylaxis (PrEP) intersected with poor English fluency. SO WHAT?: This study suggests that existing models of access for HIV treatment and PrEP in Australia have been developed for high health literacy and may not support consumers who experience communication barriers due to low health literacy. The Australian Commission on Safety and Quality in Health Care recommends addressing health literacy systemically, including embedding assessment of health literacy into organisational systems and policies. We recommend developing tools to assess knowledge levels of consumers accessing sexual health services and incorporating health literacy into clinician training on working with patients from non-English-speaking backgrounds.

The Cancer Clear & Simple Story: Developing a Cancer Prevention Curriculum for Rural Wisconsin Through a Community Partnership.

To address rural cancer disparities, the University of Wisconsin Carbone Cancer Center launched a rural cancer project through its Cancer Health Disparities Initiative (CHDI) in 2010. With support from the National Cancer Institute's (NCI) National Outreach Network, CHDI conducted an assessment of rural counties and partnered with Adams County to implement a collaborative cancer education project. Together CHDI and Adams County partners selected an evidence-based educational curriculum, Understanding Cancer, as a basis for local adaptation for use with rural Wisconsin communities. The new curriculum, titled Cancer Clear & Simple (CC&S), consists of three modules: (1) cancer basics, (2) cancer prevention, and (3) cancer screening. CC&S has also been culturally tailored for African American and Latino populations. The adaptation utilized community involvement throughout a multi-step process to ensure cultural appropriateness. The process included materials selection, translation, conceptual adaptation, visual adaptation, and validation with target audiences. All adaptations of the curriculum incorporate health literacy principles and is designed to build knowledge and improve health-related decision-making around lung, colorectal, skin, breast, cervical, and prostate cancer. Current efforts seek to (1) increase the evidence of CC&S's effectiveness through additional research, (2) expand its use by new audiences, and (3) adapt it into a web-based platform featuring a cancer prevention serious game.

Using health literacy techniques to support pharmacist practice when counselling on antibiotics courses

Introduction Increased education may improve awareness of antimicrobial resistance (AMR)1 however 43% of people aged 16-65 in England lack skills to understand health information2. This study aimed to improve patient knowledge on short course antibiotics using a patient information leaflet (PIL) incorporating Health Literacy (HL) techniques supporting the governments’ 5 year 2019 AMR strategy. Method This study received ethics approval. A revised Royal Pharmaceutical Society (RPS) checklist for Community Pharmacy PIL incorporating HL techniques was piloted then used for 5-weeks as a counselling tool by 8 consenting community pharmacists. It was handed to patients during the dispensing of short-course antibiotics after which the pharmacists filled out a questionnaire. Results 106 patients were counselled and all 8 pharmacists completed questionnaires on how the PIL supported their practice. On a scale of 1 (not at all) to 5 (improved a lot), pharmacists scored how much they thought the PIL could improve patient’s knowledge on appropriate antibiotic use. 63% of pharmacists (5/8) scored the PIL ‘5’ or ‘4’. 63% of pharmacists (5/8) did not feel that the PIL took longer than their standard counselling. 66% (2/3) felt that the extra time was worthwhile. Conclusion Pharmacists believed written information using HL techniques led to improved AMR education at the point of antibiotic dispensing.

Using health literacy techniques to develop patient information for counselling on antibiotics courses

Introduction Increased education may improve awareness of antimicrobial resistance (AMR), however 43% of people aged 16-65 in England lack skills to understand health information1.This study aimed to improve patient knowledge on short course antibiotics using a patient information leaflet (PIL) incorporating Health Literacy (HL) techniques supporting the Governments’ 5 year 2019 AMR strategy. Method This study received ethics approval. A revised Royal Pharmaceutical Society (RPS) checklist for Community Pharmacy PIL incorporating HL techniques was piloted, then used for 5-weeks as a counselling tool by 8 consenting community pharmacists. It was handed to patients during dispensing of short-course antibiotics, after which the pharmacists filled out a questionnaire. Patients receiving counselling using the PIL completed face to face questionnaires. Results 106 patient questionnaires were completed. 94% of patients had taken antibiotics previously and 90% of these thought the counselling received using the PIL was easier to understand than previous counselling. 96% of patients agreed the PIL improved their knowledge on appropriate antibiotic use. 81% of patients intended to change their behaviour and thought the PIL had improved their antibiotic knowledge especially to “always finish a prescribed course of antibiotics”. All patients stated the PIL was easy to follow. Conclusion This pilot suggests that patient behaviour can be influenced using structured counselling on AMR drawing on HL techniques. References 1 Rowlands G, Protheroe J, et al. A mismatch between population health literacy and the complexity of health information: an observational study. British Journal of General Practice. 2015;65(635):e379-e386.

Health Literate Communication: Teach-Back Training for First-Year Medical Students

BACKGROUND: Effective physician communication skill requires implementation of basic standards of practice, such as empathy, listening, and close attention to non-verbal indicators. Medical students must learn and understand that enhanced communication skills ensure better patient understanding of diagnosis and prognosis, and compliance to treatment plans.  Health literate communication techniques like Teach-Back must be part of primary skills training for medical students in the early stage of medical education.  The purpose of this study was to measure medical students’ beliefs/knowledge about health literate communication and to evaluate use of Teach-Back skills during patient history taking and examination in the simulation center with standardized patients. METHODS: First-year medical students’ health literacy beliefs/knowledge of health literate communication were measured using pre- and post- Beliefs and Knowledge surveys.  A one-hour health literacy skills training intervention lecture was delivered after pre-testing.  Students were assessed for use of Teach-Back during the standardized patient encounter. RESULTS: 36 students participated in the study.  Median Belief scores increased from 9.25 pre-intervention to 10.00 post-intervention; mean Knowledge scores increased from 8.08 pre-intervention to 10.42 post-intervention with moderate to large effect sizes (beliefs r= .342, knowledge d=1.08).  There was a significant post-intervention increase in both belief and knowledge scores, p>.001 with high power (.954).  Eleven (11) students used Teach-Back successfully in the simulation center. CONCLUSIONS: Medical students’ beliefs, knowledge, and communication skills may benefit from a one-hour health literacy communication skills training.  Primary care skills courses should incorporate health literacy training as a key competence along with existing curricular foci in order to improve health literate patient communication. 

Education and Promotion of MRD Testing within the Multidisciplinary Cancer Care Team for Adults with Acute Lymphoblastic Leukemia in the Community Setting

Background: The Association of Community Cancer Centers (ACCC) is an education and advocacy organization with a diverse membership, representing all cancer program types with the largest majority (75%) being community-based cancer programs and private practices. Beyond the academic setting, ACCC seeks to expand education on the advancements in all cancer care and since measurable residual disease (MRD) is the most important prognostic factor that guides the therapy for patients with acute lymphoblastic leukemia (ALL), this project aimed to emphasize the importance of MRD testing for adult patients with ALL in the community oncology setting. Objective: The ACCC led a national initiative, in partnership with the Leukemia & Lymphoma Society (LLS), to improve the diagnosis, treatment and management of adult patients diagnosed with ALL in community oncology practices. This educational program focused on understanding the benefits of knowing patients' MRD testing and interpretation and the need to integrate this testing into standard of care practice in community oncology practice settings. Methods: This one-year programmatic initiative was designed by a group of multidisciplinary oncology faculty and structured around a peer-to-peer learning format that enabled ALL expert faculty to share effective practices for the treatment, care coordination and management of adult patients with ALL. An environmental scan was conducted to understand the landscape for utilization of MRD data in the community setting. Challenges and barriers identified in six key areas ((Initial Diagnostic Workup, Shared Decision Making, MRD Testing, Patient Access, Cost, and Reimbursement, Side-effect Management and Transitions in Care) were addressed by the development of healthcare professional-focused educational tools. Results: The educational material developed as part of the program include an environmental scan, blog series and webinar series that was viewed over 300 times by engaged ACCC members representing more than 75 cancer programs across 27 states. The four-part blog series covered a pathologist's perspective on the importance of MRD testing, a pharmacist's views on incorporating health literacy for patients, and social work and nursing perspectives on challenges with helping adult patients manage an ALL diagnosis. The three-part webinar series included an informative ASH 2018 update that included key abstracts and findings, a webinar that included a patient and care providers which shed light on the support needed along a patient's journey, and a webinar that explored critical insights for treating adult ALL from the perspective of a pharmacist, pathologist and oncologist. These enduring resources are available on-demand for the multidisciplinary care team. Conclusions: This program demonstrated the success of adopting a peer-to-peer educational learning platform to educate the multidisciplinary team providing care for adult patients diagnosed with ALL. Given rapid technological advances and emerging indications, the comprehensive educational materials developed were useful for the education of both the treating team and the patients in the community oncology setting. Disclosures Emadi: Jazz Pharmaceuticals: Research Funding; NewLink Genetics: Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; KinaRx: Membership on an entity's Board of Directors or advisory committees, Other: Co-Founder and Scientific Advisor, Patents & Royalties; Genentech: Consultancy, Honoraria. Jabbour:Takeda: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Adaptive: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Cyclacel LTD: Research Funding. Kendall:Eli Lilly: Speakers Bureau; Novartis: Speakers Bureau; Pfizer: Speakers Bureau. Rogers:Teva: Speakers Bureau; Takeda: Honoraria; Genentech: Speakers Bureau; Seattle Genetics: Speakers Bureau; Abbvie: Speakers Bureau; Cardinal Health: Honoraria; Genentech: Honoraria; Mylan: Honoraria; Coherus: Speakers Bureau.

Incorporating Health Literacy Into English as a Second Language Classes.

Incorporating Health Literacy Into English as a Second Language Classes.

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors.

The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community-dwelling elderly participants. This cross-sectional study enrolled 990 community-dwelling elderly participants in three residential areas, with a mean age of 71.53±7.22years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer-administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β=0.73, p <0.001), attitude (β=0.06, p=0.038) and decision (β=0.14, p<0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β=0.57) than hospice knowledge (β=0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β=0.59) than hospice knowledge (β=0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.

Health literacy: An essential element of health care professionalism and resilience

This report discusses the importance of incorporating health literacy into health care professionalism and resilience. It defines health care management professionalism and its subcomponents. The report addresses the need for an improved definition of health care management professionalism. The inclusion of health literacy is not only important to the improved definition, but also to health care management education competencies. The report builds on the move towards competency-based education as a strategy to address health literacy in the areas of professionalism and ethics for healthcare professionals. This could lead to building healthcare systems with healthcare professionals who encompass high levels of professionalism as well as incorporating tools to combat burnout and increasing resilience.

Examining Health Behaviors, Health Literacy, and Self-efficacy in College Students With Chronic Conditions

ABSTRACTBackground: Every year, young adults with chronic conditions matriculate into college, which is a unique transitional period in that students may be managing a chronic condition on their own for the first time. Therefore, it is important to examine which factors may contribute to positive health behaviors and risky behaviors in college students with chronic conditions. Purpose: The current study examined associations between health literacy, self-efficacy, and health behaviors in a sample of college students with chronic conditions. Methods: Data were collected from 147 undergraduate students at a Mid-Atlantic U.S. university. Students completed an online consent and questionnaires assessing chronic conditions, health literacy, self-efficacy, and health behaviors (general behavior, wellness maintenance, substance use). Results: Asthma was the most prevalent self-reported chronic condition (26.1%). Higher levels of health literacy and self-efficacy were significantly associated with general health behaviors and wellness maintenance and fewer substance use behaviors. Discussion: These findings highlight health literacy and self-efficacy as potential foci for maintaining healthy behaviors in college students with chronic conditions. Translation to Health Education Practice: College health centers are important facilitators of promoting college student health. Incorporating health literacy and self-efficacy into Health Education interventions could be effective in improving student health.

Cooperative Extension and Health Literacy: A National Focus

Health literacy is often defined as the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions. Research shows that 30 million Americans have Below Basic health literacy skills. People with low health literacy skills contribute to higher utilization of health care services. This equates to an excess of $230 billion a year in health care costs linked to low literacy in the United States. The primary responsibility for improving health literacy lies with public health professionals and the health care and public health systems. However, studies find that interventions using principles of health literacy, applied in community-based settings, can result in improved outcomes at the population level. In this article, the Health Literacy Action Team members consider the role of Extension in this important area, and suggest practices in incorporating health literacy into existing Extension programs and educational materials, and future resources for Extension and community partners.

Integrating participatory design and health literacy to improve research and interventions

Health communication is an essential health promotion strategy to convert scientific findings into actionable, empowering information for the public. Health communication interventions have shown positive outcomes, but many efforts have been disappointing. A key weakness is that expert-designed health communication is often overly generic and not adequately aligned with the abilities, preferences and life situations of specific audiences. The emergence of the field of health literacy is providing powerful theoretical guidance and practice strategies. Health literacy, in concert with other determinants of health, has greatly advanced understanding of factors that facilitate or hinder health promotion at individual, organizational and community settings. However, health literacy models are incomplete and interventions have shown only modest success to date. A challenge is to move beyond the current focus on individual comprehension and address deeper factors of motivation, self-efficacy and empowerment, as well as socio-environmental influences, and their impact to improve health outcomes and reduce health disparities. Integrating participatory design theory and methods drawn from social sciences and design sciences can significantly improve health literacy models and interventions. Likewise, researchers and practitioners using participatory design can greatly benefit from incorporating health literacy principles into their efforts. Such interventions at multiple levels are showing positive health outcomes and reduction of health disparities, but this approach is complex and not yet widespread. This chapter focuses on research findings about health literacy and participatory design to improve health promotion, and practical guidance and case examples for researchers, practitioners and policymakers.