Interactive Health Literacy Research Articles

A process evaluation of a LifeLab Dublin; an interactive health literacy intervention

Abstract The argument for targeting adolescent health has been made strongly, with poor lifestyle behaviours often emerging during this life stage. Furthermore, there is consistent evidence of a widening socioeconomic gap in health indicators. Developing health literacy (HL) in youth populations to improve lifelong health behaviours has garnered increased interest in recent years. This process evaluation examines the acceptability, fidelity and dose delivered of the pilot of LifeLab Dublin: a nine-week, school-based HL intervention for low socioeconomic adolescents. The intervention, which comprised of two out-of-school, interactive HL experiences in conjunction with seven school-based lessons, took place between September and December in 2021 and involved students aged 11 - 13. The health issues targeted were previously identified by the teachers and students of the target population, and the learning activities within the out-of-school experiences were co-designed by adolescents of a similar demographic. Overall, the intervention was perceived positively by the students and teachers, particularly the two interactive out-of-school experiences. The teachers, however, highlighted issues with the volume and content of the school-based lessons, resulting in a reduced number of lessons being delivered. The fidelity of the two LifeLab experiences was high, demonstrating that the students engaged well with the learning activities and that the experience aligned with LifeLab’s core principles and underpinning theoretical constructs. The findings from this study highlight the value in implementing experiential style learning in school-based HL education and the benefit of involving participants in the design of intervention. The evaluation provided valuable insight into the refinements required to enhance the efficacy of the intervention, as well as providing an evidence-base to inform future school-based HL interventions for low socioeconomic adolescents. Key messages • The benefit of adopting experiential style health literacy education with young people. • The benefit of including young people in the design of a health literacy intervention.

MyPlate Food Model and Family Grocery Shopping with Second and Third Graders are Significant Interventions for the Development of Interactive Health Literacy Skills

A school-based nutrition education intervention was implemented with second and third graders who used their functional health literacy skills of reading, writing, and speaking to learn about the MyPlate food model from the United States Department of Agriculture. The pretest-posttest intervention determined if children had ever seen the MyPlate food picture and if children participated in grocery shopping and meal making events with their family at home. Interactive health literacy accounted for the conversations that children had with their teachers about food and nutrition when learning about the MyPlate food model and when preparing three recipes over three days in the school classroom. Interactive health literacy strategies also included children’s ability to interact and learn about the MyPlate food model as a valid and reliable print and electronic material associated with meal planning. Implications and guidelines for teachers and parents are discussed for advancing the need for and understanding of functional and interactive health literacy for elementary children in the United States.

Functional Ovulatory Menstrual Health Literacy Amongst Adolescent Females in Western Australia

Study objectiveTo assess the knowledge of ovulation and menstruation of adolescent females in Western Australia. MethodsA validated adolescent ovulatory menstrual health literacy questionnaire was used in a cross-sectional study, which included an open-response question inviting participants’ reflections. ResultsParticipants (n=297) were from two single sex and seven co-educational schools of varied socio-educational advantage. Mean chronological age was 15 years and mean gynaecological age was two years. The prevalence of dysmenorrhoea was 69%. Primary sources of information included mothers (91%), friends (61%) and, for post-menarcheal participants (n=274), mobile applications (52%). Most adolescents enjoyed finding out information about ovulatory menstrual health, and understood the information given to them. However, participants’ knowledge of ovulation, menstruation and their occurrence in the cycle were low. Attendance at a single sex or Catholic school or use of mobile applications did not confer a knowledge advantage overall (p<0.05), except for knowing the meaning of cervical mucus. Thematic content analysis of open-ended responses resulted in five themes, including normality, menstrual flow, charting, ovulation and dysmenorrhoea. ConclusionInadequate functional ovulatory menstrual health literacy hampers progression to acquiring complete health literacy. This has negative implications for progressing towards the interactive and critical ovulatory menstrual health literacy domains, which include providing an accurate menstrual history when engaging with healthcare providers.

The effect of health literacy on early postoperative recovery of patients undergoing outpatient surgery.

The measurement of the health literacy level of patients undergoing outpatient surgery has become a major challenge in perioperative nursing of outpatient surgery. To analyze the effect of health literacy on early postoperative recovery of patients undergoing outpatient surgery by developing a health literacy assessment tool for this population. A scale for the assessment of health literacy was established based on Nutbeam's health literacy model. From April to September 2021, 264 patients were selected in the daytime operating rooms of six Class A tertiary hospitals in Kunming, Yunnan Province to investigate health literacy and early postoperative rehabilitation quality, and the influencing factors of the two variables were analyzed. An assessment scale of health literacy of patients undergoing outpatient surgery was developed, including 3 dimensions and 24 items. The Cronbach's α coefficient of the total scale was 0.944, the split-half reliability was 0.902, and the content validity was 0.920. Exploratory factor analysis showed that the cumulative variance contribution rate was 66.37%, and the scale had good structural validity. Multiple linear regression analysis showed that age, functional health literacy, interactive health literacy, and critical health literacy could explain 60.4% of the variation (adjusted R2= 0.583) of postoperative recovery quality of patients undergoing outpatient surgery. Health literacy of patients undergoing outpatient surgery is an important factor that affects the quality of early postoperative recovery. The health literacy assessment scale can assist medical staff in implementing personalized perioperative nursing and health education.

End-of-life health literacy, knowledge and behaviours towards advance care planning among older adults: cross-sectional evidence from Switzerland

IntroductionPopulation ageing, technological advancements and an increasing emphasis on patient empowerment imply that individuals are increasingly confronted with intricate end-of-life decisions. Personal end-of-life health literacy skills may help empower individuals...

The association between interactive health literacy and dietary behaviors among Chinese college students: a large-scale cross-sectional study.

The association between health literacy and healthy dietary behaviors has been explored in the European population. However, there is currently no evidence available specifically pertaining to Chinese college students particularly for interactive health literacy. The objective of this study was to investigate the association between interactive health literacy (IHL) and dietary behaviors in Chinese college students. This study included 11,856 Chinese college students (mean age = 18.8 years, SD = 1.2 years). We defined nine healthy dietary behaviors as consumption of water, egg, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. For each food group, participants who met the criterion for being a regular consumer of the item were assigned a score of 1, and otherwise were assigned a score of 0. Thus, the dietary behaviors score ranged from 0 to 9, with higher scores indicating healthier dietary behaviors. We used the revised 28-item Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ) to evaluate IHL; a higher score on this scale indicates a greater health literacy. Multivariate logistic regression was used to analyze the association between IHL level and frequency of different numbers of dietary behaviors. After adjusting for sex, age, annual family income, place of residence, father's education level, and mother's education level, there was a clear and significant positive association between IHL and the likelihood of exhibiting diverse dietary behaviors. The adjusted odds ratio (95% CI) of exhibiting given nine dietary behaviors with reference to tertile 1 according to categories of IHL was as follows: 1.055 (0.694, 1.603) for tertile 2 and 1.849 (1.269, 2.696) for tertile 3 (p for trend = 0.001). Similarly, there are significant positive associations between IHL and the likelihood of exhibiting 2-8 dietary behaviors, except for exhibiting any one dietary behavior. We further found that, in addition to the health awareness factor, there were significant positive associations between physical activity and nutrition factors, and healthier dietary behaviors. Further, there was a significant negative association between interpersonal relationships and dietary behavior. The findings indicate a positive relationship between IHL and dietary behavior, such that the higher the level of IHL among college students, the healthier the dietary behavior they tend to adopt in their daily lives. These findings suggest the importance of developing stages of change-based educational interventions, which could help individuals with limited IHL to not only acquire necessary health-related knowledge but also to strengthen their motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials to establish a causal association between IHL and healthy dietary behaviors.

Improving health and scientific literacy in disadvantaged adults: a scoping review of interventions

Abstract Background People with low socioeconomic status face high health risks and poor health literacy. Tailored health education could help reduce these disparities. This scoping review sought to provide an up-to-date overview of approaches to craft and conduct interventions to improve health and scientific literacy in disadvantaged adults. Methods 7 databases were searched from 2012 to 2022. Data about research design, settings, target groups, topics, skills, theoretical foundations, materials, methodologies, outcomes, and evaluation tools were extracted from the selected articles. Quality assessment was done using the Crowe Critical Appraisal Tool. Results The review included 50 studies, most of which were quasi-experimental, involving participants with low income or limited education, ethnic minorities, or immigrants. Frequently theory-driven, these interventions were conducted in community settings and used various interactive methods like discussions and practical exercises. Functional and interactive health literacy dimensions were emphasised more than critical and scientific ones. Many programs highlighted cultural appropriateness and customization. Researchers often involved participants in program development or execution. Evaluations assessed knowledge, health literacy, behavioural and psychological gains using various quantitative and qualitative instruments. Critical appraisal of the studies revealed quality limitations. Conclusions Participatory methods, interactivity and culturally appropriate materials are crucial for crafting relevant health education for disadvantaged groups. Greater emphasis should be placed on developing critical and scientific health literacy skills. Key messages • This study provides novel findings on the ways to design and evaluate health literacy interventions targeted at vulnerable groups. • Such guidance can be valuable for health education practitioners.

Letting people flourish: defining and suggesting skills for maintaining and improving positive health.

The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health. Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers. The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.

A Refined Teach-back Observation Tool: Validity Evidence in a Pediatric Setting.

Teach Back (TB) is recommended to assess and ensure patient understanding, thereby promoting safety, quality, and equity. There are many TB trainings, typically lacking assessment tools with validity evidence. We used a pediatric resident competency-based communication curriculum to develop initial validity evidence and refinement recommendations for a Teach-back Observation Tool (T-BOT). This study aimed to develop initial validity evidence for a refined T-BOT and provide guidance for further enhancements to improve essential TB skills training among pediatric residents. After an interactive health literacy (HL) training, residents participated in recorded standardized patient (SP) encounters. Raters developed T-BOT scoring criteria, then scored a gold standard TB video and resident SP encounters. For agreement, Fleiss' Kappa was computed for >2 raters, and Cohen's Kappa for two raters. Percent agreement and intraclass correlation (ICC) were calculated. Statistics were calculated for gold standard (GS) and TB items overall for all six raters, and for five faculty raters. Agreement was based on Kappa: no agreement (≤0), none to slight (0.01-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), almost perfect (0.81-1.00). For six raters, Kappa for the GS was 0.554 (moderate agreement) with 71.4% agreement; ICC = .597; for SP encounters, it was 0.637 (substantial) with 65.4% agreement; ICC = .647. Individual item agreement for SP encounters average was 0.605 (moderate), ranging from 0.142 (slight) to 1 (perfect). For five faculty raters, Kappa for the GS was 0.779 (substantial) with 85.7% agreement; ICC = .824; for resident SP encounters, it was 0.751 (substantial), with 76.9% agreement; ICC = .759. Individual item agreement on SP encounters average was 0.718 (substantial), ranging from 0.156 (slight) to 1 (perfect). We provide initial validity evidence for a modified T-BOT and recommendations for improvement. With further refinements to increase validity evidence, accompanied by shared understanding of TB and rating criteria, the T-BOT may be useful in strengthening approaches to teaching and improving essential TB skills among health care team members, thereby increasing organizational HL and improving outcomes. [HLRP: Health Literacy Research and Practice. 2023;7(4):e187-e196.].

Mixed Method Evaluation of My Vital Cycles®: A Holistic School-Based Ovulatory Menstrual Health Literacy Program.

There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program's impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.

Interactive Health Literacy and Symptom Self-management in Patients With Lung Cancer: A Critical Realist Analysis.

Patients with lung cancer experience multiple symptoms requiring self-management. Little is known about how self-management is influenced by interactive health literacy, defined as communicating with healthcare providers to obtain and process information. This study explored how interactive health literacy relates to symptom self-management among patients with lung cancer. A second aim explored how interactive health literacy might be integrated into the Individual and Family Self-management Theory. This study used a cross-sectional mixed-methods design. Quantitative data included demographics, the All Aspects of Health Literacy Scale, and the Memorial Symptom Assessment-Short Form. Qualitative data were collected using semistructured interviews. Data analysis followed a critical realist model. Twelve adults who recently received treatment for lung cancer reported an average of 14 symptoms that caused moderate distress. Average interactive health literacy of the sample was in the moderate range. Participants' experiences of self-management differed based on their interactive health literacy. A generative mechanism proposes that those with higher interactive health literacy who accessed online information used this information as a basis for engaging with providers regarding potential symptom self-management strategies. Interactive health literacy skills may play a role in patients' ability and confidence in symptom self-management through interactions with oncology providers. Further research should clarify the relationship between interactive health literacy, self-efficacy, and collaboration with oncology providers. The patient-provider relationship is a key factor influencing how patients obtain and process symptom self-management information. Oncology providers should implement patient-centered strategies to engage patients in symptom self-management.

Validation of an adolescent ovulatory menstrual health literacy questionnaire.

This study aimed to face validate an adolescent ovulatory menstrual (OM) health literacy questionnaire and to measure reliability by test-retest. Draft questions from an earlier content validation were adjusted following face validity assessment with 28 adolescents. Test-retest reliability was assessed by 89 adolescents aged 14-18 years over a two-week period across four school sites. The mean levels of agreement recorded from the critical, interactive and functional health literacy domains were 83%, 74% and 68%, respectively. There were 44 out of 74 items with Kappa statistics >0.40. The questionnaire has confirmed face validity and adequate test-retest reliability for assessing adolescent OM health literacy.

Impact of genomic literacy components on genetic testing decision-making in the general Japanese population in the 20s and 30s.

In promoting genomic medicine, genomic literacy, which is the public's ability to acquire and utilize the knowledge and skills related to genetics and genomes, requires urgent improvement. This study determined how the three components of genomic literacy (genetic/genomic knowledge, health numeracy, and interactive and critical health literacy) are associated with risk and benefit perception for genetic testing and decision-making related to genetic testing. Using an online questionnaire, we surveyed genetic/genomic knowledge, health numeracy, interactive and critical health literacy, risk and benefit perception of genetic testing, and intention toward genetic testing of 857 Japanese citizens (aged 20-39). A vignette was created to measure the intention toward genetic testing, and respondents were asked about their willingness to undergo genetic testing and to share the results with their partners and children. The path analysis, which was done by creating a path diagram revealing the relationship of the three components with risk and benefit perception, revealed that genetic and genomic knowledge and interactive and critical health literacy affected the respondents' intention to undergo genetic testing via recognition of the benefits of such testing. Further, it was suggested that health numeracy affects benefit perception through risk perception toward genetic testing. However, the goodness of fit of this model for the intention of conveying positive results to partners and children was relatively low, thus indicating that the hypothetical model needs to be reexamined.

The relationship between health literacy and internet addiction among middle school students in Chongqing, China: A cross-sectional survey study.

Internet addiction has emerged as a major global concern as a potential adverse impact of internet exposure on adolescents. Internet addiction is associated with many demographic variables; however, there is a lack of consensus on its relationship with health literacy. Therefore, the aim of the present study was to assess the rates of internet addiction and health literacy level among middle school students (grades 7 to 12) in Chongqing, China, as well as to investigate the association between them. A cross-sectional, questionnaire-based study was conducted among 8971 students who were randomly selected by using stratified cluster sampling between November and December 2019. The Internet Addiction Diagnostic Questionnaire, Adolescent Health Literacy Scale and a self-designed basic information questionnaire were used to collect data. Chi-square tests were performed to compare the differences in the distribution of internet addiction across health literacy levels as well as some sociodemographic characteristics. Multivariate logistic regression analyses were conducted to identify the association between health literacy and internet addiction. The prevalence of internet addiction among middle school students in Chongqing was 6.1%. The percentage of the students who spent more than 4 hours online every day in the past week was 14.3%. In addition, 26.7%, 26.0%, 28.3% and 26.3% of the participants reported low functional, interactive, critical and total health literacy, respectively. After adjusting for the confounding effects of demographics, multivariate regression analysis showed that critical health literacy was a protective variable for internet addiction, while functional, and interactive health literacy were the risk variable (P<0.05). Furthermore, the internet addiction rates were higher among boys, students with good peer relationships, and students without parental supervision, whereas internet addiction rates were lowest among students in grade 12. The prevalence of internet addiction among middle school students in Chongqing is relatively high. Internet addiction is strongly negatively associated with critical health literacy, but it is positively associated with functional and interactive health literacy but not total health literacy. This study provides preliminary evidence for the predictive role of health literacy in internet addiction of adolescents.

Functional Health Literacy, Invented Spellings, and MyPlate Representations of 2nd and 3rd Grade Children Learning about Breakfast Eating and Food Groups in Health Education

PURPOSE: We had three purposes for this study: 1) to introduce 2nd and 3rd grade children to the concepts of breakfast and food groups in the MyPlate nutrition model while using an interactive constructivist approach; 2) to evaluate what foods children ate for breakfast over two days and to assess the visual-textual-lexical representations that they constructed to show their thinking about the MyPlate food model; and 3) to explore functional health literacy and inventive spellings from children who learned about food groups over two class sessions. METHODS: Pre to post student assessments focused on self-reported breakfast eating and ability to represent the MyPlate food model during the learning process. Student thinking about those topics were also elicited by multimodal approaches: oral language (conversations), written language (visual-textual-lexical illustrations), and body language (making nutritious snacks). For the latter, students constructed a snack to eat on both days at school and were encouraged to make the food at home to model nutritious eating behavior. RESULTS: Most children who participated in the lesson ate breakfast either at home or at school. Some students chose to communicate in words and pictures when asked to write about the foods they ate for breakfast. Many students illustrated and labeled food groups by drawing and using inventive spellings about their early understandings of the MyPlate food model. From the first to the second day of instruction, breakfasts with three food groups increased from 3% to 7% but breakfasts with two food groups declined from 55% to 41% due to more children (n = 60) eating breakfasts with only one food group on the second day. CONCLUSIONS: Some of the food items that students ate were not sufficient to produce an adequate nutritional benefit. The constructivist pedagogical approach assisted children with multimodal ways to communicate their understanding, including making two different snacks when planning a breakfast with multiple food groups. Functional health knowledge about a nutritious breakfast made with three food groups should be further aligned with functional health literacy skills of speaking and writing in multimodal ways in order to improve health behaviors. Inventive spellings demonstrated a developmental step in learning a vocabulary in a new domain. Use of written words and pictures reflected a positive way to learn health and nutrition, because children represented their understanding in more than one way. RECOMMENDATIONS: By adding fruit to the breakfasts of children who participated in the lessons, almost one-half of the children would be able to increase their consumption from two food groups to three food groups when consuming an ideal breakfast. Future work should elaborate on the role of interactive health literacy in school and home contexts when children are learning about breakfast eating and food groups. Future integration of the MyPlate food model with the National Health Education Standards can foster new classroom assessments that will support students to practice observable nutrition behaviors that can lead to consistent health habits for personal, family, and school health.

Development of the health literacy assessment instrument for chronic pain patients: A Delphi study.

To develop health literacy assessment instrument for patients with chronic pain. Qualitative methods based on Delphi technique, assessed against the CREDES checklist. A 2-round Delphi method was adopted in this study. The panel consisted of 19 experts. The health literacy assessment instrument for chronic pain patients was constructed, which contained 3 dimensions (functional health literacy, interactive health literacy and critical health literacy) and 41 items. The positive coefficients of two rounds Delphi were 100.00% and 89.5%, respectively. The authority coefficient of experts was 0.848 and 0.858, respectively. The coordination coefficients of dimension and items were 0.222 and 0.364, respectively. The health literacy assessment instrument dimensions and items for patients with chronic pain based on a Delphi method are valid. This instrument is suitable for investigating the health literacy level of patients with chronic pain.

The competence in health issues of population of circumpolar region of the Russian Federation

The health literacy of citizen is determined by a set of demographic and social factors. The deficiency of health literacy of population in the Russian Arctic Zone conditions delay in indicators characterizing population health from their all-Russian values and menaces ability to achieve the targets of the National Strategy of Development of Russian Arctic Zone and Ensuring National Security up to 2035.The purpose of the study is to assess level of health literacy of patients and healthy population residing in circumpolar territories of Russia (Arkhangelsk Oblast).The level of general health literacy in the subgroups of respondents varied in narrow range of 26.9-36.3 points. The most significant difference was established between scores of interactive health literacy (Δ = 4.1 points) and critical health literacy (Δ = 3.4 points), which were higher in group of healthy respondents. The predictors of level of general health literacy are clinical status (value of dependent variables in healthy respondents was on average higher on 0.75-1.73 points), self-assessment of one's positioning in society (every additional point increases average level of general health literacy by 0.47-0.79 points) and age (every additional year of life reduces level of general health literacy by 0.08 - 0.09 points). The results of the study indicate on dependency between clinical status and the level of health literacy, determine social characteristics of risk group with low health literacy as object of additional preventive measures directed at citizen residing in in circumpolar terrotories of The Russian Federation.

Literasi Kesehatan Dalam Pencegahan Covid-19 (Studi Kasus Unilak)

The aims of this study to determine the level of health literacy of lecturers and employees at Lancang Kuning University, one of the steps in preventing covid-19, in addition to studying the behavior in implementing health protocols for awareness of the importance of preventing covid-19. This study uses a quantitative descriptive method with a population of 420 respondents and a sample of 80 respondents. This study instrument use a questionnaire that has been tested for validity with a total of 30 questions with a Cronbach alpha result of 0.926, there are 3 indicators in this study, namely functional health literacy, interactive health literacy and critical health literacy. The results of this study from those 3 indicators, functional health literacy by 72%, interactive health literacy 76% and critical health literacy 77% overall the level of health literacy of Lancang Kuning University lecturers and employees is 76% in the 76%-100% range. which is included in the very good category. This means that the health literacy of Lancang Kuning University lecturers and employees is very good. Keywords: Health literacy, covid-19; health literacy level; health protocol; lecturers and employees.

The Relationship between Health Literacy and COVID-19 Vaccination Prevalence during a Rapidly Evolving Pandemic and Infodemic.

The gap between how health information is communicated and what people understand and can use to make informed health decisions is called health literacy. This gap was exacerbated by the rapidly changing and excessive volume of information, misinformation, and disinformation during the COVID-19 pandemic. People with lower health literacy may not have understood the importance of COVID-19 vaccination for themselves or for their communities. Our aim was to understand health literacy levels within Fulton County, Georgia, and their relationship to vaccine prevalence. Fulton county residents ages 18 and over (n = 425) completed an on-line Health Literacy Questionnaire. Individual, organizational, functional, interactive, and critical health literacy scales were created. Vaccination prevalence data were collected from the Georgia Vaccine Distribution Dashboard. All data were divided into one of three county areas. There were statistically significant variations in vaccine prevalence χ2(3) = 29.325, p < 0.001 among the three county areas. All levels of health literacy predicted overall county vaccination prevalence F (4,420) = 85.941, p < 0.001, There were significant differences in health literacy levels among two of the three county area pairs; the lowest resourced county area had the lowest vaccination prevalence and health literacy rates. This is the first example of relating direct health literacy measures across a major metropolitan US county with vaccine prevalence data.

LifeLab: Co-Design of an Interactive Health Literacy Intervention for Socioeconomically Disadvantaged Adolescents'.

Low socioeconomic populations, when compared to more affluent groups, are at greater risk of initiating risky behaviours and consequently developing health complications. Health literacy has been identified as a possible means to improve and sustain positive health behaviours, with adolescence being a time point when such behaviours can be embedded. To develop a meaningful health intervention, it has been recommended that relevant stakeholders be included in the design phase. This formative evaluation study was the second phase of co-design of an engaging health literacy intervention ‘LifeLab’ with, and for, socioeconomically disadvantaged adolescents in Ireland. In Spring 2021, a series of co-design workshops (n = 17) were facilitated with a convenience sample of adolescents from socially disadvantaged areas (n = 22) to gather their perceptions, feedback, and suggested changes on the LifeLab learning activities that had emerged from Phase 1 of the work. The data was analysed using reflexive thematic analysis, resulting in the development of three themes: (i) preferred learning engagement strategies, (ii) practical and logistical considerations and (iii) ideas for LifeLab content. The results highlight the value in adopting a participatory approach, as participants offered an array of suggestions and details to maximise the potential for LifeLab to be contextually relevant and engaging; suggestions which will directly inform the development and implementation of the intervention.