HL Levels Research Articles

Health literacy and its association with health outcomes among students in upper secondary education

Abstract Background Health literacy (HL) - as a broad range of health-related competencies and skills- has been recognized as a determinant of health outcomes, and suggested to be a modifiable health resource and a factor contributing to empowerment and equity. Thus, there is a need to identify the state of HL in various population groups. The aim of this study was to investigate HL levels and associations between HL, physical activity and subjective health among students in general upper secondary and vocational Swedish-language schools in Finland. Methods The study used cross-sectional data from the Finnish LIITU-study among students in Swedish-speaking general upper secondary and vocational schools (N = 887; age 16-20 years) conducted in the spring and autumn 2020, during the covid-19-pandemic. Students answered a web-based questionnaire during school hours. HL was measured with the 10-item Health Literacy for School-Aged Children (HLSAC) instrument. Data was analyzed with descriptive statistics and logistic regression analyses. Results According to preliminary findings, one third of students had high HL. HL was higher among female than male students, general upper secondary school students than vocational school students, and in spring than in autumn 2020. A higher proportion of students with high HL, as compared to students with low/medium HL, reached the national recommendations for physical activity, perceived their health to be excellent and, moreover, did not have recurrent psychological symptoms. Conclusions The findings confirm previous research findings on the importance of HL in promoting health outcomes. The pandemic year 2020 provided a unique perspective to the subject. It would be important to survey and discuss the role of schools in providing equal opportunities for the promotion of HL as this may contribute to decreasing health disparities in the population. Key messages • One third of students in upper secondary education (age 16-20 years) had high HL; there were differences between genders, students on different educational paths, and in spring and autumn 2020. • High HL was associated with better self-rated health, less psychological symptoms and reaching national recommendations for physical activity among students in upper secondary education.

The role of health literacy in vaccination behaviours: a systematic review

Abstract Background Health literacy (HL) is recognized as a driver of health-promoting behaviors, including preventive actions. However the influence of HL on vaccines uptake remains unclear. This study aimed at summarize the evidence on the role of HL in vaccination behaviors. Methods PubMed, Scopus, and Web of Science were searched. Observational studies of any design conducted worldwide, published through June 2021 and investigated the association between HL and vaccination intention or status using HL validated tools were included. Any vaccine was considered. An adapted Newcastle-Ottawa Scale was used to assess quality. Results Twenty-one articles were included, 6 investigated intention to vaccinate and 15 explored vaccination status. Studies of the first group had a cross-sectional design, considered anti-COVID-19 vaccination and were judged of high or fair quality. Population investigated was heterogeneous as well as the tool used to assess HL. Five analysis provided adjusted estimates. HL seemed not influence the vaccination intention in 3 studies whereas adequate HL was associated with positive attitude to get vaccinated in the remained 3 ones. The majority of articles assessed vaccine status, had a cross sectional design (N = 11) and were of high quality (N = 8). The HL tool more frequently used was TOFHLA (N = 5), sample investigated was heterogeneous included parents of children who received vaccinations (N = 5). Four articles considered multiple vaccinations, thus providing a total of 19 analysis. Vaccine against influenza was the most investigated (N = 11) and 15 studies provided adjusted estimates. No association was found between HL and the receipt of vaccination in 11 analysis, whereas HL levels significantly influenced vaccination uptake in 8 studies. Conclusions Health literacy did not seem to strongly influence people decision on vaccinations. Difference in population and vaccines considered, but also in tool used to measure HL might explain the heterogeneity of the results. Key messages • The impact of HL on vaccination behaviours remains controversial. • Efforts to extend the studies on targeted populations applying a comprehensive HL measurement tool should be devised.

Health Literacy in Health Professionals Two Years into the COVID-19 Pandemic: Results From a Scoping Review.

BackgroundHealth literacy (HL) is an important public health goal but also crucial in individuals providing medical care. During the pandemic, COVID-19–related HL of health professionals (HPs) has gained momentum; it helps to minimize the risk of self-infection, on the one hand, and to protect patients and relatives from infection, on the other. However, comprehensive information about the levels of individual pandemic-related HL in HPs is scarce.ObjectiveIn this paper, we aimed at describing the extent of existing research on HL (concept) conducted in HPs (population) in the COVID-19 pandemic (context). The review intends to map the literature on HL in HPs, thereby highlighting research gaps.MethodsThis scoping review was conducted using the methodology of Khalil et al (2016). This involved an electronic search of PubMed (MEDLINE) and PsycInfo and a hand search. The included studies were iteratively examined to find items representing the four HL dimensions of access, understand, critically appraise, and apply COVID-19–related health information.ResultsThe search yielded a total of 3875 references. Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19–related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19–related HL outcome.ConclusionsHigh levels of COVID-19–related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19–related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary.Trial RegistrationOpen Science Framework dbfa5; https://osf.io/dbfa5/

Cross-Cultural Adaptation and Validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL-SR) for Diabetic Patients in Serbia.

Thoroughly validated instruments can provide a more accurate and reliable picture of how the instrument works and of the level of health literacy in people with type 2 diabetes mellitus (T2DM). The present work aimed at cross-cultural adaptation and validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL) in patients with T2DM in Serbia. After translation and back-translation, views from an expert group, one cognitive interview study (n = 10) and one survey study (n = 130) were conducted among samples of diabetic patients. Item analysis, internal consistency, content validity, confirmatory factor analysis (CFA) and reliability testing were performed. When all 14 items were analyzed, loading factors were above 0.55, but without adequate model fit. After removing two items with the lowest loadings FHL1 and IHL2 the fit indexes indicated a reasonable normed χ2 (SB scaled χ2/df = 1.90). CFI was 0.916 with SRMR = 0.0676 and RMSEA = 0.0831. To determine internal consistency, Cronbach’s alpha coefficient was 0.796 for the whole FCCHL-SR12. With only minor modifications compared to the English version, the 12-item FCCHL instrument is valid and reliable and can be used to measure health literacy among Serbian diabetic patients. However, future research on a larger population in Serbia is necessary for measuring the levels of HL and their relationship with other determinants in this country.

Does health literacy promote COVID-19 awareness? Evidence from Zhejiang, China.

BackgroundHealth literacy (HL) is considered a crucial determinant of disease prevention and control. However, the role of HL in the Coronavirus Disease 2019 (COVID-19) pandemic has not been studied using provincial representative data among Chinese residents. This study aimed to assess the association between HL and COVID-19 awareness among Zhejiang residents based on the 2020 China Health Literacy Survey (CHLS).MethodsThe study was conducted among 5,596 residents aged 15–69 in Zhejiang using multistage, stratified, and probability proportional to size sampling. COVID-19 awareness and HL were assessed using the “Chinese Citizen Health Literacy Questionnaire (2020)” in Zhejiang. The covariates were divided into predisposing factors, enabling factors, and need factors according to Anderson's model. Data were analyzed by the chi-square test and logistic regression.ResultsThe study showed that HL and COVID-19 awareness levels of residents were 24.84% and 8.06%, respectively, in Zhejiang in 2020. After adjusting for covariates, residents with adequate HL were more likely to have better COVID-19 awareness (odds ratio [OR] = 5.22, 95% CI = 4.13–6.59, p < 0.001). Three dimensions of HL (knowledge and attitudes, behavior and lifestyle, and health-related skills) were associated with COVID-19 awareness. Additionally, COVID-19 awareness was associated with age, occupation, family size, annual household income, and chronic conditions.ConclusionCOVID-19 awareness is significantly associated with HL, suggesting that promoting HL is an important component of health education, disease prevention, and health promotion in response to the COVID-19 pandemic and even possible public health emergencies in the future.

How to make more people adopt healthy behaviors? Assessing health literacy, health promoting lifestyle and their association of community residents in Shenzhen, China.

IntroductionHealth literacy (HL) has been concerned a key factor for determining the use of health information and promoting health. The study aimed to explore the relationship between different health literacy types and health promoting lifestyle (HPL) in different health literacy population.MethodsThe survey analyzed a sample of 16,921 community residents in Shenzhen. The Chinese Citizen Health Literacy Questionnaire and health-promoting lifestyle profile II (HPLP- II) were used to assess health literacy and health promoting lifestyle.ResultsParticipants were divided into different populations based on the correlation between HL and HPL. The low-HL and medium-HL populations were judged to lack health literacy, and demographic characteristics were significantly different between different HPL levels in low-HL and medium-HL populations. There were 6 types of HL, and health information literacy (β = 0.08, P < 0.001) and chronic disease literacy (β = 0.08, P < 0.001) positively predicted HPL in the low-HL population. In the medium-HL population, the results of reward and punishment analysis showed that health information was a basic factor, chronic disease was performance factor, medical care was a motivating factor for HPL; there were 6 dimensions of HPL, and health responsibility (HR), stress management (SM) and physical activity (PA) were not significantly different in medium-HL population. The results of regression analysis showed that HR and PA had a great impact on HPL (HR: β = 0.193, PA: β =0.179, β for other dimensions was 0.186, 0.176, 0.171, 0.164), but the HR and PA standardized scores were lowest in the HPL dimensions (HR: 69.42, PA: 68.5, lower than other dimensions), so it may be HR and PA that cause HPL unchanged between groups in the medium-HL population.ConclusionsDifferent HL levels have different relationships with HPL, and different HL types have different effects on HPL. Shenzhen community residents need to improve their HL, and they have great potentials for further progress to improve the population health. Public health policy makers need to consider formulating different policies for people with different HL levels.

Monochromatic blue light not green light exposure is associated with continuous light-induced hepatic steatosis in high fat diet fed-mice via oxidative stress

Irregular light exposure is a newly identified environmental factor for the progression of lipid metabolism; however, the specific effect of light color exposure on lipid homeostasis remains unknown. Herein, 4-week-old male C57BL/6 J mice (n = 12) fed a high-fat diet (HFD) were exposed to a standard 12-h light: 12-h dark cycle (LD-WF) and a 24-h continuous monochromatic blue light (LL-BF), green light (LL-GF), or white light (LL-WF) condition for 12 weeks. LL-BF interfered with the expression of circadian genes in the hypothalamus and upregulated the plasma corticosterone (CORT) levels (p < 0.05) compared with LD-WF. Along with elevation of the CORT level, LL-BF enhanced glucocorticoid receptor synthesis, increased the Hsp90 mRNA level, reduced the antioxidant capacity, increased the production of ROS and MDA, and reduced the Pgc-1α mRNA level in the liver (p < 0.05). Furthermore, LL-BF disrupted the hepatic expression levels of genes involved in lipid metabolism, Acc and Hl, which further aggravated the hepatic steatosis status and significantly increased the liver pathological scores, TG, TC, IL-6, and TNF-α levels (p < 0.05). LL-BF consistently increased the body weight and incidence of dyslipidemia and lipid deposition. However, no difference was observed between LL-BF and LL-WF (p > 0.05). Surprisingly, LL-GF did not show any changes induced by LL-BF and LL-WF, and contrary to LL-BF, LL-GF and LD-WF showed no significantly differing changes (p > 0.05). Taken together, exposure to monochromatic blue light but not green light is associated with continuous light-aggravated hepatic steatosis in HFD-fed mice. The effect of continuous blue light exposure may be attributed to the disturbance of biological rhythm, increase in CORT secretion, induction of oxidative stress, and interference of the Acc and Hl levels in the liver.

General health literacy scale for Thais and comparison between age groups

BackgroundHealth literacy (HL) has captured the world's interest since it was first defined by WHO in 1998. In Thailand, a number of HL scales for risk groups have been developed but none for the general population. Therefore, this research aimed to develop a general health literacy (GHL) scale for Thais and compare HL levels between groups, i.e. students, youth, adults, and older. MethodsIn this mixed-methods study, a focus group was conducted with 20 health policy-makers. Data were collected from 4,000 participants from all regions of Thailand through questionnaires between 2018 and 2019. The participants were divided into 4 age groups: aged 7–14, 15–24, 25–59, and 60–75. All of them were selected using stratified random sampling. Data analysis was performed using CFA and ANOVA. Results1) The GHL Scale for Thais comprised 47 items, covering 5 domains i.e. access to health information and services, understanding of health information and service leading to practice, health information and service appraisal, communication and social support, and health self-management. The scale had high Cronbach's alpha values for all participants and different age groups (Cronbach's alpha = 0.95–0.97) and factor loadings ranging from 0.45 to 0.77. 2) Most Thai people (58.9%) had a fair level of HL, followed by high HL (24.3%) and low HL (16.8%). 3) The comparison of HL among age groups had different mean scores (P < .05) and low HL was found in adults (25.00%), older (18.60%), youth (12.60%), and students (11.40%), respectively. ConclusionThe GHL Scale for Thais can be used to screen people of all ages for potential health problems and develop strategies for promoting health resilience and preventing disease in each age group.

Perceptions of Cardiac Rehabilitation Participants Regarding their Health Behaviors and Information Needs during the COVID-19 Pandemic in Brazil.

ResumoFundamento A COVID-19 afetou como as pessoas recebem atendimento de saúde para várias doenças, inclusive doenças cardiovasculares.Objetivos Examinar as percepções dos participantes de reabilitação cardíaca (RC) sobre seus comportamentos em saúde e necessidades de informação durante a pandemia da COVID-19 no Brasil.Métodos Neste estudo transversal, um questionário de 27 itens elaborado pelos investigadores foi administrado online a participantes de dois programas de RC. As perguntas incluíam letramento em saúde (LS; usando a Brief Health Literacy Screening Tool - Breve ferramenta de triagem de letramento em saúde), uso de tecnologia, percepções antes e durante a pandemia da COVID-19, e necessidades de informações. Foram usados coeficiente de correlação de Pearson, testes t pareados e ANOVA, conforme apropriado. Um p <0,05 foi considerado estatisticamente significativo para todos os testes.Resultados No total, 159 (25,5%) participantes de RC responderam ao questionário. Desses, 89,9% tinham LS limitado ou marginal, e 96,2% relataram ter acesso à internet de casa. Os pacientes se preocupam principalmente com a saúde de sua família e própria, além de como o coronavírus é perigoso para sua saúde e como mudou seu estilo de vida. Os participantes perceberam que a qualidade de seus comportamentos em saúde diminuiu significativamente durante a pandemia. A pandemia também mudou as necessidades de informações dos participantes de RC, já que novas necessidades surgiram, tais como, controle de níveis de ansiedade, manter a motivação para levar uma vida saudável durante a pandemia, e como a COVID-19 pode afetar sua condição de saúde. Participantes com LS adequado perceberam significativamente a gravidade da doença e tinham significativamente mais acesso a informações do que os pacientes com LS limitado.Conclusões Nossos resultados destacaram o impacto da pandemia nas percepções dos participantes de RC em relação a seus comportamentos em saúde e necessidades de informação, que podem ser influenciados pelos níveis de LS.

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings

BackgroundHealth literacy (HL) is important for individuals in terms of knowledge and competence to make decisions about healthcare, health promotion and disease prevention. Migrants generally demonstrate lower HL levels compared to the majority populations. HL interventions among migrants are rarely studied. Thus, there is a need to find useful HL measurements for multicultural settings. The importance of understanding parents’ HL is related to their key role in providing and promoting the health of their children. This study aimed to add knowledge about the psychometric properties of the HLS-EU-Q16 instrument (Swedish version) among parents in Swedish multicultural settings.MethodsA cross sectional design was used. Totally 193 first-time parents (N = 193) were recruited through two child healthcare centres in Stockholm. Parents were interviewed when their infants were < 2 months old using structured questionnaires including HLS-EU-Q16. For psychometric evaluation of HLS-EU-Q16 instrument, exploratory factor analyses (EFA) were used to test internal consistency (N = 164). HL levels in sub-groups were explored with Kruskal-Wallis/Chi2 tests. Participants’ comments on HLS-EU-Q16 questionnaire were viewed to explore how the questions were perceived by the target population.ResultsOne factor solution of EFA explained 37.3% of the total variance in HLS-EU-Q16. Statistically significant differences in HL levels were found in relation to migration including language difficulties and level of education of the study population and access to support in line with previous research. Challenges related to understanding HLS-EU-Q16 questionnaire were found among participants with migrant background.ConclusionsThe Swedish version of HLS-EU-Q16 could be used together with other instruments for measuring overall HL in multicultural settings. HLS-EU-Q16 appears to discriminate between different levels of HL in relation to migrant background and shorter education and limited access to support. However, other measures of HL which should be adapted to use in multicultural settings, need to be explored in further studies of parental HL and its relationship to child health in multicultural settings.Trial registrationThe study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).

Protective effects of gallocatechin gallate against ultraviolet B induced skin damages in hairless mice

Epigallocatechin gallate (EGCG) has the effect to protect skin from ultraviolet B (UVB) induced damages, but it is unstable under ambient conditions, being susceptible to become brown in color. Gallocatechin gallate (GCG), an epimer counterpart of EGCG, is more stable chemically than EGCG. The potential effects of GCG against UVB-induced skin damages has not been available. The objective of this study was to investigate the protective effects of GCG against UVB-induced skin photodamages. GCG was topically applied on the skin of hairless mice at three dosage levels (LL, 12.5 mg/mL; ML 25 mg/mL; HL, 50 mg/mL), with EGCG and a commercially available baby sunscreen lotion SPF50 PA+++ as control. The mice were then irradiated by UVB (fluence rate 1.7 µmol/m2 s) for 45 min. The treatments were carried out once a day for 6 consecutive days. Skin measurements and histological studies were performed at the end of experiment. The results show that GCG treatments at ML and HL levels inhibited the increase in levels of skin oil and pigmentation induced by UVB irradiation, and improved the skin elasticity and collagen fibers. GCG at ML and HL levels inhibited the formation of melanosomes and aberrations in mitochondria of UVB-irradiated skin in hairless mice. It is concluded that GCG protected skin from UVB-induced photodamages by improving skin elasticity and collagen fibers, and inhibiting aberrations in mitochondria and formation of melanosomes.

Differences of gut microbiota and lipid metabolism in Chinese perch ( Siniperca chuatsi ) with different growth rates

This study is aimed to explore the differences of gut microbiota and lipid metabolism in Chinese perch (Siniperca chuatsi) with different growth rates. After 180 days post-fertilization, among the population of Chinese perch (1,275 fish in total), 36 fish with different growth rates were selected from the low growth rate group (L group, initial weight 87 ± 2 g), the medium growth rate group (M group, initial weight 223 ± 4 g) and the high growth rate group (H group, initial weight 468 ± 13 g), respectively, with a total of 108 fish. The microbial species abundance and evenness in both M and H groups were obviously higher than those in the L group. The activities of lipase and trypsin in the gut showed a similar changing trend to the intestinal microbial diversity in L, M and H groups. The M and H groups showed a similar microbial composition, but they had different main functional bacteria. There were more microbial species in the H group than in the M group. Butyricicoccus might be used as an indicator to distinguish the growth rate of the M and H group. The intraperitoneal fat ratio and levels of triglyceride and total cholesterol in the plasma increased gradually with the increase in the growth rate. A large amount of fat accumulation was observed in the liver and gut of the H group, and the H group showed significantly higher levels of low-density lipoprotein and high-density lipoprotein in the plasma compared with the L and M groups. It was also found that the fat of the L and M groups mainly accumulated in the liver and gut, respectively, and the level of low-density lipoprotein in the plasma of the M group than that in the L group. The mRNA level of fas and srebp1 decreased gradually with the increase in the growth rate. The M and H group had high mRNA levels of pparα and cpt1 than the L group. The mRNA levels of lpl and hl were higher in the H group than those in the L and M groups.

The Association Between Health Literacy and Tobacco Use: Results from a Nationally Representative Survey

Dual use of conventional cigarettes and electronic cigarettes presents an emerging public health issue. Previous research has demonstrated a negative relationship between health literacy and conventional cigarette (CIG) use. However, the relationship between health literacy and e-cigarette (ECIG) use remains unclear. This studies examines the possible association of health literacy and CIG, ECIG, or dual use. A multinomial regression was used to model the association between health literacy and current CIG use, current ECIG use, or dual tobacco use status using state-optional data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS; N = 40,404). One-third of the sample (N = 13,478; 33.3%) had initiated tobacco use. Approximately 36.6% of participants exclusively used cigarettes. A smaller proportion of participants were dual users of ECIG and CIGs (7.0%) and e-cigarette exclusive users (4.5%). After adjusting for covariates, higher levels of oral health literacy was associated with lower odds of current dual use. However, there was no significant association between written HL and either conventional cigarette use or electronic cigarette use or after adjusting for covariates. Oral messaging around the dangers of CIG use may be effective at lowering odds of CIG or dual use, especially for those with higher levels of HL. Further research is needed to examine how to best disseminate information regarding the health risks of ECIGs.

Dietary supplementation of exogenous probiotics reduces excessive liver lipid deposition in Chinese perch ( Siniperca chuatsi )

This study aimed to screen the exogenous probiotics that can be used to reduce excessive liver lipid deposition in Chinese perch (Siniperca chuatsi). Chinese perch were, respectively, fed with basal diet (CK) supplemented with Bacillus subtilis BS1 (B) and Lactobacillus plantarum LP1 (L) for 8 weeks. B group and L group exhibited significantly lower crude lipid content in liver than CK group. The relative area of lipid droplets of B group and L group were significantly reduced compared to CK group. B group and L group showed higher levels of total triglyceride and cholesterol than CK group in plasma. The levels of acetate in gut chyme and plasma of B group and L group were significantly higher than those in CK group. The transcript levels of ampk, pparα, cpt1, cs, hl and apoe in B group and L group were significantly higher than those in CK group. The present study indicated that the two exogenous probiotics (Bacillus subtilis BS1 and Lactobacillus plantarum LP1) can be used in aquaculture to reduce excessive liver lipid deposition in Chinese Perch.

Does health literacy explain regional health disparities among adolescents in Finland?

Health literacy (HL)-as a broad range of health-related competencies-has been proposed to be a promising construct in understanding health disparities better, also among adolescents. Several factors have been found to explain differences in adolescents' HL levels; however, not much is known about how different regions of a country or majority/minority status is associated with HL, or whether HL is associated with regional health disparities. The aim of this study was to examine and compare HL and health levels among majority- and minority-language-speaking adolescents living in different regions of Finland, and to explore if HL explains regional health disparities, taking into account other important structural stratifying factors. The study uses Health Behaviour in School-aged Children survey data, collected among 13- and 15-year-old pupils in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). Findings suggest that regional differences in HL levels and regional health disparities exist in both language groups. Health disparities were present in the Finnish-speaking sample among boys, the proportion rating their health as excellent ranging from 23 to 31% across regions, and in the Swedish-speaking sample among girls, the corresponding numbers ranging from 13 to 20%. In addition to other important structural stratifying factors, comprehensive HL explains these regional health disparities. This study adds to prior studies on the role of HL as a modifiable health resource by showing that regional health disparities among adolescents can partially be attributed to corresponding HL differences.

The relationship of health literacy, wellbeing and religious beliefs in neglected and unequal contexts-Results of a survey study in central Afghanistan.

While multiple studies worldwide reveal the strong impact of various determinants on health literacy, empirical data on the link between health literacy and other important dimensions of health equity (such as quality of life, beliefs and health literacy in crisis-affected religious countries such as Afghanistan) is scarce. To inform and develop promising health promotion for people in need, we analysed the relationship between health literacy, quality of life and spiritual and religious beliefs. In this first study on health literacy in Afghanistan, we interviewed 522 men and 324 women in the Ghazni province. Besides the HLS-EU-16, we used Quality of Life (WHO-QoL-BREF) and the WHO-SRPB-BREF questionnaires in Dari and Pashto. We performed descriptive, uni- and multivariate analyses. The levels of HL, QoL and SRPB_coping are comparatively low among Afghan men from the Ghazni province, but higher among women on all scales. HL and QoL are positively associated with education and negatively with age (in the female subsample). HL and QoL show a moderate correlation among women but not among men. We found mixed results for the relationship between SRPB and HL or QoL. The study highlights that health literacy is not a singular factor but related to wellbeing. SO WHAT?: Health education might be promising while combining health literacy to the idea of quality of life of everyone, even those living in poor and illiterate environments.

The accuracy of standard audiometric hearing level thresholds in pediatric patients

ObjectivesStandard audiograms provide decibels Hearing Level (dB HL) thresholds, which are referenced to normative values specified in decibels Sound Pressure Level in an acoustic coupler. Due to variability in external ear acoustics, the actual sound levels reaching the eardrum can vary across individuals. The real-ear to coupler difference (RECD) is a frequency-specific measurement of the difference between sound levels measured at the eardrum and in a coupler. Here, we compare the standard audiogram dB HL levels to RECD corrected hearing thresholds (dB RECHL) in children. MethodsChildren who underwent standard audiometric and RECD testing were included. The dB RECHL was established and the differences between dB HL and dB RECHL (threshold error) was calculated. A threshold error >5 dB was considered significant. ResultsA total of 166 children were included (mean age 12 years). Overall, 14% had normal hearing, 52% had conductive hearing loss and 27% had sensorineural hearing loss. Hearing threshold levels were overestimated by the standard audiogram compared to dB RECHL, at all frequencies (250–6000 Hz). In the lower frequencies and at 6000 Hz, 33–59% of patients were overestimated, with a threshold error up to 25 dB. In the mid frequencies, 33% were overestimated with a similar threshold error. ConclusionStandard audiogram thresholds overestimated hearing levels in children which may have clinical implications. This problem can be addressed by correcting thresholds with RECD. More studies are needed to assess the effect of correcting thresholds on hearing outcomes in children.

Measuring Health Literacy in Tuscany through the Italian risk factor surveillance system (PASSI)

Abstract Background Health literacy (HL) can be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. A module to measure HL has been implemented in Tuscany since 2017 within the Italian risk factor surveillance system (PASSI). Here, we aimed to assess HL levels and their relations with social determinants and health behaviours. Methods During 2017-2018, a representative sample (N &amp;gt; 7000, aged 18 to 69 years) of the Tuscan population was interviewed in PASSI. HL was measured using the Italian version of the short-short form (HLS-EU-Q6) of the HLS-EU-Q47. Multivariate analysis was performed to investigate associations between HL, social determinants and selected health behaviours (diet and physical activity). Results 61% of the interviewees had an adequate HL level, 30% problematic and 9% inadequate. In the multivariate analysis, the odds of inadequate HL level increased for all social determinants except gender and loneliness. The strongest association was observed for foreign citizenship (OR 3.38, 95% CI 2.63-4.34) followed by financial problems (OR 2.10, 95% CI 1.73-2.55), low education (OR 1.91, 95% CI 1.58-2.32), being aged 50-69 years (OR 1.51, 95% CI 1.18-1.94) and unemployment (OR 1.42, 95% CI 1.17-1.72). With regard to health behaviours, subjects with inadequate HL level had the lowest odds of engaging in regular physical activity (OR 0.59, 95% CI 0.49-0.71) and one of the lowest odds of eating at least three portions of fruit and vegetables (OR 0.79, 95% CI 0.65-0.95). Conclusions Our findings suggest that HL is strongly associated with social determinants and has major influence on health behaviours. Our study is still ongoing, with the next step being to build a conceptual model to depicting the effect of HL as a mediator of the association between social determinants and health behaviours. Key messages Health Literacy is strongly associated with social determinants. Health Literacy has major influence on health behaviours.

Health Literacy level and related factors of students in a health vocational high school

Abstract Background Health literacy (HL) is defined as the capacity to acquire, interpret and understand basic health information and services in a way to improve person's health. Population health literacy level was found to be inadequate or limited with 64,4% Ä°n Turkey Health Literacy Research (2015). The aim of this study is to determine the HL levels of students attending health vocational high schools and the related factors. Methods The population of this cross-sectional study was students who attended to the vocational school in the center of Malatya. The sample size was determined as 337 by using the power analysis based on Turkish data. Official permission was obtained for the research. In May and June 2019, Turkish Health Literacy Questionnaire-32 (THLQ) developed by the Ministry of Health was applied to the accepting students in this study.The score obtained from the scale is considered to be insufficient of 25 and below, limited to &amp;gt; 25-33 points and a score of &amp;lt; 33 and above is sufficient or excellent. In the analysis of the data, Kolmogorov Smirnov, Mann Whitney U and Kruskal Wallis tests were used and p &amp;lt; 0.05 was chosen as the level of error. Results 68% of the students is female and 32% is male. The average age of the research group is 16.6 ± 1.1 (min. 14, max. 20). 18.3% of male students stated that 6.6% of female students smoke. The THLQ score of the study group was found to be 33.7 ± 8.9. 53.7% of male students and 39.5% of female students had insufficient or limited HL different from each other significantly (p &amp;lt; 0,025). 56.4% of students in 9th and 10th grades and 37.4% of 11th and 12th grade students were found to have insufficient or limited HL significantly (p &amp;lt; 0,0001). There was no difference between HLL scores and other socio-demographic characteristics(p &amp;gt; 0,05). Conclusions The frequency of adequate or excellent HL in the study group is higher among females (60.5%) than males (46.3%). It can be said that female students value health more. Key messages The limited level of health literacy of health vocational high school students indicates the insufficiency of health education in schools. Health topic campaigns should be organized frequently for awareness on health education during school education.

Health literacy among participants from neighbourhoods with different socio-economic statuses in the southern region of Hungary: a pilot study

BackgroundHealth literacy (HL) has a deep impact on people’s decisions about their health and health care system. Measurement and improvement of HL level is essential to develop an appropriate health care system. The aim of the study was to (1) conduct a pilot study among the population of Baranya County in Hungary with different socio-economic statuses, (2) evaluate the HL level and (3) found the correlations between socio-economic data, emergency departments’ visits, medical history and HL.MethodsIn a cross-sectional study conducted in 2019 with 186 participants, socio-economic status, health status, HL level and knowledge about the triage system were measured. The questionnaire included questions on socio-economic status, previous chronic diseases, and satisfaction with the emergency care system as well as the standardised European Health Literacy Survey Questionnaire (HLS-EU-Q47). Descriptive statistical analysis (mean, SD, mode) and mathematical statistical analysis (ANOVA, chi2 test, Pearson Correlations, Two sample t-test) were applied. SPSS 24.0 statistical software was used to analyse the data. Relationships were considered significant at the p < 0.05 level.ResultsOne hundred and eighty-six people were involved in the research, but 45 of them were excluded (N = 141). The participation rate was 75.8%. There were significant differences in HL levels by gender and educational level (p = 0.017), health education (p = 0.032) and presence of children in the household (p = 0.049). Educational level (p = 0.002) and type of settlement (p = 0.01) had strong impacts on economic status. We found that 46.1% of the participants had limited comprehensive HL (cHL) level. This proportion was slightly lower for the disease prevention sub-index (33.3%). The average cHL index score was 34.8 ± 8.7 points, the average health care sub-index score was 34.6 ± 9.7 points, the average disease prevention sub-index score was 35.8 ± 9.9 points, and the average health promotion sub-index score was 34.2 ± 9.4 points. 46.1% of the examined population in Hungary had limited HL level.ConclusionsSocio-economic status has a strong influence on HL level. It is not enough to improve awareness but we need to improve knowledge and cooperation with the doctors and health care system.