Literacy Levels Research Articles

Gauging growth in undergraduate information literacy: A case study in library-faculty collaboration

How do academic librarians and teaching faculty assess the impact we exert on students' capabilities as researchers? This paper describes the authors' unique six-week approach to incorporating library instruction into a research assignment for students in introductory Teacher Education and American Politics classes. We constructed a pre- and post- instruction survey that measured change in students' attitudes toward 1) their own level of information literacy, 2) their skills as researchers, and 3) the usefulness of the library's resources. The survey consisted of statements regarding students' attitudes toward the aforementioned categories, measuring agreement on a 6-point scale. We conducted this survey over three consecutive semesters (N = 208). We find that students began the project with high degrees of confidence in their own knowledge and abilities, but also increased their confidence in all categories. Moreover, the change between the pre- and post-project survey was statistically significant on all questions, as assessed by a difference of means test.

The effect of caregivers’ health literacy levels on the quality of life and self-care of patients with heart failure

BackgroundThe aim of this study is to examine the effects of health literacy levels of caregivers on the self-care behaviors and quality of life of patients aged 65 years and older with heart failure. MethodsThe study was conducted in a university hospital in Erzincan, Türkiye between November 4, 2023, and February 12, 2024, on patients hospitalized in internal medicine, cardiology, and cardiovascular surgery wards and their caregivers (n = 206 pairs). ResultsAs a result of the multivariate regression analysis, it was determined that the access, appraisal, and application sub-dimensions of the health literacy of the caregivers positively affected the self-care behaviors and quality of life levels of the patients. ConclusionsThese results reveal the significant effect of the health literacy levels of the caregivers in the management process of heart failure disease. Healthcare providers -especially nurses- can improve patient outcomes of patients with heart failure by considering the health literacy level of their caregivers and using innovative educational methods that can improve the health knowledge and skills of caregivers.

Engagement in Healthcare Decision-Making and Associated Factors among Patients with Chronic Non-Communicable Diseases in Southwest Ethiopia, 2023

BackgroundChronic Non-communicable diseases require lifelong care involving patients, families, a team of their care providers, and significant others. Additionally, engaging patients in their healthcare decision-making is crucial for achieving better clinical outcomes. This study aimed to assess patients' engagement in healthcare decision-making and associated factors among adults with chronic non-communicable diseases in Southwest Ethiopia MethodsA cross-sectional study design was used among 422 participants at the public hospital of Jimma town. Study participants were consecutively recruited from May 01 to June 01, 2023. A structured Patient Activation Measure was used to measure patient engagement in healthcare decision-making. Descriptive statistics and binary logistic regression analysis describe the association between dependent and independent variables. ResultA total of 422 patients with chronic diseases participated in the study yielding a response rate of 99.3%. Slightly greater than one-third (35.8% (95% CI: 31.19, 40.41)) of participants in The study area had a high engagement in healthcare decision-making. Residence (Odd ratio 0.27; 95% confidence interval 0.137-0.534), educational level(Odd ratio 0.168; 95% confidence interval 0.064-0.443), access to information materials(Odd ratio 0.226; 95% confidence interval 0.112-0.458), duration(Odd ratio 3.864; 95% confidence interval 2.083-7.169), health literacy(Odd ratio 1.192; 95% confidence interval 1.111-1.28), and preference for autonomy(Odd ratio 1.097; 95% confidence interval 1.058-1.136) were factors statistically associated with patient engagement in healthcare decision-making. ConclusionOne-third of study participants reported high engagement in healthcare decision-making. Thus, healthcare providers should pay attention to patients with low educational levels, who do not have access to information materials, low health literacy levels, and their preference for autonomy to engage them in their healthcare decision-making.

Digital health literacy and associated socio-demographic characteristics in the French population

Abstract Background With the development of digital devices in the health field, digital health literacy has become an important issue in promoting and protecting people’s health. Digital health literacy was measured in a representative sample of the French adult population in order to assess its level and to identify the socio-demographic characteristics of individuals with the lowest literacy levels. Comparisons with works carried out in other European countries as well as implications for the implementation of digital interventions will be discussed. Methods Digital health literacy was assed using the HLS19-DIGI-HI Instrument. This 8-item scale measuring the skills related to dealing with digital health information was introduced in the 2023 Health Barometer survey, conducted by the French national public health agency. The survey included French-speaking individuals living in France, aged 18-85, selected through randomly generated phone numbers. 3007 persons were interviewed using a computer assisted telephone interview. A continuous score and categories were calculated to determine the level of Digital Health Literacy. Their associations with sociodemographic characteristics were studied using univariate and multivariate analysis. Results 1902 persons declared they used internet to search information or advice on health on internet in the last 12 months and completed the Digital health literacy questionnaire. 61 % of these individuals have a low level of digital health literacy (29 % “inadequate” and 32% “problematic”). Multiple sociodemographic characteristics were associated with lower levels of literacy in univariate and multivariate analysis. Conclusions These results are useful to better understand and assess the digital health literacy of the population according to their socio-demographic characteristics. They will provide a knowledge base to implement web-based interventions for promoting targeted digital health interventions, according to targeted audiences. Key messages • This study in large random sample of the French population showed frequent difficulties to deal with online health information. • Multiple sociodemographic characteristics were associated with digital health literacy and can help to support implementation of targeted digital health interventions.

Digital health divide in Indonesia: evidence from national-level data

Abstract Indonesia is a country in south-east Asia with a diverse population and context underlined by its geographical condition as an archipelagic country. Due to closer proximity to the capital, the Western regions (e.g., provinces in Sumatra and Java islands) are relatively more developed than the central and eastern parts of Indonesia (e.g., Nusa Tenggara, Sulawesi, and Papua). In the last few years, the country started to embrace digital transformation for public services including the health sector. Accelerated by the COVID-19 pandemic, a proliferation of digital health services through for example the use of telehealth and health apps is now considered important to improve access and availability of health services, especially among marginalized and hard-to-reach populations. Nonetheless, the difference in access to information and technology infrastructure and services as well as in the level of digital literacy across different regions in Indonesia may perpetuate the existing inequity in access to health services. In 2022, data from the Indonesian Central Bureau of Statistics showed that the level of internet access in Indonesia’s capital Jakarta has reached 85%, while the level in the eastern part of Indonesia (i.e., Papua) is only 26%. Similarly, the level of internet access in the Western provinces tend to be higher than their Eastern counterparts. Additionally, a survey performed by the Ministry of Communication and Informatics to assess the level of digital literacy in Indonesia shows that 85% out of 10,000 respondents accessed the internet through smartphones. However, almost all respondents encounter problems when accessing the internet, especially regarding network quality which causes unstable and frequent connections disconnected. In addition, the level of digital literacy varies across different regions, with the Western region performing better than other regions (e.g., digital literacy index of 3.64 in Yogyakarta vs 3.55 in Papua in 2022).

Health literacy and individuals’ perception regarding Heart Failure management: patient perspective

Abstract Background Heart failure (HF) is a multidimensional disease that has a significant impact on the quality of life of people with this condition and the person’s level of health literacy is a key element in disease management. Therefore, this analysis aims to assess the correlation between the level of health literacy of people with HF and their level of concern about managing the disease, their perception about quality of life, and access to healthcare. Methods Cross-sectional study conducted through a survey among adults with HF, residents, and healthcare consumers in Portugal. The survey comprised 6 questions on health literacy (HLS-EU-Q6); 9 dimensions of concerns in HF management (4-level scale ranging from “not concerned” to “very concerned”); quality of life and access to healthcare perceptions (5-level scale ranging from “very bad” to “very good”). Concerns global score was calculated based on 9 dimensions of concerns about HF management. The statistical analysis included Spearman’s and Pearson’s correlations. Results A total of 428 responses were analysed. Respondents had a mean age of 70 years, 52.1% were men and 67.9% have secondary education. 47.0% of respondents perceived their access to healthcare as “good”, 63.3 % perceived their quality of life as “reasonable” and 61% have low levels of health literacy. Individuals with a higher health literacy level tended to have lower levels of concerns regarding HF management (r=-0.133; p = 0.006); individuals with a higher level of health literacy tended to have a better perception of their access to healthcare (ρ = 0.145; p = 0.003) and quality of life (ρ = 0.220; p < 0.001). Conclusions The findings reinforce that overcoming health literacy obstacles must continue to be a focus of healthcare systems and institutions to enhance healthcare access, quality of life, and chronic disease management. These efforts may result in better health outcomes, promote health equity and general well-being in this population. Key messages • Individuals with Heart Failure with higher levels of health literacy report less concerns about the management of their condition. • Individuals with Heart Failure and lower levels of health literacy have a worst perception of their access to healthcare and quality of life. Health literacy promotion must continue to be a priority.

The association between cancer literacy and cancer screening behaviours: a systematic review

Abstract Background This study aimed at investigating the association between cancer literacy (CL) and adherence to cancer screening programs. Methods PubMed, Scopus and Web of Science were searched. Any study, published until March 2024, that investigated the associations between CL and cancer screening intention or uptake in any target population were eligible. For CL measurement, both validated and ad hoc tools were considered. For each outcome, articles were grouped according to the type of cancer investigated and results were narratively synthesized. Results A total of 3426 records were retrieved. After deduplication and screening process, six studies were included. Population enrolled was heterogeneous as well as the tool used to measure CL. Four studies explored the relationship between CL and screening uptake, one focused solely on screening intention and another investigated both intention and uptake. Significant association was found between CL and screening intention in the two studies included, with higher literacy levels correlating to increased intent for screening. A significant association between higher CL and skin cancer screening uptake was reported, while the uptake of prostate cancer screening was not significantly associated with CL levels. By contrast, mixed results were obtained investigating breast, cervix and colorectal screening uptake. Conclusions Higher levels of cancer literacy appeared to be associated with screening intention, while its association with screening uptake was found barely significant for any screening type, suggesting that other factors influence the actual screening uptake. However, the scarce number of studies, along with the absence of validated tools and the heterogeneity of target populations, limits the generalizability of the results. Further research, differentiating screening types and timelines and using multivariate models, is needed to clarify the role of CL in screening behaviours. Key messages • Higher levels of cancer literacy appear to be associated with screening intention, suggesting its importance in promoting motivation for early cancer detection. • Association between cancer literacy and screening uptake was found barely significant for any screening type, suggesting that other factors influence actual screening uptake, urging further research.

Patient and practice characteristics related to patient’s consent for health data exchange

Abstract Background Sharing patient health data electronically between healthcare providers can prevent medical errors and improve patient safety. In the Netherlands, exchange of health information is facilitated on a national level and is only allowed with patient consent. Consequently, it is important to know which factors are related to this patient consent. Methods Routine electronic health records data from up to 10% of Dutch general practices (sourced from the Nivel Primary Care Database) were utilized, covering the period from 2016 to 2020. We examined whether patient consent for health data exchange varied depending on patient and practice characteristics, which are expected to have a relationship with granting consent for health data exchange. Therefore, multilevel analysis was performed. Results The percentage of patients granting consent ranged between 40%-50% in the period 2016 to 2019, while this was 97% in 2020, due to the governmental corona opt-in regulation. Significant disparities were observed across several of the included patient and practice characteristics in relation to patient consent for all the years examined. In most years, patient consent provision varied by gender, age, socioeconomic position, location, and healthcare use. Practice characteristics showed notable differences in patient consent across information systems, patient volumes, and practice types over all years examined. Conclusions We observed significant variations in patient consent for health data exchange, both among the included patient (need) and practice characteristics. These differences may stem from unequal exposure to opportunities to grant consent, differences in risk of inadequate communication between healthcare providers, levels of health literacy, and practice resources. These factors should be taken into account by policymakers when further implementing and upscaling the national health data exchange system. Key messages • Variations in patient consent for health data exchange were observed among different patient groups and general practices. • Variations in patient consent for health data exchange may stem from unequal exposure to opportunities to grant consent, levels of health literacy, and practice resources, among other factors.

The Effect of Parents Health Literacy Level on Attitudes Towards Childhood Vaccinations

Abstract While the importance of vaccination services increases day by day, WHO declared vaccine hesitancy as one of the 10 threats to global health in 2019 due to the decrease in vaccination numbers in recent years. Raising parents awareness about childhood vaccines with adequate and accurate information is likely to positively affect vaccination decisions.Although the level of knowledge on this subject depends on parents being able to obtain information using the right sources, this situation can also be associated with a sufficient level of health literacy.This study aimed to evaluate how parents health literacy level affects their attitudes towards vaccines. This cross-sectional study was conducted through a facetoface survey with 400 parents of children under the age of 18 who applied to the Istanbul Faculty of Medicine, ChildHealthDiseasesPolyclinic. Asdata collection tools, a survey form including general approaches to preventive health services and knowledge level about vaccines, as well as the TSOY-32 and PACV were used. As a result of our study, the average of the correct answers given by the participants to the questions regarding their vaccination knowledge levels was determined as 12.1±4.3. The average health literacy general index score was found to be 33.6±4.5. It was determined that 2.5% of the parents had insufficient health literacy levels, and 67.8% had problematic or limited health literacy levels. Parents received a total score of 30.2±23.7 (13 (1-83)) from the PACV scale. It was determined that 13.5% of parents were hesitant about childhood vaccines. It was determined that individuals with vaccine hesitancy had lower general health literacy and vaccine knowledge levels, and they used the media and neighbors as sources of information at a higher rate. Additionally, it was determined that low level of knowledge about the vaccine(OR 1.4 95%CI 1.3-1.6). and using the media(OR 2.3 95%CI 1.0- 4.9) as a source of information poses a risk for vaccine hesitancy. Key messages • Providing community-based training to increase the health literacy level of parents will also create positive changes in vaccine hesitancy. • Community-based studies should be carried out regarding misconceptions about vaccines, especially those acquired from the media, and individuals should be made aware.

An update on the concept and importance of health literacy in young people

Abstract The burden of non-communicable diseases is a growing public health crisis that requires immediate action. As health literacy (HL) has been strongly linked with health behaviours and health outcomes, it has many potential implications for health care and health education. Although recent research has emphasised the importance of developing HL early in life, much of the research has focused on understanding and improving HL in adult populations. As young people socialise in different contexts and are exposed to different health-related situations, they require different HL competencies. As part of a wider project, this study aims to gather the perceptions of international academics and community-based practitioners on the concept and importance of HL in and for young people. Specifically, the study aims to (i) explore current understandings of the concept of HL in young people; (ii) examine the importance of HL for young people; (iii) identify those at risk of having low levels of HL; and (iv) determine the specific health behaviours that young people are currently struggling with. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that HL is a very broad yet individualised concept that is critical to develop at an early age given the difficulty young people face in adopting healthy behaviours in their social and physical environment. Furthermore, the participants highlighted that minority groups, such as members of the travelling community and refugees, and those from low socioeconomic populations, are at greatest risk of low HL. Finally, the health issues that appeared to be of most concern in young people were vaping, social media use and poor mental health. These findings can be used to inform appropriate interventions and policies to target the HL of young people. Key messages • Health literacy is a very, yet individualised, concept that is critical to develop given the difficulty young people face in adopting healthy behaviours in their social and physical environment. • Minority groups, such as members of the travelling community, refugees, and those from low socioeconomic populations are at greatest risk of low levels of health literacy.

The relationship between health literacy level and quality of life in bariatric surgery patients

Abstract Background Today, obesity is an important public health problem. In addition to the intervention programmes developed to prevent obesity, the necessity of medical and surgical treatment is increasing with the growing population. This study was conducted to determine the relationship between health literacy and quality of life in patients undergoing bariatric surgery. Methods This cross-sectional study was conducted with the participation of 136 patients aged 18 years and older who underwent bariatric surgery in a general surgery service between January 2021 and December 2023 and whose contact information was available. The survey participation rate was 75.1%. The questionnaire used for data collection consisted of questions about the sociodemographic information of the participants, The European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Postbariatric Surgery Quality of Life Scale items. Descriptive statistics, Mann Whitney U, Kruskal Wallis H test and Spearman correlation analysis were used to analyze the data. A value of p < 0.05 was considered statistically significant. Results The mean age of the patients who participated in the study was 38.2 ± 10.8 years; mean BMI was 42.3 ± 6.4 before surgery and 29.0 ± 6.2 after surgery. In the study, 44.1% of the patients who underwent bariatric surgery were found to have inadequate/problematic health literacy level. Participants who had less than a bachelor’s degree (p = 0.009) and low income (p < 0.001) had significantly lower health literacy levels. In addition, a moderate positive correlation was found between overall health literacy score and quality of life score (r = 0.252; p = 0.003). Conclusions In conclusion, this study shows that improved health literacy positively affects quality of life in patients undergoing bariatric surgery and that health literacy education should be emphasized in this context. Key messages • The level of health literacy of bariatric surgery patients is a determining factor on quality of life, and therefore health literacy education is important, especially in identified risk groups. • Increased health literacy can have positive results in terms of psychosocial and physical health and improve quality of life after bariatric surgery.

Health literacy in adult cardiac surgery patients; a multi-site Australian study

Abstract Background Almost 60% of Australians report low levels of health literacy (HL). International evidence indicates limited comprehension of the risks and benefits of cardiac surgery, in addition to understanding the basic elements of informed consent. Purpose The aim of this study was to explore HL in adult cardiac surgical candidates. Methods We recruited consecutive English speaking adult patients from a major public (Site 1), major private (Site 2) and regional hospital (Site 3) in Victoria, Australia. Prior to discharge, a Registered Nurse conducted a semi-structured interview using the Health Literacy Questionnaire (HLQ). The HLQ is a multidimensional validated instrument comprised of 9 independent scales. Data were analysed using descriptive statistics, t-tests and ANOVA. Results We recruited 164 (29.5%) eligible participants from; Site 1 (63, 32.1%), Site 2 (49, 19.3%) and Site 3 (52, 49.5%) respectively. Average age was 64.6 (SD 11.8), most participants were male (n = 134, 81.7%), few lived alone (n = 28, 17.1%), 122 (74.4%) identified as being Australian 5 (4.1%) of whom were indigenous and 9 (5.5%) spoke a language other than English at home. The majority of participants highest level of education was aligned with a trade certificate (n = 48, 29.3%) or not completing high school (44, 26.8%) and most were retired (n = 68, 41.5%), working full time (n = 51, 31.1%) or part time (n = 24, 14.6%). Less than half had private insurance (n = 72, 43.9%), more than half had presented to emergency (n = 87, 53.0%) in the previous 12 months and a history of cardiac complaints (n = 137, 83.5%) was as expected. In this study participants felt understood and supported by healthcare providers (Scale 1 M 3.32, SD 0.26), had sufficient information to manage their health (Scale 2 M 3.13, SD 0.35), proactively managed their health (Scale 3 M 2.98, SD 0.39), had strong social supports (Scale 4 M 3.31, SD 0.36), could appraise health information (Scale 5 M 2.88, SD 0.49) and were proactively engaged (Scale 6 M 4.00, SD 0.50). More challenging was their ability to advocate on their own behalf (Scale 7 M 3.80, SD 0.60), to explore information (Scale 8 M 3.70, SD 0.60) and to understand all written information (Scale 9 M 3.90, SD 0.60). Site 2 participants were highly educated, less likely to live alone, more likely to have private insurance, had fewer emergency presentations and higher scores on scales 6 to 9 (p < 0.05) that measure health care interactions, than those from Site 1 or 3. Conclusions There was a high level of HL in this cohort and findings indicate patient strengths in relation to HL differed according to site. In measuring individual skills and experience of participants interacting with services, systems and the health care environment this study provides valuable insight into HL levels in cardiac surgery candidates.

Vaccine literacy and cultural competence training of Professional FOR health to improve the vaccination offer

Abstract Background It is essential that healthcare institutions have a high level of organizational vaccine literacy so that they can support Newly Arrived Migrants (NAM) to navigate, understand and make informed decisions on vaccinations in an effort to make uptake equitable. Developing training material for Professional-FOR-health (PfH) working with NAM, i.e. health and non-health workers, can improve the vaccination offer for NAM. Objectives A holistic training framework for PfH was designed to increase capacity building skills and cultural sensitivity of the healthcare system in promoting active immunization of NAMs. The blended training should cover four topics: “Vaccine Literacy”, “Cultural awareness/migrant sensitivity”, “Health promotion tools with community-based approach” and “Entitlement to vaccination for NAMs/NAMs profile”. As learners cannot be seen as mere recipients of notions, their needs, motivations, and experiences should be put right at the center of the training process. Therefore, a training guide and materials were shared to Consortium Countries to be adapted and implemented in their context. Training sessions were conducted in the summer of 2023. Results A total of 180 participants showed an average increase of 8.2% in correct answers from pre- to post-raining. Notably, 112 participants experienced more than a 10% increase in correct answers. Significant increases were observed across all topics, particularly in Vaccine Literacy (A1) and NAM Profile (A4), with increases of 52% and 74%. The training was evaluated positively with an overall index of 4.2 out of 5. All items analyzed from the satisfaction questionnaire yielded positive evaluations, with an average rating of 4 out of 5. Conclusions The evaluation underscores the effectiveness of training in meeting educational needs of participants. This type of training can be the groundwork for the changes needed to make the NAMs vaccination process more guaranteed and inclusive.

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Health literacy & somatic education: a salutogenic self-resource critical health intervention

Abstract Issue Non-communicable diseases (NCDs), such as musculoskeletal conditions, cause severe functional limitations. Therapeutic practices in this field have employed a theoretical-practical framework with a pathogenic and mechanistic bias. However, the causes of these NCD’s are also related to biopsychosocial factors. Therefore, a critical theoretical-practical approach, such as Somatic Education, becomes relevant as it introduces a subjective experience to an educational praxis, modifying the meaning processes in human movement experience in a complimentary approach to the pathogenic perspective. Description of the problem There is a perceptual poverty in movement experience, which dissociates doing from feeling. Somatic practices aim to foster movement awareness (perception) and autonomy (self-regulation), placing the individual as a valuable resource, strengthening the capacity for understanding, reflection and habitus change. This presentation will focus on the following research questions: Can Somatic Education, as a critical intervention of the body, contribute to increased levels of health literacy? Can somatic practices contribute to sustainable health development? Is it possible to create a new meaningful process in human movement experience through this practice incrementing its salutogenic emphasis? Results/Effects Somatic practices foster integrative approaches of health, promoting subjective bodily experience (interface between doing, thinking and feeling). Integrative progress can urge the embodiment of health literacy, encouraging more active and awareness of individuals related to their well-being, contributing to sustainable health development. Moreover, subjective bodily experience transforms the process of meaning in movement experience. Lessons Somatic practices enhance NCDs prevention and education, increasing health literacy rates through innovative conceptual foundations.

11.K. Scientific session: Roots of public health: school health literacy to enhance population health outcomes in Europe

Abstract This workshop will present empirical results from three representative studies on health literacy and digital health literacy conducted in primary and secondary schools in Wales and Germany: (1) Digital Health Literacy in Schools, (2), HLCA HL-Kids, (3) WHO HBSC Wales. While research on child and adolescent health literacy has gained traction in the past decade, only a few studies focus on health literacy in schools. While the European Commission and WHO, as well as most European governments, highlight the importance of schools to support children’s health literacy, schools remain neglected as a research context. With only little evidence available, it is difficult to derive strategies and programs to promote health literacy in schools. We aim to provide practical novel knowledge and contribute to closing the school health literacy gap that is prevalent in Europe. In turn, this will also contribute to European public health development and population health outcomes. Levels of health literacy in child and adolescent populations across European countries and age groups are alarmingly low, making low health literacy a severe risk factor for health outcomes. Low health literacy is associated with worse health conditions and unhealthy behaviours, and in turn, impacts school attainment and educational outcomes. Evidence suggests that health literacy acts as a determinant of health and itself is influenced by other social determinants of health, such as education, intertwining health and education. All studies conducted so far provide evidence that low health literacy follows a social gradient, with children from less affluent families being more likely to have lower health literacy, widening preexisting health inequities observed in almost all health domains within Europe. While effective interventions on the individual and system levels are needed to enhance health literacy, implementation and evaluation research concerning children’s health literacy is rare. Workshop objectives The aim of this workshop is to present findings from three representative studies on health literacy and digital health literacy in primary and secondary schools: (i) The 1st speaker will introduce a study on health literacy and health behaviours of children aged 8-11 (ii) The 2nd speaker will discuss the influence of living environments on health literacy in 4th-grader school kids (iii) The 3rd presentation will have its focus on navigating the infodemic through digital health literacy in adolescent students (iv) The 4th speaker will show links between digital health literacy and health behaviour in adolescent students The format of this workshop will be 4x10-minute presentations followed by a 20-minute panel discussion with the audience, reflecting the relevance of the results to public health research, practice, and policy. The chairs will provide a brief introduction to the concept and moderate the presentations and panel discussion. Key messages • Our results show that health literacy should be addressed as early as in primary schools and that the places, households, and environments children grow up are critical social determinants of health. • Digital health literacy has proven to be a valid learning topic in secondary schools and is linked to digital and media literacy, allowing us to define it as a targeted curriculum item.

Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia

Abstract Background Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population. Methods We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI). Results Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups. Conclusions Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services. Key messages • Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality. • It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.

An action plan to improve organizational health literacy in hospitals in the Czech Republic

Abstract Background The National Institute for Health Literacy conducted in 2023 as part of the M-POHL network and in close collaboration with the team of the Klaudian Hospital a survey on the level of organizational health literacy using the OHL-Hos tool. The OHL-Hos tool was proven by the project implementation team as suitable for initiating and monitoring organizational change. Methods Based on the self-assessment and the results of the consensus workshop, the project implementation team identified development priorities that were submitted and approved by the hospital management. To keep the sustainability of the implementation, the hospital management decided to formulate an action plan, with the time horizon 2025. Results The proposed action plan, approved by hospital management, focuses on feasible measures within a given time horizon. For each development goal, responsible teams, time frames, and expected results were formulated. The implementation project team evaluated as the most innovative standard the standard dealing with internal communication with patients and their family after discharge and thus to ensure the continuity in supporting personal health literacy of patients and relatives. In addition, as further important standards, easy navigation and access to documents, materials, and services for patients and healthcare professionals were recognized. Interventions focusing on public education, especially for children and students of all school levels, have been proposed to enhance external communication and increase health knowledge in the region. Conclusions The process of regular OHL assessment of set up measures has been considered as a way how to ensure the long-term fulfilment of the newly adopted action plan by the hospital.

Assessment of the level of health literacy in students with specific learning disorders

Abstract Background Specific Learning Disorders (SLDs) include dyslexia, dysorthography, dysgraphia, and dyscalculia and are referred to as specific educational learning disabilities. For students with SLDs, the issue of health literacy (HL) arises because understanding, evaluating and utilising health information are critical to making informed decisions about one’s health. This study aims to determine the level of HL in students with a certified SLD. Methods From November 2023 to April 2024, students with an SLD studying at the University of Udine (Italy) who agreed to participate, were surveyed using an online questionnaire on the EUSurvey platform. This consisted of the HLS-EU-Q47 to measure HL, followed by a socio-demographic section. The HLS-EU-Q47 classified HL into 4 levels: inadequate, problematic, sufficient and excellent; descriptive analysis was performed and the correlation with the sociodemographic data was examined using χ² test. Results 38 students participated (mean age 24 years, 60.5% female), 60% of whom are in an undergraduate degree program. 42% of the sample had a single SLD (26% dyslexia, 13% dysgraphia), while 58% of them have multiple SLDs. Overall, 42% of students were found to have a problematic HL level, 24% inadequate, only 24% sufficient and 11% excellent. No statistically significant association was found between) HL level and gender, number of SLDs, school attended at the time of SLD certification, and use of supports (all p-values>0.05). Conclusions The level of HL in students with SLDs appears to be consistent with data from the Italian population (58% inadequate or problematic) from the 2019-HLS19 Health Literacy Survey. This suggests that the presence of an SLD does not affect the level of HL and that it is likely that the university degree is able compensate for HL difficulties that could be related to the presence of an SLD. A larger sample is needed to see if it is confirmed that there is no association between the investigated variables. Key messages • Despite the presence of SLDs, the HL of academic students follows the same trend compared to the general Italian population. • The structural use of supportive measures by these students probably bridges the gap in access to and correct use of health information.

STI/HIV care in times of COVID-19 according to Dutch healthcare professionals: A mixed methods study

Abstract Background Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers in access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers. Methods We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to care, demand and provision of care, shifts online care, and quality of care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals. Results According to participants, specific subgroups of priority populations may have had difficulties accessing STI/HIV care during the pandemic especially during lockdowns and at public sexual health services. Professionals were concerned to have lost sight of subpopulations in vulnerable circumstances and that the pandemic may have magnified inequalities in access to STI/HIV care, which may be related to different levels of health and digital literacy required for telephone and video consultations. Furthermore, participants found online care provision was not up to standards and were concerned about follow-up care for patients using private online providers of remote tests. Conclusions Professionals experienced that COVID-19 measures may have compounded existing disparities. To minimize inequalities in access to STI/HIV care during a pandemic, it is recommended to prioritize services for people in vulnerable circumstances such as recent migrants and people with low health or digital literacy. More collaboration between and within sectors may help in better organizing healthcare and prevent overburdening of specific sectors. Key messages • According to STI/HIV care providers, the COVID-19 pandemic differentially impacted different STI/HIV care sectors, but also increased existing inequalities in access to care for vulnerable groups. • Professionals experienced that COVID-19 measures impacted the provision of STI/HIV care, access to care for vulnerable populations, and quality of care.