Limited Health Literacy Research Articles

Association of Limited Health Literacy With Frailty, Health-Related Quality of Life, and Health Care Utilization Among Older Adults With Cancer: The Cancer and Aging Resilience Evaluation Registry.

Limited health literacy-ability to obtain, process, and understand health information-can hinder communication, access to medical treatment, and identification and management of comorbidities. Older adults have high rates of poor health literacy, but its role in aging-related outcomes among older adults with cancer is understudied. We included 876 older adults age 60 years and older with cancer from the Cancer and Aging Resilience Evaluation Registry completing self-reported geriatric assessment, including health literacy, at first visit to medical oncology. The exposure was limited health literacy. Outcomes were frailty, physical/mental health-related quality of life (HRQOL), and health care utilization. We used modified Poisson regression to examine the association of exposure on outcomes adjusting for age, race-ethnicity, sex, and cancer type/stage. Median age at enrollment was 68; 57.8% were male; 20.2% were non-Hispanic Black. The most prevalent cancers were advanced-stage (46.8% stage IV) colorectal (26.9%) and pancreatic (19.0%). Those with limited health literacy were older (70 v 68 years; P < .001), male (63.0% v 55.1%; P = .026), non-Hispanic Black (28.8% v 16.1%; P < .001), ≤high school educated (62.3% v 28.1%; P < .001), and retired/disabled (86.3% v 71.2%; P < .001). In multivariable analysis, limited health literacy was associated with higher prevalence of frailty (prevalence ratio [PR], 2.64 [95% CI, 2.15 to 3.26]), impaired physical (PR, 1.90 [95% CI, 1.59 to 2.27]) and mental (PR, 2.08 [95% CI, 1.76 to 2.47]) HRQOL, and hospitalization in the last year (PR, 1.28 [95% CI, 1.10 to 1.48]) versus adequate health literacy. Older adults with cancer and limited health literacy had higher adjusted prevalence of frailty, impaired physical and mental HRQOL, and recent hospitalization. Interventions to address limited health literacy should be explored in this vulnerable and growing cancer population.

The Association of Health Literacy With the Quality of Discharge Planning and Readiness for Hospital Discharge in Jordanian Acute Myocardial Infarction Patients.

To examine the relationship between health literacy with the quality of discharge planning and readiness for hospital discharge in acute myocardial infarction patients in Jordan. Acute myocardial infarction is a major heart disease caused by plaque formation in coronary arteries. Complications after acute myocardial infarction include readmission and physical complications such as chest pain, and limited health literacy increases the risk of complications. Improving the health literacy of patients can improve postdischarge outcomes and decrease complications. This study was conducted using a cross-sectional design. Data were collected from 123 patients who were recruited from three hospitals in Jordan. A demographics questionnaire and three valid and reliable instruments (Health Literacy Questionnaire, Readiness for Hospital Discharge Scale and Quality of Discharge Teaching Scale) were used to collect the data. The authors adhered to the STROBE checklist during the preparation of this study. The results demonstrated that the Readiness for Hospital Discharge had weak to moderate positive correlations with health literacy scales (r = 0.24-0.36, p < 0.05). The content subscale of the Quality of Discharge Teaching Scale showed weak positive correlations with navigating the healthcare system, finding good health information and understanding health information scales of the Health Literacy Questionnaire. The results reported here indicate that health literacy positively correlates with readiness for hospital discharge and quality of discharge teaching. Improving the health literacy of acute myocardial infarction patients can enhance their discharge planning outcomes. The findings of this study are beneficial for healthcare providers in designing targeted interventions that correspond to health literacy among acute myocardial infarction patients. No patient or public contribution.

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease.

Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited. This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD. This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records. The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = -0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables. Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Australian private healthcare staff perspectives on patient reported experience measures (PREMs): a qualitative interview study

ObjectivePatient reported experience measures (PREMs) are common tools utilised in hospitals to support quality improvements, allow consumers to provide feedback on care experiences and can be used to support consumers’ hospital selections. This study aimed to understand the views and opinions of private hospital staff on PREM use and the utility of PREMs as a consumer decision-making tool.MethodQualitative, semi-structured interview study conducted via telephone between March-June 2023. Participants (n = 10) were recruited from major private healthcare providers in Australia with half representing hospital-based staff and the other half corporate head office staff who work in patient experience and quality. Interviews were audio-recorded, transcribed, and analysed thematically.ResultsPREM benefits included an understanding of patient experience that improved provision of patient centred care with feedback acting as catalyst for change, to corporate-level strategic initiatives that address specific issues. Drawbacks of PREM reporting included concerns around skewed results by biased respondents, and completion based on hard to alter items (e.g., infrastructure) or on matters outside of hospital control (e.g., insurance). Staff had mixed reactions to consumers using PREMs results when selecting a hospital, some advocated for transparency while others feared consumers would misinterpret the data.ConclusionsImproved real-time reporting of PREMs, learning from other industries about recording customer experience, and mandatory reporting by private hospitals could further the benefits of PREM measurement in private healthcare. Recognised was the need for PREMs to be displayed in a readily understood way so those with limited health literacy can correctly interpret.

Health literacy and COVID-19 pandemic impacts among adults in rural northern Arizona.

Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona. A cross-sectional, interviewer-administered survey was conducted with 119 adults from June 2020 to August 2021. Participants were recruited from two federally qualified health centers and by word of mouth. The Newest Vital Sign was used to measure health literacy, and the Epidemic-Pandemic Impacts Inventory was used to measure the effects of the COVID-19 pandemic on various aspects of personal and family life (eg spent more time on screens and devices, had family celebrations canceled or restricted). Descriptive, bivariate, and multivariable linear regression statistics were computed. Nineteen percent of participants had limited health literacy, and participants had an average of 22 individual impacts and 2 household impacts of the 92 COVID-19 impacts assessed. Multivariable regression model results showed that being male versus female or having public only versus any private insurance was significantly associated with fewer individual COVID-19 impacts on average. Being black, Indigenous, people of color versus White or being Hispanic, Latino, or Spanish versus not were each associated with significantly more individual COVID-19 impacts on average. Limited versus adequate health literacy was significantly associated with more household COVID-19 impacts on average. Sensitivity analysis results further showed that limited versus adequate health literacy was associated with significantly higher adjusted rates of household social, emotional, and infection COVID-19 impacts. This study's findings highlight the importance of assessing and accounting for health literacy in clinical practice and health services research addressing the impacts of the COVID-19 pandemic and future emergency events.

Factors associated with over-the-counter drug misuse among young people: a narrative review

Abstract Background Over-the-counter (OTC) medications are sold directly to customers without requiring a doctor’s prescription. Misuse of OTC drugs is higher in adolescents and young adults than in the general population. This review is the first to narratively synthesize the factors associated with OTC drug misuse among adolescents and young adults (14-25 years old). Aim To identify the factors that are associated with OTC drug misuse among adolescents and young adults (14-25 years). Methods A comprehensive search of three electronic databases, including MEDLINE, PsycINFO and Web of Science, was conducted to retrieve publications between 1 January 1997 and 31 July 2023. The AXIS tool was used to aid critical appraisal. Papers were analysed using thematic analysis. Results Eight studies were eligible for inclusion in this narrative review We identified four key themes: motivational factors; health literacy; illicit drug use and socioeconomic status. Sensation-seeking and using OTC drugs for recreational purposes were associated with OTC misuse. Limited health literacy and lack of understanding of OTC drugs were significant factors for misusing OTC drugs. Greater use of OTC drugs at the same time as alcohol and other illicit drugs represented that they were at increased risk for misusing OTC drugs. Finally, adolescents and young adults with low income, from rural areas and with lower educational attainment were most likely to misuse OTC drugs. Conclusions Although over-the-counter medications (OTCs) encourage self-medication, their rising misuse has led to a public health problem to which nations worldwide are responding. Therefore, education and awareness among OTC drug users policy will be helpful further on strategies to prevent the misuse of OTC drugs. Key messages • This review identifies some of the factors for misusing OTC drugs, and education and awareness among OTC drug users policy may be helpful further in strategies to prevent the misuse of OTC drugs. • This review also identifies that changing the user habits and availability of OTC drugs policy may also be helpful in further strategies to prevent the misuse of OTC drugs.

Limited critical and communicative health literacy is related to poorer health among older adults

Abstract Background Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults. Methods Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age. Results Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL. Conclusions Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way. Key messages • Limited health literacy among the older population is associated with several negative health-related outcomes. • Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.

Factors influencing protective gear use in crisis-affected Afghanistan during COVID-19

Abstract Background Afghanistan has faced considerable challenges in healthcare delivery during the COVID-19 pandemic. These challenges were compounded by limited health literacy, shortages of skilled health workers, and fragile health infrastructure, which increased the country’s double burden of disease. The World Health Organization (WHO) recommended the use of masks as part of a comprehensive strategy to mitigate the spread of SARS-CoV-2. Nevertheless, research on mask-wearing practices in Afghanistan is limited. This study aims to investigate the factors influencing the wearing of protective gear, including masks, during the COVID-19 pandemic in Afghanistan. Methods This study analyzed 16,058 households from the 2020 Afghanistan Multi-Sector Needs Assessment (MSNA) survey data. This survey was conducted between August and September 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative. Sampling weighted multivariable binary logistic regression analysis was performed. Results Recent internally displaced persons (IDPs) and returnees in Afghanistan were more likely to wear protective gear to prevent COVID-19 compared to non-recent IDPs. Factors such as household sizes, household income, knowledge of humanitarian support, and the distance to healthcare facilities were significantly associated with the likelihood of wearing protective gear. Conclusions The study suggests that certain factors place crisis-affected populations in Afghanistan at high risk in COVID-19 preventive behaviors, especially in wearing protective gear. The findings in this study indicate that public health interventions should focus on improving healthcare accessibility and enhancing information dissemination while considering socioeconomic factors. Additionally, this study highlights the need for access to personal protective gear during outbreaks of infectious disease, such as the COVID-19 pandemic. Key messages • Socioeconomic factors and accessibility on health services and information can affect COVID-19 preventive behaviors in crisis-affected populations. • This study can inform public health professionals to develop adequate interventions during infectious disease outbreaks.

4.X.1. Health literacy policies – how can they be developed and implemented?

Abstract In Europe and beyond, there is political recognition of health literacy being an important factor for good health and well-being. As health literacy is considered critical to achieving health and as limited health literacy is still a widespread phenomenon, the topic is steadily attracting more attention among policy and decision makers. To meet growing demand from decision makers, a policy guide was initiated by M POHL, the World Health Organization (WHO) Action Network on Measuring Population and Organizational Health Literacy. The guide aims to support awareness-raising, the building of commitment and the implementation of effective policies to improve health literacy. It mainly addresses decision-makers in health policy and administration, but may also inspire researchers and other relevant stakeholders in the health literacy area. Objectives of the workshop This skills building seminar seeks to contribute to capacity building and to offer time for exchange and discussion on health literacy policy work. More specifically, the objectives of the workshop are to: - provide an overview on national health literacy policy implementation; - increase the knowledge of participants on what countries are doing already and identify needs for further support; - support participants in reflecting, initiating, developing and implementing effective measures to improve population and organizational health literacy. Methods of the workshop The workshop will start off by a presentation introducing the guide “Health literacy policies - how can they be developed and implemented?’ and sharing some national experiences in implementing health literacy policies, strategies, and interventions. After these impulses attendees will be divided into groups to enable exchange. A checklist for self-assessment will be provided as a tool to guide the discussion and to identify and address potential challenges in implementing health literacy policies and interventions. The input and identified needs will be captured. They will support M-POHL’s continuing efforts to support policy makers and administrators in their work. Key messages • Health literacy is steadily gaining more interest from policy- and decision-makers. • In this seminar, participants will learn on how evidence-informed policies and practice can be supported.

Youth voices: A participatory approach to promoting mental health literacy through digital means

Abstract A concerning number of young people worldwide experience mental health challenges, often compounded by limited mental health literacy, such as a lack of knowledge about how to recognize mental disorders and strategies for seeking help (Cairns &amp; Rossetto, 2019). Therefore, it is crucial to promote mental health literacy among youth. Due to the scarcity and often high cost of readily available mental health services, as well as concerns about anonymity, digital programs have become an alternative means of reaching youth. To this end, a digital prevention program was developed. The pivotal question now is how to effectively promote young people’s mental health literacy through digital means, more specifically: How to develop (1) evidence-based and (2) target group-specific content? To investigate these questions, two systematic reviews were conducted that analyzed a total of 65 digital evidence-based mental health programs. Since the active use of programs also depends on how suitable and appealing the content is for the target group, a participatory approach was chosen to actively involve the target group in the process of developing the program’s design and content. Therefore, four participatory workshops were conducted in Slovenia, Poland, and Austria, with 12-15-year-old students (N = 182). Selected results from the systematic reviews and cross-national results from the workshops will be presented. It was found that psychoeducation is an important and effective method for promoting mental health literacy among youth and that young people prefer this content to be delivered as briefly and concisely as possible, and in a multimodal format. The discussion will highlight key takeaways regarding the benefits and challenges of this approach, emphasizing the necessity of including student voices in the creation of psychoeducational content for a digital mental health program in order to highlight and recognize young people’s right to participate. Key messages • The value of youth participation - Involving young people in the development of content for a digital mental health literacy program is a means to increase its relevance and appeal to them. • The intricacies of youth participation - Involving young people in the development of a digital mental health literacy program presents challenges that require careful consideration.

Public Health Literacy: a concept to develop – Qualitative study among public health professionals

Abstract Background Health literacy can be defined as individuals’ motivation and skills to access, understand, evaluate, and utilize information to make decisions about their health. Despite Sorensen’s widely used definition encompassing both individual and population levels, also known as Public Health Literacy, it remains poorly detailed and is rarely taken into account by measurement tools. As evidenced by the Covid-19 health crisis, limited public health literacy impacts reluctance to accept government recommendations, vaccine hesitancy, and fosters mistrust of science and conspiracy theories in the health field. The main objective of this study was to derive specific public health knowledge and skills from public health professionals for the general population constituted the first step of the development of a public health literacy measurement tools. Methods A qualitative study, based on ten semi-structured interviews with public health professionals from various settings (academic, hospital, health prevention, and promotion), working across various public health fields (nutrition, sexual health, mental health), has been conducted since March 2024. Results Preliminary analysis identified three main themes: (1) fundamental concepts including identification of health determinants, epidemiology and the purpose of public health interventions, (2) critical skills including the assessment of the level of evidence and reliability of public health information, and (3) civic orientation including environmental impact on health and community approach to interventions. Conclusions These detailed insights will guide the creation of a valid measurement tool for public health literacy. This will facilitate the investigation of specific impacts on people’s adherence to public health interventions or messages and the development of actions targeting literacy in a more holistic manner. Key messages • Specific public health dimensions have been identified to enrich the existed definition of health literacy. • Public health concepts, reliability of public health information and community approach constitute the core of public health literacy.

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.

Using PPI and UDL principles to design a gastrointestinal endoscopy patient information video series

Abstract Introduction Patients undergoing GI endoscopy often experience anxiety and due to limited health literacy. Traditional paper-based information leaflets are often not sufficient to accommodate for the diverse way in which people consume information. Public and patient involvement (PPI) and universal design for learning are two well-described pedagogical principles. We wanted to use these principles to design more effective patient education materials. Objectives Given the heterogeneity of resources available to patients, the authors wanted to develop a high-quality and trustable video resources for patients that would be available on our hospital website. These videos would be co-designed by patients and ancillary staff, through the formation of a key stakeholder panel. Results Using PPI principles, we were able to improve the relevance and quality of our content, through the use of storyboards and the expertise of the stakeholder panel. Through the three key UDL principles of multiple means of representation, engagement and action and expression, we were able to ensure that our videos were accessible and appropriate for all of our patients. Initial feedback from stakeholders and patients provided valuable insights, prompting necessary adjustments for accuracy and patient understanding. This comprehensive approach underscores the commitment to enhancing healthcare delivery. Our project is the first guide in combining both pedagogical principles in the development of patient information and education materials. Conclusions The meticulous steps taken, from stakeholder engagement to video production, reflect a commitment to inclusivity and patient-centred care. Ongoing evaluation and feedback mechanisms ensure continuous improvement, contributing to the overall success and sustainability of the digital service. Key messages • This is the first research/patient education piece designed using both PPI and UDL principles. • The importance of patient-centred educational design is key to improving health literacy and education in our patients.

Empowering health literacy: Turkiye’s Health Literacy Action Plan 2022-2026

Abstract Issue/Problem The ‘Health Literacy Action Plan 2022-2026’ of the Turkish Ministry of Health addresses the critical public health issue of limited health literacy, leading to increased hospital admissions, inappropriate emergency department use, and poor health outcomes. This underscores a significant challenge in individual health self-management and higher healthcare expenditure within the country. Description of the Problem The Health Literacy Action Plan aims to tackle disparities in health literacy levels among people. It employs customized teaching schemes, digital communication, and inclusive healthcare practices to reach every demographic group. The plan seeks to enhance health knowledge and empowerment among Turkish people by increasing access to medical information, simplifying clinician instructions, and promoting closer communication between patients and healthcare professionals. Results Comparative evaluation of nationwide surveys conducted in 2017 and 2023 with 15,000 participants shows remarkable improvements. Despite delays due to the pandemic, the action plan led to a notable increase in adequate health literacy levels from 31.9% in 2017 to 46.1% in 2023. Additionally, significant improvements were observed in ailment prevention and health promotion, with health literacy levels in disease prevention increasing from 28.4% to 45.7%. Lessons The Health Literacy Action Plan plays a crucial role in developing and implementing multifaceted public health strategies based on data and stakeholder participation. These interventions, requiring continuous monitoring and adjustment, are essential steps toward achieving high-level health literacy. Key messages • Strategic health literacy interventions are essential for improving health outcomes and optimizing the use of public resources. • Evidence-based interventions and ongoing evaluation are key to promoting health literacy.

The effect of health literacy course on the level of health literacy in medical students

Abstract Health literacy (HL) concerns not only individuals but also health systems and health professionals. Most of the literature on HL has focused on patient factors, with little emphasis on the communication skills and practices of health professionals. Training is needed at all levels to understand the concept of HL and its impact on health inequalities. This study is an intervention study. Data were collected from 29 students taking the third year elective course at the Faculty of Medicine through an online survey. The survey consists of 40 questions aimed at assessing the demographic characteristics of the participants, the TSOY-32 Scale and some factors affecting HL. During the training period, role-play scenarios were played to teach the importance of HL, sample videos were watched to evaluate physician-patient communication, and case studies were conducted. The mean pre-test TSOY-32 scale score of the participants was 32.8±5.8. The mean post-test TSOY-32 scale score was 36.4±7.1. There was a significant difference between pretest and posttest groups in terms of TSOY-32 scale score (p = 0.033). Health professionals often overestimate patients’ HL levels and do not have sufficient competence to effectively manage limited HL. These gaps need to be addressed through the curricula of medical schools and specialties. Key messages • Training on health literacy improves medical students’ communication skills, bridging gaps in patient care. • Addressing health literacy in medical training enhances patient-doctor communication, vital for quality care.

Patient autonomy in self-managing their bronchial asthma exacerbation and its associated factors, 2024.

Asthma, a global chronic respiratory condition, varies in patient autonomy due to limited resources, health literacy, and cultural beliefs, emphasizing the importance of understanding this autonomy for improved asthma management. A cross-sectional study was conducted at Jimma University Comprehensive Specialized Hospital, involving face-to-face interviews with 175 patients. Data was collected on sociodemographic characteristics, clinical factors, and autonomy levels using a validated Patient Autonomy Preference Index. Descriptive statistics and binary logistic regression analysis were used. A total of 175 participants were recruited, out of them 41.7% (95% CI: 31.19, 40.41)) of participants were autonomous in managing their asthma exacerbation. 127 (72.6%) of study participants were female, with a mean age of 47.51 (SD ± 13.96), 101(57.7%) were live in urban areas, 54 (30.9%) had no formal education, 140 (80%) were married, 112 (64%) had health insurance, and 102(83.3%) obtained health information about their condition from healthcare workers. Reside in an urban area (AOR = 3.24; 95% CI: 1.40-7.49, p < 0.006), have health insurance (AOR = 4.30; 95% CI: 1.76-10.51, p < 0.001), those doing regular exercise (AOR = 4.79; 95% CI: 1.69-13.64, p < 0.003), have family history (AOR = 7.47; 95% CI: 1.61-34.60, p < 0.01), have a duration above five years since diagnosis (AOR = 0.44; 95% CI: 1.04-1.26, p < 0.003), and participants with a high level of health literacy (AOR = 1.10; 95% CI: 1.00-1.20, p < 0.042) become associated with being autonomous in managing asthma exacerbation. Only around forty-two percent of study participants were autonomous in managing their asthma exacerbation. Thus healthcare providers should give due attention to those who reside in rural areas, are not insured, recently diagnosed with asthma, and with low health literacy to enhance patient autonomy and self-management practices, ultimately improving health outcomes for individuals with asthma.

Limited health literacy increases the likelihood of cognitive frailty among older adults

BackgroundCognitive frailty is a dual geriatric syndrome that is preventable with lifestyle changes. Lifestyle changes are influenced by literacy level. However, the association between limited health literacy (HL) and cognitive frailty (CF) is yet to be discovered.ObjectivesThis study aims to determine the association between HL and CF among older adults.MethodsData was collected between April 2021 to March 2022 in this cross-sectional study. Citizens aged 60 years and older who can understand Malay and English were selected through purposive sampling from the AGELESS Trial screening sample frame. HLS-M-Q18 was administered to determine HL and CDR, and Fried’s Criteria were used to assess the CF status.ResultsA total of 757 participants were included in the analysis. 68.2% of the total participants had a limited HL level. The prevalence of CF among older adults with limited HL was 48.2% as compared to those with adequate HL (28.2%) (p < 0.001). Based on the HLS-M-Q18 index scores, the robust group had a higher HL index score than those in the CF group: 36.1 (SD = 10.5) and 33.4 (SD = 8.6), respectively, p < 0.05. In binary logistic regression, limited HL, increasing age, lower income, lower education level and rural locality were associated with the increase of CF occurrence. Older adults with limited HL have 2.6 times higher odds of having CF.ConclusionApproximately two-thirds of multiethnic older adults in the study had limited HL, with those with limited HL has 2.6 times higher odds of having CF. These findings emphasize the importance of addressing HL to improve their health outcomes and well-being.

7991 A Quality Improvement Initiative to Increase Documentation of Carbohydrate Ratios and Correction Factors on Insulin Sliding Scales

Abstract Disclosure: R.J. Vitale: None. C. Lu: None. A. Sonawalla: None. T.K. Maxwell: None. S. Nanavati: None. N.E. Renthal: None. E.T. Rhodes: None. C.E. Cherella: None. Background: In the management of insulin-dependent diabetes mellitus, sliding scale (SS) tables - which contain precalculated insulin doses for ranges of blood glucose and carbohydrate intake, usually based on a carbohydrate ratio (CR) and correction factor (CF) - provide a safer alternative for families with limited health literacy and numeracy. However, as insulin needs change, adjusting SS tables can be more difficult than adjusting CRs and CFs, which can cause less frequent or non-standard adjustments in SS tables, result in potential errors, and lead to disparities in the quality of care for these patients. We identified challenges to standardized SS documentation and adjustment at our institution and conducted a quality improvement (QI) initiative to address this problem. We aimed to increase the use of CR/CF to generate and adjust SS to improve the ease and accuracy of SS adjustments and ultimately improve care for this vulnerable patient population. Methods: Our goal was to increase the proportion of patients with diabetes mellitus discharged with CR/CF documented on the most recent SS in the medical record (the primary outcome measure) by 20% over 12 months. The process measure was clinician-reported utilization of CR/CF when generating or adjusting SS. To achieve our goal, we made two process improvements and used Plan-Do-Study-Act cycles to evaluate them. First, we standardized the template for documentation of the SS which also prompted inclusion of the CR/CF to preserve it for future adjustments. Second, we developed a Microsoft Excel SS generator based on clinician input of CR/CF. Clinicians were educated about the importance of CR/CF documentation and were taught to use the new process. SS documentation of CR/CF in the medical record was evaluated through monthly chart review and tracked on a run chart. Clinicians were periodically surveyed on the frequency of use of CR/CF in the creation of SS. Results: The median value of SS that included CR/CF documentation in medical records increased from 0% at baseline to 58% after the interventions. Reported use of CR/CF to make and adjust SS increased from 6/15 (40%) to 6/7 (86%). Provider qualitative feedback on the new process was positive. Conclusion: In this QI project, the implementation of a template that promoted documentation of CR/CF, and a standardized and automated SS calculator that generated SS based on CR/CF, led to both increased documentation of CR/CF for SS, and increased clinician-reported use of CR/CF to adjust SS. The latter may indicate a decrease in barriers to adjusting SS regimens. By facilitating adjustment, this low-cost, reproducible system could increase frequency of changes to SS and may help to improve the quality of care for children with diabetes mellitus using SS. Presentation: 6/2/2024

Effectiveness of a health literacy intervention targeting both chronic kidney disease patients and health care professionals in primary and secondary care: a quasi-experimental study.

Chronic kidney disease (CKD) patients with limited health literacy are at risk for faster disease progression. To counteractthis problem, we developed 'Grip on your Kidneys' (GoYK), an intervention targeting patients and health care professionals. We assessed the effect on self-management, patient activation, clinical parameters, consultation quality, and the professionals' use of health literacy strategies. We further evaluated the process. A quasi-experimental study included 147 patients with CKD and 48 professionals from Dutch general practices and nephrology clinics. Patients and professionals in the intervention group (IG) received GoYK. Control patients received care-as-usual from the participating professionals. Data were collected with questionnaires and from patient records at baseline (T0), 4months (T1) and 9months (T2). No effects on self-management and patient activation were found. Conversely, at T2, the proportion of patients with hypertension decreased in the intervention group (odds ratio = 0.45, 95% confidence interval (95%CI) [0.20, 0.99]). In the intervention group, more lifestyle topics were discussed, at T1 (difference = 0.80, 95%CI [0.28, 1.31]) and T2 (difference = 0.69, 95%CI [0.14, 1.25]). Furthermore, several outcomes related to consultation quality improved. Professionals in the intervention group improved the use of health literacy strategies more, at T1 (difference = 0.64, 95%CI [0.33, 0.95]) and T2 (difference = 0.56, 95%CI [0.19, 0.93]). In general, patients and professionals considered GoYK to be useful. GoYK is promising, and offers a blueprint to optimize care for patients with limited health literacy. Researchers should develop and test interventions like GoYK, focusing on patients at risk for CKD, and with very low health literacy.

Knowledge and perceptions of health literacy among pharmacists in Ohio in 2013 and 2021

BackgroundThere is limited existing literature on pharmacists' knowledge of health literacy and the interventions pharmacists use to address limited health literacy. ObjectivesThe primary objectives of this study were to evaluate pharmacists' knowledge and perceptions of the impact of limited health literacy on patients and their practice, and to review the techniques used to care for patients. MethodsWe conducted a cross-sectional, web-based survey of registered Ohio pharmacists in 2013 and repeated the survey in 2021. The Nursing Professional Health Literacy Survey was adapted and employed to assess 1) general knowledge; 2) health literacy in the workplace; and 3) demographics. Changes in pharmacists' knowledge and perceptions of health literacy, self-reported use of communication techniques, and methods for assessing a patient’s health literacy were evaluated. ResultsResponse rates were 12.4% (N = 62) in 2013 and 3.5% (N = 174) in 2021. Awareness of the term health literacy increased, rising from 82.3% to 89.7% (P = 0.127). Less than 41% of pharmacists in both cohorts had received formal health literacy training; a regression model indicated that pharmacists with more years of practice were less likely to have had such training (P < 0.05). Most pharmacists admitted they never formally assess health literacy (79.0% in 2013 and 81.6% in 2021; P = 0.875) but reported often relying on their gut feeling to gauge a patient's health literacy (37.1% in 2013 and 41.4% in 2021; P = 0.658). The percentage of pharmacists who orally reviewed written instructions with patients, used layman’s terms, and had patients demonstrate instructions significantly increased (P < 0.05) between 2013 and 2021. ConclusionGaps remain in pharmacists' knowledge and practices related to health literacy. From 2013 to 2021, there were improvements in how pharmacists communicate with patients who have limited health literacy, but no significant change in the methods used to assess health literacy.