To evaluate whether GPT-4-turbo can generate accurate, patient-centered prostate cancer pathology reports at or below a 6th-grade reading level using a validated reporting template. We retrieved 44 prostate cancer pathology reports from The Cancer Genome Atlas database. We used twenty reports to iteratively refine our prompt refinement and tested the final prompts on 24 unseen reports. GPT-4-turbo generated two patient-centered versions for each report, one below and one above the 6th-grade reading level. We assessed readability using the TextEvaluator tool, which measures eight educational text-complexity dimensions aligned with Common Core standards. We performed paired t-tests to compare the original reports to both simplified versions. GPT-4 significantly reduced the overall text complexity of the pathology reports (p < 0.001). The below 6th-grade versions showed the most improvement. These versions reduced academic vocabulary (mean 68.47-23.16), simplified syntactic structures (p = 0.0018), and used more concrete language (36.65-44.12). Our iterative prompt engineering eliminated hallucinations and ensured clinical accuracy. GPT-4-turbo, when guided by a well-designed prompt and validated template, can produce accurate, patient-accessible prostate cancer pathology summaries. This approach could improve health communication, particularly for patients with limited health literacy, and offers a low-cost, scalable solution for integrating PCPRs into clinical workflows with minimal burden on clinicians. This workflow may improve patient comprehension of cancer diagnoses, enhance shared decision-making, and promote more equitable access to understandable medical information without substantial additional resource demands.

Routine follow-up of lung cancer patients involves thoracic computed tomography (CT) scans every 3-6 months for 2 years and then annually up to 5 years. With increasing numbers of survivors, risk-stratified follow-up, tailoring surveillance to recurrence risk, may reduce unnecessary scans while maintaining high-quality follow-up. This study explored healthcare professionals' (HCPs) perceived barriers and facilitators to implement risk-stratified follow-up in lung cancer care. A qualitative study was performed, involving 14 semi-structured individual interviews with HCPs engaged in lung cancer care. Transcripts were analyzed using inductive thematic analysis, with codes subsequently organized according to the Grol and Wensing framework across six different levels: Innovation, Patient, Professional, Social context, Organization, and Economic and Political. Barriers and facilitators were identified across all levels. HCPs generally viewed risk-stratified follow-up as a promising approach to align care with individual patient risk. Facilitators included its personalized nature, potential to reduce unnecessary imaging, and improve follow-up efficiency. However, HCPs emphasized the need for robust evidence demonstrating safety, effectiveness, and resource optimization. Patient-level barriers included varying follow-up preferences and limited health literacy, while tailored communication was seen as a facilitator. Organizational barriers such as staffing shortages and unclear role delineation were frequently mentioned. Integration into care pathways and interprofessional collaboration were identified as facilitators to address these challenges. Concerns about reduced clinical autonomy and patient safety were also expressed. Financial constraints at the economic and political level were reported to potentially hinder implementation. HCPs are generally receptive to evidence-based risk-stratified follow-up. Successful implementation requires evidence of effectiveness, integration into care pathways, clear roles, and aligned reimbursement.

Poor medication adherence remains a significant public health issue. Although pictograms are established as intuitive visual aids for medication guidance, a current evidence synthesis is lacking, particularly regarding their role in the rapidly advancing digital health landscape. To systematically evaluate the potential effect of pictograms on patients' medication adherence and exploring implications for the digital health era. We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data Knowledge Service Platform, VIP Network, and CBM databases for relevant studies on the effect of pictograms on patients' medication adherence, from the inception of each database to April 27, 2025. A total of 21 articles were included, comprising 19 English and 2 Chinese publications, all of which were randomized controlled trials. These studies varied in terms of study background, sample size, and drug regimens tested. All studies had methodological limitations, with pictographic interventions differing in complexity, duration, and adherence outcomes measured. Twelve studies (57.1%) reported statistically significant effects of pictographic interventions on patient adherence. Pictograms serve as an effective adjunct to enhance medication adherence, particularly among patients managing complex medication regimens or possessing limited health literacy. Future efforts should focus on developing standardized, evidence-based pictogram libraries and integrating them into multimodal medication education systems. Incorporating pictograms into digital health platforms, such as those using AI and smart devices, represents a promising direction for enhancing their reach and impact.

Health Literacy During Inpatient Rehabilitation and Its Association with One-Year Health and Functional Outcomes in Individuals with Traumatic Spinal Cord Injury.

Hereditary cancer syndromes account for 5%-10% of all cancers. Identifying pathogenic variants in a proband guides clinicalmanagement and enables targeted testing of at-risk relatives through cascade testing. By clarifying carrier status,relatives can adopt early surveillance and undergo risk-reducing interventions, while noncarriers are reassured. Despiteclearclinical benefits and cost-effectiveness, cascade uptake remains low worldwide, averaging only ~15%-30%. This review examines facilitators and barriers to cascade testing, and outlines strategies to strengthen uptake. Barriers that existacross three interrelated levels are as follows: Individual, providerand health system. At the individual level, psychosocial concerns such as stigma, discriminationand fear of causing distress to family may limit disclosure. Limited health literacy, misconceptions and cultural norms may further reduce uptake, particularly among underserved groups. Overcoming these challenges requires culturally sensitive, patient-friendly communication to empower families to make informed choices. At the provider level, ethical dilemmas around confidentiality, confidence gaps among non-genetics professionals and shortage of genetic counsellors constrain service delivery. Embedding genetic counsellors in the wider healthcare setting, upskilling non-genetics professionals and normalising conversations about cascade testing can mitigate these barriers. At the health system level, prohibitive costs, fragmented referral pathways and administrative inefficiencies impede access, while legal gaps around genetic discrimination discourage uptake. Sustainable financing models, streamlined care pathways, legislation and international collaborations are needed to support equitable implementation of cascade testing. Cascade testing remains a powerful means for cancer prevention. Addressing individual, professional, and structural barriers through context-specific, multi-level solutions is key to realising its potential and advancing precision medicine globally.

Quality assessment of persian epilepsy mobile applications: A systematic review using uMARS and DISCERN.

There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature. We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine. We conducted a systematic review and a narrative synthesis. Medline, Embase, PsycInfo and CINAHL were searched for studies published between 2015 and 2024. Studies were eligible if they reported on inequities in the diagnosis of mental disorders and applied a quantitative, qualitative or mixed-methods design. Studies had to be peer reviewed, US based and published in English. The Mixed-Methods Appraisal Tool was used for quality appraisal. Data were analysed with a descriptive intent, and inequities were mapped into the diagnostic process. 20 studies of varying methodological quality were included. Though not the initial focus, autism spectrum disorder (ASD) emerged as the most studied mental disorder (n=17). Of the diagnostic errors identified, most fell into the category of delayed diagnosis. 11 factors emerged as contributors to diagnostic inequities. Limited health literacy among patients and caregivers was the leading cause of diagnostic error in symptom recognition. Insurance coverage issues delayed patient engagement with the healthcare system. Provider bias during clinical history-taking and interviewing was seen as a key cause of delays and misdiagnoses. Within diagnostic testing and interpretation, culturally inequivalent assessment measures might cause misdiagnosis and delayed diagnosis for Black/African American and Hispanic/Latino patients. The use of medical jargon and lack of qualified language interpreters during communicating the diagnosis were associated with diagnostic errors impacting patients with limited health literacy and low English language proficiency. Diagnostic inequities in ASD and other mental disorders persist across US patient populations. Multiple factors such as parental health literacy, provider bias and limited access interact and impact the diagnostic process. Addressing these interconnected barriers is essential to ensure timely, accurate and equitable care. CRD42024581271.

Clinical trial (ClTr) participation is critical to high-quality pediatric oncology care, but significant sociodemographic disparities in trial enrollment exist. Identifying modifiable barriers to participation such as household material hardship (HMH) and limited health literacy (HL) is essential to improving ClTr access. We compared differences in caregiver-reported barriers to pediatric oncology ClTr participation across socioeconomic status (SES) and racial and ethnic groups through a nationwide anonymous online survey of caregivers of children with cancer. We also explored associations among caregiver HL, HMH, and barriers to trial participation. English- and/or Spanish-speaking caregivers of children diagnosed with cancer in the last 5years completed the Research Participation Survey - Caregiver (RPS-C) assessing caregiver-reported barriers to ClTr participation, the validated Health Literacy Survey-12 (HLS19-Q12) assessing HL, and the WellRx questionnaire measuring unmet needs. Of 59 participants, 64% were socioeconomically under-resourced, 52.5% identified as racially or ethnically underrepresented per NIHcriteria, and 62% reported their child had not participated in a ClTr. Under-resourced caregivers reported higher RPS-C barrier scores than adequately resourced caregivers (z = 3.18, p = 0.001). There were no significant differences in barrier scores across underrepresented vs represented racial and ethnic groups (p = 0.069). Lower HL (rho = -0.51, p < 0.001) and higher HMH (rho = 0.57, p < 0.001) were associated with higher barrier scores. The most frequently identified barrier was difficulty understanding study risks (> 90%). Under-resourced SES, HMH, and lower HL were associated with increased reported barriers to ClTr participation. Caregivers reported modifiable barriers that could be targets for intervention to improve ClTr participation and reduce disparities in childhood cancer outcomes.

Multimorbidity may affect oral health, especially in individuals with limited health literacy (HL), or specific multimorbidity patterns; however, evidence remains scarce. Understanding these associations could improve early detection and prevention, both in clinical care and public health strategies. This study aimed to assess the association of multimorbidity and multimorbidity patterns with complete tooth loss, i.e. edentulism, and whether HL moderates this association. A total of 42 357 participants from the prospective multigenerational Dutch Lifelines Cohort Study were included. Multimorbidity was defined by ≥2 affected disease domains. Multimorbidity patterns were constructed with latent class analysis. Associations between multimorbidity (and patterns) with edentulism were assessed using logistic regression, with HL as a potential moderator. Models were adjusted for age, household income, and education. Edentulism prevalence was 9.5% and was higher among limited than adequate HL (14.5% vs. 7.9%) and among multimorbid vs. absent (19.5% vs. 7.7%). We identified five patterns: (1) Endocrinological + Psychiatry; (2) Cardiovascular + Endocrinological; (3) Neurological + Otorhinolaryngologic; (4) Endocrinological + Otorhinolaryngologic, and (5) Otorhinolaryngologic + Psychiatric. The odds of edentulism were 2.26 higher (95% CI: 2.06—2.47) in multimorbid. Pattern 2 (Cardiovascular + Endocrinological) had the highest odds ratio of edentulism (OR: 3.52, 95% CI: 3.03; 4.08) compared to multimorbidity absent. HL did not moderate the associations between multimorbidity and edentulism. Edentulism is more likely in the case of multimorbidity, especially if cardiovascular and endocrinological conditions co-occur, an explanation being the shared risk factors. This association remains the same across different HL levels. Our findings support collaborative medical and oral healthcare.

In Madagascar, measles remains a leading cause of infant mortality, and recurrent epidemics highlight the urgent need to strengthen vaccination strategies. Despite regular mass immunisation efforts, such as the national campaign in October 2024, the effectiveness of these programmes is often undermined by complex non-medical factors. This study aims to qualitatively explore the specific religious and socio-cultural beliefs and perceptions that act as barriers to the acceptance of the measles vaccine across the country. This qualitative exploratory study was integrated into the 2024 Post-Measles Campaign Evaluation conducted across all 23 regions of Madagascar. We used purposive sampling to conduct semi-structured, in-depth interviews with key health system stakeholders, including regional health officials, community leaders, and managers of Basic Health Centres. Data were analysed using manual inductive thematic content analysis to identify recurring patterns and cultural narratives related to vaccine hesitancy. The results indicate that from the perspective of health system stakeholders, opposition to measles vaccination is perceived as being primarily driven by deep-seated religious and socio-cultural convictions. Opposition is also driven by limited health literacy; EPCR 2024 data reveals that 34% of caregivers are unable to name a single vaccine in the routine program, and only 4% possess high vaccine knowledge. Key barriers identified include explicit theological rejection specific to Evangelical or Pentecostal worldviews (e.g., 'Jesus heals, not your vaccine'), often characterized by 'healing theology' which views vaccines as an interference with divine sovereignty. This is accompanied by a fundamental functional misconception of vaccines as curative treatments for the sick rather than preventive tools for the healthy, and ancestral skepticism regarding modern medicine's impact on longevity. Additionally, institutional mistrust, fear of adverse side effects, and low educational levels among caregivers significantly contribute to resistance. Specific ethnic groups, such as the Antemoro and Antandroy, manifest localised social prohibitions against injections. Resistance to measles vaccination in Madagascar is multifaceted, rooted in fatalism, institutional mistrust, and functional misunderstandings of immunisation. To achieve national elimination goals, public health strategies must move beyond traditional biomedical solutions. Engaging local and religious leaders as trusted messengers is essential for building community trust and developing culturally sensitive communication strategies that integrate local realities into future vaccination campaigns.

Embedding LLMs in the patient portal to summarize acute minor illness information: a three-arm experimental study.

Limited health literacy affects millions globally, impairing patient understanding, treatment adherence, and health outcomes. Nurses, as primary healthcare educators, navigate complex communication challenges with vulnerable patients. However, research examining nurses' lived experiences of managing these challenges remains limited, particularly regarding how organizational and systemic factors enable or constrain communication effectiveness. This study aimed to explore registered nurses' experiences, perceived barriers, adaptive communication strategies, and systemic factors influencing nurse-patient communication in acute care settings with diverse patient populations. Descriptive qualitative study employing semi-structured interviews with 18 registered nurses across emergency, intensive care, medical-surgical, and specialized acute care units. Data were analyzed using Braun & Clarke's six-phase thematic analysis approach. Trustworthiness was enhanced through member checking, peer debriefing, comprehensive audit trail documentation, and prolonged engagement with data. Four interconnected themes emerged: (1) Multifaceted Communication Barriers encompassing language limitations, cultural-epistemological incongruence, and foundational knowledge gaps; (2) Strategic Communication Approaches including simplified language, visual demonstrations, teach-back methods, and family engagement; (3) Systemic Obstacles comprising inadequate resources, time constraints, unclear policies, and institutional ambivalence substantially constraining communication effectiveness; and (4) Emotional Labor and Professional Resilience capturing nurses' psychological experiences, moral distress, and coping mechanisms. Effective nurse-patient communication with individuals with limited health literacy requires interventions at individual, interpersonal, and organizational levels. Findings suggest that communication effectiveness is substantially shaped by organisational factors staffing, resourcing, policy, and accountability and that framing communication gaps as primarily individual competence deficits misrepresents what is, in large part, a structural problem. Individual skill and professional effort remain important; however, they operate within organisational parameters that participants frequently experienced as inadequate. Healthcare organisations must allocate dedicated resources, establish explicit patient education policies, and create accountability mechanisms to enable nurses to communicate effectively with patients with limited health literacy.

Non-Hispanic Black (NHB) Iowans experience significantly higher cancer incidence and mortality rates compared to their non-Hispanic White (NHW) counterparts. Yet, their unique barriers to cancer-related care remain understudied, particularly in the context of a geographically rural state with limited racial and ethnic diversity like Iowa. A deeper understanding of the nuanced challenges faced by this population is essential to the creation of equitable, community-based solutions to cancer care across the continuum. We conducted key informant interviews with 20 Black Iowans: 14 African Americans and 6 Black African immigrants. Using descriptive thematic analysis, we organized themes according to the Health Equity Framework. Six dominant themes emerged: health literacy and cultural understanding; structural barriers to care; interpersonal dynamics and communication; trust; strengths and resiliencies; and, community identified solutions. These themes revealed distinct experiences across subpopulations, highlighting both similarities and differences in barriers to care. Differences between groups primarily occurred within health literacy, and trust. For example, African Americans often understood the health system but reported distrust shaped by historical and cultural trauma, whereas Black African immigrants' mistrust frequently co-occurred with limited health literacy and unfamiliarity with the local health system. Black Iowans face multifaceted barriers to accessing cancer care, underscored by heterogeneity in cultural and social norms, resource limitations, and variations in cancer-related health literacy. Given differences between African Americans and Black African immigrants, our findings highlight the necessity for tailored interventions for specific subpopulations to effectively address inequities and improve cancer-related care outcomes.

BackgroundEffective physician-patient communication is essential for building trust and sustaining positive relationships, yet becomes increasingly challenging in China’s tertiary hospitals, where physicians face heavy workloads.ObjectiveThis study explored the barriers and facilitators of physician-patient communication by synthesizing perspectives from Chinese hospital-based physicians and patient relations coordinators.MethodsA qualitative study using semistructured interviews was conducted with 17 participants (11 physicians and 6 patient relations coordinators) from tertiary hospitals in China (April-July 2025). Data were analyzed using thematic analysis following Braun and Clarke’s framework.ResultsBarriers and facilitators of physician-patient communication were organized into a multilevel framework comprising patient-level, physician-level, and system-level factors. Patient-level barriers included individual background differences, inadequate expression and limited health literacy, and psycho-emotional states with expectation misalignment, whereas facilitators included effective expectation management, good health literacy and communication readiness, and trust in physicians with shared decision-making. Physician-level barriers involved communication style deficiencies, empathy gaps, and time pressure constraints; facilitators included active listening and patient-centeredness, empathy and emotional support, and clear explanations with cultural adaptability. At the system level, barriers included hospital environment and medical visit settings, legal and policy deficiencies, insufficient communication training, and media-driven distrust with digitally mediated information challenges, while facilitators included institutional support and security assurance, educational training and policy promotion, process optimization and patient health education, and artificial intelligence–assisted baseline knowledge.ConclusionsPhysician-patient communication is influenced by multiple factors, necessitating comprehensive intervention measures: enhancing patient education, improving physician communication skills, and strengthening organizational support systems. Notably, special attention should be directed toward addressing the unique challenges posed by digital technologies while concurrently leveraging the opportunities they present to optimize communication outcomes.

PurposeEvaluate trends and correlates of self-reported awareness of and responses to front-of-package warning labels (FoPWLs) on packaged Mexican foods among Mexican Americans (MAs) in the United States (US).DesignInternational Food Policy Study annual cross-sectional surveys (2021, 2022, 2023).SettingOnline survey.SampleMA adults in the US (n = 9662).MeasuresSelf-reported past-month frequency of buying food at Mexican-oriented stores (recoded: often/very often vs less often), awareness of Mexican FoPWLs (recoded: often/very often vs less often), and self-reported reductions in purchasing less healthy foods (yes vs no for eight foods) due to FoPWLs.AnalysisAdjusted logistic models regressed binary outcomes (above) on sociodemographics and survey year.ResultsMost participants bought food in Mexican-oriented stores (87.2%). Of those who noticed Mexican FoPWLs (67.6%), many reported that FoPWLs influenced them to reduce purchasing less healthy foods (range = 31.1% [snacks like chips] to 43.9% [cola]). In adjusted models, noticing FoPWLs often/very often (vs less often) increased over time (AOR2022 vs 2021 = 1.30; AOR2023 vs 2021 = 1.21), as did self-reported reductions in purchasing sweetened fruit drinks (AOR2022 vs 2021 = 1.27), and desserts (AOR2022 vs 2021 = 1.32). People with limited vs adequate health literacy reported higher awareness of FoPWLs (AOR = 1.21).ConclusionMAs' awareness and reported effects of Mexican FoPWLs were high and stable or increased over time, with greater awareness among those with limited health literacy.

Although the relationship between health literacy and health self-management has been studied in older adults, it is understudied in middle-aged, primary care patients. To determine the prevalence of limited health literacy and health self-management among middle-aged adults and associations with self-reported physical function. Cross-sectional analyses from interviews assessing health literacy, self-management capacity, and physical function. 942 middle-aged, primary care patients in Chicago, IL participating in a longitudinal cognitive aging cohort study ('MidCog'). We assessed health literacy using the Newest Vital Sign, health self-management skills using the Comprehensive Health Activities Scale Short Form, and self-reported physical function using the Patient Reported Outcomes Measurement Information System Physical Function Scale. About one in eight adults (13.2%) presented with low health literacy and 19.3% had marginal abilities. Low health literacy was associated with less education, lower income, unemployment, and identifying as non-Hispanic Black or Hispanic/Latino. Those with low health literacy had more chronic conditions, more prescription medications, and worse performance on a cognitive screener. In multivariable models controlling for age, race, sex, education, income, and number of chronic conditions, compared to those with adequate health literacy, performance on health management tasks was worse among individuals with low (β = -15.5; 95% CI: -19.7 to -11.2; p < 0.001) and marginal health literacy (β = -8.4; 95% CI: -11.6 to -5.0; p < 0.001). Although initially significant, after adjusting for covariates, the relationship between health literacy and physical function was no longer significant for either low (β = -0.3; 95% CI: -2.2 to 1.6; p = 0.75) or marginal groups (β = -1.1; 95% CI: -2.6 to 0.3; p = 0.13). Our results suggest a significant proportion of this middle-aged primary care sample, some already managing multiple chronic conditions, demonstrated limited health literacy and health self-management, potentially leading to greater risk of poorer physical health in later life.

Australia's increasingly diverse population includes a nearly one third from Culturally and Linguistically Diverse (CALD) backgrounds, who often face significant challenges in accessing and utilizing healthcare services, particularly for non-communicable diseases (NCDs). These challenges stem from various factors including understanding and communication barriers in English, cultural differences, limited health literacy and healthcare system related limitations. This project aims to co-develop and test a culturally responsive community-based, multi-packaged model of care to enhance access to and utilization of health services for common NCDs (screening of hypertension and diabetes mellitus, and initiation of treatment for those diagnosed) among CALD communities in Australia. This project will follow a four-phased approach, based on the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Other complementary frameworks including the consolidated framework for implementation research will also be utilized depending on contextual requirements. In Phase I, formative research will be conducted through a scoping review, quantitative survey, and qualitative interviews with service users and healthcare providers to identify successful care models, service preferences, and key facilitators and/or barriers to service access and utilization. Phase II of the project will focus on co-developing a culturally responsive care model informed by the findings of the first phase, which will then be reviewed and standardized with input from stakeholders, including healthcare providers and CALD community members. The Phase III activities will involve capacity building and collecting baseline data and implementing the care model. Finally, in Phase IV, implementation outcomes will be assessed by collecting follow‑up data using the same tools from Phase III, but not necessarily from the same individuals. The quantitative follow up window for outcome assessment is 6 to 12 months after site activation, with any longer activity focused on qualitative work, sustainment assessments, and dissemination. Overall, this project may play a pivotal role in enhancing the accessibility, quality, and cultural responsiveness of healthcare for CALD communities and reducing health disparities. We believe the lessons learned and the model developed through this process will be useful not only in Australia but also in other countries with similar multicultural communities.

Type 2 diabetes mellitus (T2DM) requires continuous self-care to prevent complications. Patients with limited health literacy often struggle to understand health information and adhere to treatment, resulting in poorer outcomes. Educational interventions tailored to improve self-care and health literacy arSCTe therefore essential. This study evaluated the effectiveness of a Social Cognitive Theory-based intervention, with and without health literacy strategies, in enhancing self-care among patients with T2DM and limited health literacy. This interventional study included 150 patients with T2DM and limited health literacy, randomly assigned to three equal groups (n = 50 each): a Social Cognitive Theory-based group (TBG), a theory-based group with an AI-designed photo-novel (TBG+AIPN), and a control group. At baseline, all participants completed questionnaires assessing diabetes knowledge, self-efficacy, outcome expectations, perceived social support, and self-care behaviors. Both intervention groups received five training sessions grounded in Social Cognitive Theory. In the TBG+AIPN group, additional health literacy strategies-such as an AI-designed photo-novel and plain language materials-were incorporated. Follow-up assessments were conducted one and three months post-intervention. Data were analyzed using SPSS version 24. Longitudinal analyses revealed significant within-group improvements from baseline to follow-up across all measured constructs in both intervention groups (all p < 0.001). Between-group comparisons showed that the TBG+AIPN group achieved significantly greater improvements than the TBG group in self-care behaviors (p = 0.002), diabetes knowledge (p = 0.040), self-efficacy (p = 0.020), outcome expectations (p = 0.030), and self-regulation (p = 0.020). No statistically significant difference was observed between the groups in perceived social support (p = 0.800). These findings highlight the added value of integrating AI-designed visual literacy tools with SCT-based education in improving self-care-related outcomes among patients with T2DM. An intervention based on Social Cognitive Theory, when combined with health literacy strategies including an AI-designed photo-novel, is more effective in improving self-care among patients with T2DM and limited health literacy. Such a comprehensive approach integrates psychological and communication strategies, offering a holistic solution for improving outcomes in this vulnerable group. Iranian Registry of Clinical Trials (IRCT), IRCT20240426061579N1. Registered on 12 May 2024.

The coping strategies and needs of caregiving burnout among family caregivers of elderly stroke survivors.

Health literacy and hypertension control are more limited in rural U.S. residents relative to metropolitan counterparts. Contemporary hypertension guidelines advocate for health education and home blood pressure monitoring (HBPM) to advance hypertension management. We conducted a preliminary assessment of the effect of health literacy on utilization of a virtual coaching agent, a computerized animation to converse with patient users, to promote HBPM. We recruited individuals from primary care practices in rural Pennsylvania; measured health literacy with the Brief Health Literacy Screen (BRIEF) and the Newest Vital Sign (NVS); and monitored virtual coach interactions and frequency of HBPM for 26 weeks. Participants (n = 59; age 58 ± 15 years, 59% female, 71%< bachelor's degree) had 1.03 ± 1.05 agent interactions and 5.4 ± 3.6 HBPM sessions/week over 1487 total participant-weeks. Virtual coach use was associated with greater odds of achieving the target HBPM frequency of 4 readings per week (Odds Ratio [OR] per interaction, 1.10 [95% Confidence Interval [CI]: 1.01-1.20]).This association was moderated byhealth literacy as measured by the BRIEF (interaction p = 0.01); with a greater magnitude among those with limited/marginal literacy (OR 1.31 per interaction, 95% CI: 1.10-1.57). NVS did not significantly moderate the association (interaction p = 0.12). In this preliminary cohort, use of a virtual coach was associated with higher adherence to HBPM in individuals with limited health literacy as measured by the BRIEF. Our results suggest that the frequency of virtual coach interactions is strongly associated with improvement in HBPM adherence among individuals with limited health literacy compared with those with adequate health literacy. Clinical Trial Registration: NCT05546931.