Reproductive Health Knowledge and Educational Priorities in Chronic Kidney Disease: A Cross-Sectional Survey of People With CKD.

Immigration involves adapting to a new country and culture, which can affect well-being. Japan's Indian immigrant population has grown rapidly, highlighting potential gaps in healthcare access. This study examined how acculturation-related factors such as health literacy and social support are associated with healthcare utilization and satisfaction among Indian immigrants in Japan. This cross-sectional study surveyed Indian immigrants in Japan between October and December 2023. Participants were recruited consecutively at Indian community events across multiple prefectures. Healthcare utilization and satisfaction were measured as primary outcomes using a validated questionnaire. Independent variables included social support (Oslo Scale) and health literacy (BRIEF Scale). Multivariate logistic regression was used to analyze associations. Of 1,335 individuals approached, 662 responded (50%), and 501 were analyzed (38%; 280 males, 221 females; mean age [SD] 38.9 [7.5] and 36.0 [6.5], respectively). A total of 191 (38%) participants visited outpatient clinics several times a year, 97 (19%) visited dental clinics several times a year, and 415 (83%) received annual health checkups. Long-term immigrants (≥ 11 years) were more likely to utilize maternal services than recent (1-3 years) or mid-term immigrants (4-10 years). Social support showed no significant association with healthcare utilization. Limited health literacy, however, was paradoxically associated with higher satisfaction. Higher satisfaction was also associated with employment/contract status, health insurance coverage, and longer residency in Japan. Employment status, gender, and residency duration were associated with healthcare patterns among Indian immigrants in Japan. While overall satisfaction was high (75-80%), higher health literacy paradoxically correlated with greater dissatisfaction. Future research should explore interventions to improve healthcare accessibility for recent immigrants.

Psychosis is a severe mental health condition that often remains untreated in low- and middle-income countries (LMICs), leading to significant health and societal costs. Early intervention in psychosis (EIP) reduces hospitalisation rates, improves treatment adherence, and preserves functional abilities. However, challenges in LMICs, such as resource constraints, reliance on traditional healers, and limited mental health literacy, hinder effective care. Proposed strategies include developing context-specific guidelines, expanding access to care, addressing stigma, fostering community engagement, and investing in workforce training. Implementing EIP in LMICs is a crucial step toward reducing the treatment gap and improving long-term outcomes for affected individuals.

Purpose This study explores how individuals with chronic low back pain (CLBP) experience and navigate return-to-work (RTW) processes and identifies their suggestions for improving coherence in RTW processes. Materials and methods Seventeen outpatients from a Spine Clinic, all of whom were either currently or recently on long-term sick leave (exceeding 30 days) due to CLBP, participated in three semi-structured interviews and four focus group sessions. The data were analyzed using reflexive thematic analysis and interpreted through a health literacy (HL) perspective. Results Four overarching themes were constructed: Psychological vulnerability; Seeking diagnostic and RTW clarity; Lack of recognition and flexible support from stakeholders; and Absence of professional consensus in RTW planning. Each theme comprised two subthemes. Conclusion By adopting an HL perspective, this study provides insight into how limited interactive and critical HL can hinder engagement in RTW processes among individuals with CLBP, particularly when combined with emotional vulnerability, diagnostic uncertainty, and fragmented service coordination. These findings suggest that HL-responsive practices may help reduce HL-related inequalities and support more coherent, equitable, and accessible RTW processes.

IntroductionNon-communicable diseases (NCDs) accounted for 74% of global deaths in 2024, with over 41 million people dying. The WHO has identified reducing behavioral and metabolic risk factors as a priority intervention. In modern healthcare, patient-centered care plays a key role by addressing individual needs, lifestyles, and motivations, thereby enhancing the effectiveness of prevention and behavior change. Food-based dietary guidelines (FBDG), such as Hungary’s OKOSTÁNYÉR®, are vital in prevention and medical nutrition therapy. However, the effectiveness of such dietary interventions largely depends on individuals’ health literacy.ObjectivesThis study aimed to explore the relationship between health literacy, dieting habits, dietary counseling, and awareness of the local FBDG recommendations.MethodsThis cross-sectional study was conducted in February 2023 on a representative sample (N = 500) of the adult Hungarian population, using the CAWI method. Data were collected with the validated HLS-EU 47-item questionnaire and additional custom items on health status, dieting, and awareness of the local FBDG. Health literacy indexes were calculated using validated thresholds. Descriptive statistics, chi-square tests, ANOVA, and multivariate regression analyses were applied (p < 0.05).ResultsA total of 77.4% of respondents had low (insufficient or problematic) health literacy. Higher education levels and younger age were significantly associated with better health literacy. Chronic diseases were more prevalent in low health literacy groups. About 32.4% of respondents followed a medically indicated diet, and 36.8% had received dietary counseling. Awareness of the local FBDG was relatively low (20.8%), particularly among men and those with lower education.ConclusionPatient-centered care necessitates a high level of health literacy, enabling patients to actively participate in their therapy. Findings of the study highlight that low health literacy in the Hungarian population poses a major challenge to the success of dietary interventions. Targeted health communication strategies and tailored dietetic support are essential to improve the effectiveness of personalized nutrition care, particularly among vulnerable groups with limited health literacy.

Sexual health literacy is critical for young people to make informed decisions and access sexual and reproductive health services. In Türkiye, factors such as social stigma, lack of information, and cultural taboos and structural barriers may negatively affect young people's sexual and reproductive health service-seeking behaviors. The aim of this study is to determine the levels of sexual health literacy and sexual and reproductive health service seeking among Turkish youth, identify the factors affecting these levels, and to examine the relationship between sexual health literacy and service-seeking behavior. The cross-sectional descriptive study was completed with 512 young people aged 18-30 years in Türkiye using an online survey distributed via social media platforms. Data were collected using the Sexual Health Literacy Scale and the Sexual and Reproductive Health Service Seeking Scale. Descriptive statistics, t-test, one-way ANOVA, Pearson correlation, and linear regression analyses were used in the analysis of the data. Participants' sexual health literacy was found to be at a moderate level (50.09 ± 9.23), while service seeking was above moderate (37.62 ± 9.87). A positive relationship was found between sexual health literacy and service seeking (p < 0.05). According to regression analysis, sexual health literacy level and history of unwanted pregnancy were factors predicting service seeking (R²=0.125, F = 7.983, p < 0.001). The level of sexual health literacy was found to be associated with gender, income level, family type, parents' education level, receipt of sexual health education, active sexual life, contraceptive use, unwanted pregnancy, and sexually transmitted disease history. The level of service seeking was influenced by marital status, family type, parental education, sexual activity, sexually transmitted disease diagnosis, unwanted pregnancy, and the need for emergency contraception. Main barriers to service seeking were embarrassment (35%), not prioritizing sexual health (22.1%), minimizing the problem (21.5%), and lack of information (18%). This study shows that limited sexual health literacy may restrict Turkish youth's access to sexual and reproductive health services. Strengthening sexual health education, improving access to reliable online information, and fostering youth-friendly health services including guidance by nurses are essential. These measures can ensure equitable, inclusive, and effective sexual and reproductive health care.

Patients with Chronic Obstructive Pulmonary Disease (COPD) often experience limited health literacy, hampering health status assessment via standard questionnaires like the Clinical COPD Questionnaire (CCQ). We aimed to develop and validate a modified, literacy-sensitive version, the CCQgraphic (CCQg), for all patients with COPD co-designed with a large stakeholder group. CCQ items were rephrased and complemented with graphics, followed by optimization through semi-structured interviews with patients with limited health literacy. In adequate health literacy (n = 64) concordance of CCQg and CCQ was 0.88 (95% CI: 0.82-0.92). Correlation with the COPD Assessment Test (CAT) was 0.81 (95% CI: 0.70–0.88). Agreement showed a mean bias of 0.22 (95% CI: 0.10–0.34, P < 0.001) with higher scores on mental and functional domains compared to the original CCQ. Test-retest reliability in limited health literacy (n = 25) was high, CCC = 0.93 (95% CI: 0.86–0.97). The majority (88%) rated the CCQg as equal or better to the original. The CCQg offers a validated, literacy-sensitive tool, narrowing the gap in health status assessment for patients with COPD with varying literacy skills.

Non-communicable diseases (NCDs) are the leading cause of premature deaths globally, largely driven by modifiable behavioural risk factors such as unhealthy diet, physical inactivity, tobacco use, and alcohol consumption. Health literacy (HL) plays a vital role in modifying these behaviours. Evidence shows that Healthcare Assistants (HCAs) in Sri Lanka despite working in hospitals often demonstrate limited HL and high rates of risk behaviours. Enhancing HL among HCAs is therefore essential both for their own health and for enabling them to serve as credible health advocates in NCD prevention. This study aimed to develop and validate a Behaviour Change Intervention Package (BCIP) to improve HL related to NCD behavioural risk factors among HCAs in government hospitals in Sri Lanka. A Behaviour Change Intervention Package (BCIP) was developed using the Intervention Mapping (IM) approach, informed by the Calgary Charter HL framework. Steps included assessment of the logic model of the problem, setting objectives, intervention design, expert content validation, pilot testing, and planning for implementation and evaluation. The BCIP comprised a curriculum, facilitator guide, participant handbook, and PowerPoint presentations, for 16 two-hour sessions across eight weeks. Sessions employed lectures, role-play, group discussions, brainstorming, and m-health tools. Content validity was assessed by a 10-member expert panel, while pilot testing in selected hospitals evaluated feasibility and acceptability. Findings revealed that HL among HCAs was limited by factors at individual, family, organizational, community, and policy levels. The BCIP addressed these determinants by focusing on HL's four domains- finding, understanding, comparing, and applying health information. Expert review confirmed high relevance and appropriateness (mean scores > 3.0), while pilot testing showed feasibility and participant satisfaction with content, delivery methods, and session duration. The validated BCIP provides a structured, theory-driven approach to improving HL and reducing NCD risk behaviours among HCAs. Pilot findings support its feasibility for integration into routine induction or in-service training. Future studies will evaluate its effectiveness, with potential adaptation for broader workplace health promotion in Sri Lanka.

BackgroundNon-communicable diseases (NCDs) are a major public health challenge in Sri Lanka, driven by behavioural risk factors. Healthcare Assistants (HCAs) play a key role in NCD prevention, but limited health literacy (HL) reduces their effectiveness. Strengthening HL among HCAs can reduce their own NCD risk, enhance their role as health promoters, and improve patient education and hospital-based health initiatives.ObjectivesThis study aimed to assess the effectiveness of a behaviour change intervention package (BCIP) to improve HL on behavioural risk factors of NCDs among HCAs in Colombo district.MethodsA cluster Randomized Controlled Trial (cRCT) was conducted with 240 HCAs from 20 hospitals in the Colombo district, 10 hospitals each for the control and intervention arms. The 16 sessions of the BCIP were conducted over eight weeks. The HL-NCD tool and STEPS questionnaire were administered two weeks before and after the intervention. HL score was analyzed as a continuous variable, while HL level was categorized as inadequate or adequate based on predefined HL score cutoffs. Analyses included unadjusted, cluster-level, and Generalized Estimating Equations (GEE) models to account for clustering effects.ResultsThe intervention group showed significant improvements in HL score (unadjusted p < 0.001; cluster p = 0.005; GEE OR = 7.80, 95% CI: 7.38–8.22, p < 0.001) and HL level (unadjusted p = 0.003; cluster p = 0.011; GEE OR = 3.80, 95% CI: 1.59–9.11, p = 0.003). Age < 35 years was a significant positive predictor of HL score and educated only up to O/Ls was a significant negative predictor of HL level. The GEE analysis revealed significant improvement in behaviour change related to diet, physical activity, avoiding smokeless tobacco, and non-exposure to secondhand smoking except avoiding smoking tobacco and alcohol intake.ConclusionsThe BCIP was effective in improving HL and reducing behavioural risk factors of NCDs among HCAs, highlighting its potential for broader implementation.Clinical trial numberSLCTR/2023/023, https://slctr.lk/trials/slctr-2023-023, 11th December 2023, Sri Lanka Clinical Trial Registry.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-26110-9.

Do people with limited health literacy access and take up treatment in a national digital mental health service? A prospective cohort study of 4578 service users.

P1207 Limited health literacy is common among patients with IBD and associated with a reduced quality of life: results of a systematic review

ObjectiveTo assess the impact of the non-reimbursement policy on vitamin D therapy discontinuation in patients from the general and rheumatic populations.DesignA cross-sectional study.SettingResearch institute specialised in health research and two outpatient pharmacies in the Netherlands.ParticipantsPatients from the general and rheumatic population with an active prescription for vitamin D supplementation therapy were included.Data collection and analysisData were collected between April and May 2023 through self-reported questionnaires. Descriptive statistics and logistic regression were performed using STATA V. 17. P value <0.05 was considered statistically significant.Primary and secondary outcome measuresThe primary outcome was the proportion of patients who discontinued vitamin D supplementation therapy following the implementation of the non-reimbursement policy. Secondary outcomes included patient-reported reasons for therapy discontinuation and the association between patient-related characteristics and the risk of therapy discontinuation. In addition, the proportion of patients who switched to an alternative supplement and whether this switch had been made in consultation with a healthcare provider was examined.ResultsOf the 4800 patients, 302 (6.4%) patients discontinued their vitamin D therapy. The three most frequently reported reasons for therapy discontinuation were the inability to afford supplements without reimbursement, not willing to pay for supplements without reimbursement and being unaware of the alternative vitamin D supplements to switch to. Younger age, financial constraints and limited health literacy were significantly associated with vitamin D therapy discontinuation (p<0.05). Among the 1478 patients that switched to an alternative supplement, 706 (17.9%) patients indicated that they made the switch in consultation with a healthcare provider.ConclusionThe implementation of the non-reimbursement policy resulted in a small proportion of patients discontinuing their vitamin D therapy. Elevated discontinuation rates were associated with specific patient-related characteristics including patients aged <50 years, those experiencing financial constraints and those with limited health literacy, suggesting the need for developing interventions and preventive strategies to support patients at risk of therapy discontinuation.

Prevalence of patients with limited health literacy in rotator cuff tears and their experiences with care: a mixed-methods study

Podcasts as a tool to support patient participation in hospital consultations: An intervention study.

Cross-border migration presents increasing challenges to healthcare systems globally. Ensuring equitable healthcare access for immigrant populations, particularly in Southeast Asia, requires a thorough understanding of the barriers to effective service delivery. This scoping review aimed to synthesize the existing literature on the challenges related to the delivery of healthcare services to immigrant communities from Southeast Asia. While previous studies (e.g., Brandenberger et al., 2019) applied the 3C framework to migrants and refugees globally, this review generates new insights by focusing specifically on Southeast Asia, a region underrepresented in the literature. By applying the 3C model in this context, our review identifies region-specific challenges, such as immigration policies, financial barriers, and COVID-19 impacts, that extend beyond the findings of earlier global reviews. A comprehensive search was conducted in ProQuest, PubMed, ScienceDirect, and Scopus databases on October 13, 2024, for studies published between January 1, 2011, and October 13, 2024. The search strategy used tailored keywords, including "challenges," "healthcare services," "immigrants," and "Asia." Inclusion criteria focused on peer-reviewed, English-language articles reporting on challenges in healthcare service delivery among immigrant populations in Southeast Asia. Data extraction and synthesis were guided by the 3C model: communication, continuation of care, and confidence in the healthcare system. The search identified 656 records, of which 7 studies met the inclusion criteria after a multi-stage screening process. Key challenges identified across the included studies were: Communication barriers, including language differences, cultural misunderstandings, and limited health literacy; Issues with continuation of care, such as poor health literacy, difficulties navigating healthcare systems, barriers to accessing services (e.g., due to legal status or financial constraints), and lack of coordination between healthcare and social services; and Lack of confidence in the healthcare system, stemming from distrust, lack of understanding, and negative experiences, including perceived discrimination. This review highlights the complex challenges in delivering healthcare services to immigrants from Southeast Asia. These challenges, encompassing communication, continuation of care, and confidence, necessitate targeted and multifaceted interventions. Addressing these issues through culturally competent care, enhanced communication strategies, and policy reforms that promote equitable access is crucial for improving the health and well-being of immigrant populations and fostering more inclusive healthcare systems within the region.

ABSTRACT Background Inappropriate self-medication and limited health literacy are pressing challenges that contribute to poor health outcomes among older adults. In rural, low-resource settings, these issues are worsened by digital exclusion, which restricts access to reliable health information and informed decision-making. Objective To assess the prevalence and determinants of inappropriate medication and health product (M&HP) use among older adults in rural Thailand, reflecting wider disparities in Southeast Asia. Methods A cross-sectional survey was conducted among 1,461 older adults aged ≥60 years, selected through stratified multi-stage sampling from Thailand’s Health Regions 7–10, which encompass 20 northeastern provinces. Structured interviews explored health-seeking behavior, digital literacy, and M&HP use. Inappropriate use was defined as the use of two or more items without professional consultation, as per national guidelines. Descriptive and multivariable logistic regression analyses were performed. Results Of participants, 84.5% reported using M&HPs without professional consultation, and only 14.0% were proficient in accessing health information via smartphones. Inappropriate use was significantly associated with rural residence (aOR = 6.33; 95% CI: 2.19–18.31), low education, chronic illness, unemployment, digital illiteracy, and financial hardship (p < 0.05). Conclusion Digital and social exclusion strongly influence unsafe self-medication practices among older adults. Improving digital health literacy and access to credible information is crucial for enhancing medication safety. Thailand’s experience may offer valuable guidance for developing inclusive aging strategies in other low- and middle-income countries.

Background: Disparities in basic childhood immunization coverage remain evident in communities with low education levels, often associated with limited health literacy, vaccine hesitancy, and barriers to accessing health services. In this context, the role of health cadres is considered crucial in supporting childhood vaccination uptake at the community level. Method: This study employed a quantitative cross-sectional design involving 210 mothers with children aged 12–24 months. Data were collected using structured questionnaires and analyzed through binary logistic regression to examine the influence of health cadres’ roles on the completeness of basic childhood vaccination. Results: The findings indicate that health cadres’ roles significantly influenced complete basic vaccination (OR = 3.08; p = 0.001) after controlling for maternal education and socioeconomic status. Schedule reminders and interpersonal communication emerged as the strongest dimensions of the cadres’ role, while assistance during vaccination visits showed the weakest contribution due to logistical constraints. Conclusion: The results demonstrate that achieving complete childhood vaccination depends not only on formal health system mechanisms but also on strengthening the role of health cadres as social and educational agents within the community. Enhancing persuasive communication skills, improving logistical support, and integrating cadres into community-based follow-up systems are essential to ensure sustainable improvements in basic childhood vaccination coverage.

Chronic kidney disease (CKD) patients often struggle to balance the risks and benefits of their treatment options, leading to dilemma in decision-making process. Shared decision-making (SDM) is considered as the cornerstone of patient-centered care by engaging patients in treatment choices across various chronic diseases, including CKD. This review explores the significance of SDM in CKD care and highlights the barriers to its implication. This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses-scoping reviews guidelines. Literature search was conducted using Scopus, ProQuest, and PubMed databases. Out of the initially searched 18742 articles, 20 articles are included in this review. The findings revealed that SDM improved patient engagement, self-efficacy, and reduced decisional conflict in CKD management. However, barriers such as limited health literacy, disease-knowledge gaps, and inadequate communication hindered effective decision-making. In addition, social, demographic, and psychosocial factors influenced self-care behaviors and treatment choices. Despite the potential benefits, many CKD patients do not experience SDM due to inadequate information and time constraints. Educating patients and training healthcare professionals are crucial steps for improving SDM practice in CKD care. Future studies should explore patient-clinician interaction and focus on the effects of culture and ethnicity on decision-making for effective treatment.

Iron and folic acid (IFA) supplementation remains one of the most widely endorsed strategies in global maternal health, yet its promise is persistently undermined by poor compliance. Pregnancy amplifies nutritional demands, and untreated iron deficiency anemia continues to jeopardize maternal well-being and neonatal outcomes. Despite decades of evidence and strong policy advocacy, including World Health Organization (WHO) guidelines and national programs such as Anemia Mukt Bharat, gaps in adherence reveal a paradox: life-saving interventions often fail to reach or resonate with those most in need. This review interrogates the complex interplay of socioeconomic, cultural, and systemic determinants that shape IFA adherence across contexts, with a particular emphasis on India and comparable low- and middle-income countries (LMICs). The findings expose how financial constraints, fragile health infrastructure, and limited health literacy intersect with cultural beliefs, traditional practices, and family dynamics to create a web of barriers that defy simple solutions. Myths linking supplementation to miscarriage or obstructed labor, alongside dietary inhibitors, side effects, and religious restrictions, reveal that the issue is not merely biomedical but deeply social. Equally, programmatic challenges, such as stock-outs, weak monitoring systems, and fragmented intersectoral coordination, further compromise the potential of supplementation campaigns. Yet, emerging evidence also illuminates pathways. Culturally sensitive education, community-based counselling, and male or family involvement have shown measurable improvements in adherence. Innovative delivery approaches, from fortified foods and micronutrient powders to workplace supplementation, expand access beyond traditional channels. Digital health technologies, particularly SMS reminders and mobile applications, represent scalable tools to enhance daily compliance and strengthen supply-chain accountability. Public-private partnerships further highlight how collaboration can bridge systemic gaps and extend reach. The analysis ultimately argues that IFA compliance must be reframed as more than a clinical prescription: it is a developmental challenge bound to women’s autonomy, education, and equity. Addressing maternal anemia requires integrated interventions that are simultaneously biomedical, behavioral, and political. Unless compliance is treated as both a health system responsibility and a societal priority, the cycle of preventable anemia and poor pregnancy outcomes will persist.

ABSTRACT Purpose Spanish-speaking adults with chronic pain experience worse outcomes compared to their English-speaking counterparts. Identifying unmet needs, barriers, and facilitators can inform behavioral interventions to improve chronic pain management and reduce existing disparities. This study explores the perspectives of Spanish-speaking adults with chronic pain and healthcare providers on pain-related needs, barriers, and facilitators to participation in a mind-body and activity program. Materials and Methods We conducted a total of four qualitative focus groups with 22 patients with chronic pain in Spanish and six focus groups with 21 healthcare providers (4 in English; 2 in Spanish). A bilingual team conducted a hybrid deductive-inductive analysis. Results Within the needs domain, we identified two key themes: the need to address co-occurring physical and psychological concerns and heterogeneity in treatment expectations and attitudes toward mind-body approaches. Within the barriers to care domain, themes were time poverty and economic hardship that deprioritized pain management, pain stigma leading to social isolation, and limited health literacy. Within the facilitators to care domain, themes were interest in walking with friends and family, and spirituality and religion as foundational sources of pain coping. Discussion Patients and providers discussed complex socio-economic and health-related needs, as well as diverse attitudes toward mind-body care. Barriers such as time poverty, stigma, and limited literacy ought to be considered and addressed in pain programs to achieve meaningful engagement of Spanish-speaking adults. Conclusion Findings underscore key factors that may increase the accessibility and generalizability of mind-body treatments for chronic pain among Latine adults.