Limited Health Literacy Research Articles

Public Health Literacy and Emergency Department Utilization in Saudi Arabia: A Cross-Sectional Study.

Health literacy (HL) is the degree in which individuals are able to access, comprehend, and use publicly available health resources and services. A previous study was done in the Kingdom of Saudi Arabia (KSA) assessing the prevalence of HL, the study shows that almost half of KSA residents had limited HL. Most studies that show the level of HL and its relationship to emergency department (ED) utilization were conducted outside KSA. This study aims to assess the association between HL and utilization of ED services and to estimate the prevalence, factors, and outcomes of low HL in KSA. A cross-sectional study was conducted among 903 participants in KSA over a period of 2 months (April and May 2023) using an online survey. Participants were asked about sociodemographic characteristics (age, sex, nationality, marital status, education, work status, income), associated factors (chronic diseases, psychiatric disorders, Covid-19 infection, Covid-19 vaccination, ED visits), and Health Literacy (read, access, understand, evaluation, decision). A health literacy instrument for adults (HELIA), which consists of the previously mentioned five subscales, was used to estimate the level of HL and its association with the risk factors. Almost 529 (58.58%) and 374 (41.42%) had limited HL and adequate HL, respectively. Participants with limited HL were mostly aged 35-45 years (61.7%), men (p < 0.05) (68.9%), divorced (65.9%), non-Saudi (69.6%), and had elementary level of education (66.7%). Participants with adequate HL had master's and PhD degree (48.1%), were healthcare students or graduates (62.8%, p < 0.05), had an income >30 thousand riyals (55.6%, p < 0.05), were previously infected with COVID-19 (43%), and did not visit ED in the preceding year (42.3%). A high prevalence of low HL among KSA residents was observed. There was no significant difference in ED utilization between participants who had adequate and limited HL.

IJCM_240A: A cross sectional study to assess the health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore.

Background: WHO defines health literacy as cognitive and social skills that determine the motivation and ability of people to understand, gain access and use the information to obtain good health. Inadequate health literacy has been linked to increased hospital admissions, poorer physical and mental health, lower use of preventive health services like vaccinations and screening tests. These ultimately lead to higher healthcare costs. This study was conducted to assess health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Objectives: To estimate proportion of inadequate health literacy and its associated factors among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Methodology: A cross-sectional study was conducted among adult attendees (i.e., patients and companions) of outpatient clinics of a government tertiary care hospital in urban Bangalore. Based on a study done by Almaleh. R et al. (P = 34.3%) with 7% absolute precision, the sample size was calculated as 200. A total of 200 adults attending outpatient clinics at the government tertiary care hospital were selected using simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire for sociodemographic factors and HLS-EU-Q16 (European Health Literacy Survey Questionnaire short version) for assessing health literacy. The data collected was entered in MS Excel and analysed using SPSS 21.0. Results: The proportion of inadequate health literacy among study participants was observed to be 38%. Factors like educational status, age, and gender were found to have an association with it. Health literacy was found to be least in lower-educated individuals. Conclusion: From the present study, it was found that a large part of adult population had limited health literacy. It should be addressed through proper interventions, like ensuring basic education and health awareness programmes.

Advancing the health literacy of migrants in second-language courses: Realist review

Background: Migrants and refugees are high-risk populations with often limited health literacy (HL). It is crucial to improve their HL early after arrival. One promising approach is to combine language and HL learning in second-language courses. Objectives: This study reviewed empirical evidence on the promotion of migrants’ HL in second-language courses and developed a theory of change to inform innovative projects. Methodology: We conducted a systematic realist review of HL in second language courses in seven scientific databases and a grey literature search. After screening titles, abstracts, and full texts, we identified 21 eligible publications from 13 programs. We systematically analyzed program context and characteristics, evaluation design, and outcomes and developed a theory of change based on the findings. Results: Programs promoting HL in second language courses are diverse in terms of contextual factors, formats, study designs, measures of HL, language improvements, effectiveness, relevant outcomes, and enabling factors. All studies reported improved HL after the program, but to varying degrees. The findings regarding second language improvement are mixed. Seven core components of HL as a social practice emerged. Numerous factors influencing course implementation, outcomes, and sustainability were described in detail. We conceptualized a theory of change for the HL promotion in second language courses. Conclusion: This realist review presents ample empirical evidence that second language courses can promote HL in various ways. However, these courses are complex, heterogeneous, and dependent on multiple factors. Despite these limitations, second language courses show promise as innovative and effective approaches that reach many migrants. Therefore, health promoters, medical professionals, adult educators, and policymakers should collaborate nationally and internationally to leverage this unique opportunity. The theory of change can serve as a blueprint for discussing existing programs thoroughly and developing promising, effective, and sustainable programs.

Socio-demographic, agricultural, and personal protective factors in relation to health literacy among farmers from all regions of Thailand.

Farmers are vulnerable to adverse health effects from pesticide exposure due to their health literacy (HL). Therefore, this study aims to investigate HL among farmers in four main regions of Thailand, investigating socio-demographics, agricultural, and personal protective factors to their HL. This cross-sectional design study was conducted on 4,035 farmers from January to July 2023. The European Health Literacy Survey Questionnaire-47 items were used to measure HL. Thai farmers had a mean HL score of 34.7 ± 8.7, and the farmers in the North region of Thailand had the highest frequency of limited HL (75.8%). Socio-demographic factors that were associated with HL included gender, region of living, marital status, education level, co-morbidity, and number of family members. Agricultural factors associated with HL included planting status, working hours on farm, spraying pesticides, harvesting crops, pesticide use of >1 type, access information from government officers, access information from posters/brochures, information from online multimedia, and access information from neighbors. Personal protective factors that were associated with HL included wearing a hat, goggles, a rubber apron, and a long-sleeved shirt. Our study recommends that strategies and interventions to enhance the HL of farmers should be focused on the target populations, which include men, widows, or divorced, those with low levels of education, those who have co-morbidities, and those who applied pesticides of more than 1 type and improper personal protective equipment (PPE) use. The primary emphasis needs to be on the North region of Thailand, making that the target area to improve health equity in Thailand. These efforts would enhance the HL of farmers and sustainably improve pesticide safety behavior. Additionally, there is an urgent need for supportive measures aimed at altering on-farm practices and promoting education on alternative pest management strategies, particularly non-chemical crop protection, to ensure sustainable agriculture.

The impact of health literacy on uterine fibroid awareness, diagnosis, and treatment in the United States: a mini literature review.

Limited health literacy is a social health determinant leading to poor health outcomes. General and health literacy correlate and can impact diagnosis and treatment understanding. Limited literacy can lead to women receiving more significant rates of invasive surgical treatment, including hysterectomies. This review explores the impact of health literacy levels on uterine fibroid awareness, diagnosis, and treatment. PubMed, CINAHL, and Academic Search Premier searched articles published between January 1, 2012, and December 31, 2022. The keywords uterine fibroids, fibroids, myomas, leiomyomas, and health literacy were used. A total of four articles were returned. Increased rates of hysterectomies were found among participants with low income and education, as well as those with limited health literacy. Hysterectomies are the removal of the uterus and thus removes a woman's right to have children. While increased efforts are needed to understand the impact of health literacy levels on disparities and inequities in uterine fibroid diagnosis and treatment, there is still a need for targeted patient education and community-based education that ensures patient understanding of the diagnosis and treatment options for uterine fibroids.

Patient experiences with prenatal cell-free DNA screening in a safety net setting.

Thirty-five states, including Florida, now cover cell-free DNA (cfDNA) screening of fetuses for all pregnant patients enrolled in state public insurance programs. We interviewed Black and Hispanic obstetric patients at a safety net clinic in Florida shortly after the state rolled out cfDNA as a first-tier screening method for publicly insured patients. Black and Hispanic patients receiving prenatal care from a prenatal or maternal fetal medicine clinic at a federally qualified health center in Jacksonville, FL were invited to participate in a qualitative interview in English or Spanish to explore experiences and perceptions of prenatal cfDNA screening. Participants were recruited following their first prenatal visit when cfDNA is typically introduced. Interview transcripts were qualitatively analyzed for iterative themes based on principles of grounded theory. One hundred Black and Hispanic patients (n=51 non-Hispanic Black, n=43 Hispanic, n=3 Hispanic Black, n=3 Not Reported/Other) completed an interview. Participants described minimal opportunity for pre-screening counseling and limited health literacy about cfDNA or its uses. Some believed that cfDNA could positively impact pregnancy health. Many were unsure if they had received cfDNA even though they were aware of the information provided by it. Most participants expressed an interest in cfDNA as a means for early detection of fetal sex and as an additional indication of general fetal health. Patient experiences indicate limited informed consent and decision-making for cfDNA, discordant with professional guidelines on pre-screen counseling. Our findings suggest that there should be additional investment in implementing cfDNA in safety net settings to ensure that patients and providers receive the support necessary for effective patient counseling and follow-on care for the ethical implementation of cfDNA.

Experiences of keratoconus patients attending public eye care facilities in South Africa.

Keratoconus (KC) is a progressive condition that usually affects young persons between their first and fourth decades. Myopia and irregular astigmatism are the common presentations which are proceeded by corneal steepening and thinning. Keratoconus is a progressive ectasia of the cornea that presents bilaterally, although often asymmetrical. To explore the experiences of KC patients attending public eye care facilities in Capricorn District of Limpopo province. Capricorn District, Limpopo province, South Africa. Descriptive qualitative phenomenology approach was used in the study to explore the lived experiences of patients diagnosed with KC, attending public eye care facilities. Purposive sampling was used to select 16 patients who were diagnosed with KC and referred for contact lens fitting. Data were collected through face-to-face, one-on-one interviews. Patients reported to have developed gradual vision loss which worsened when they grew older. There was lack of knowledge of KC amongst patients and this was exacerbated by limited health literacy and vocabulary barriers. Patients had difficulty performing daily activities where some had dropped out of school while others worked at a slower pace and reduced working distances. Patients with KC received inadequate information on their condition due to limited health literacy and vocabulary barriers. Programmes to promote practitioner and patient education are required to improve the perceived service level provided to KC patients.Contribution: The findings of this study will assist to improve the experiences of KC patients on perceived service quality received from public facilities.

Sources and perceived credibility of child nutrition information in relation to maternal health literacy

ObjectiveTo examine sources and perceived credibility of child nutrition information by maternal health literacy. MethodsUS mothers of children (0–12 years) who used social media regularly (N = 340) completed an online survey. Health literacy was assessed using the Newest Vital Sign. Child nutrition information sources and perceived credibility of sources were compared by health literacy using logistic and quantile regression models. ResultsSeventeen percent of mothers had limited health literacy. Compared to mothers with adequate health literacy, those with limited health literacy were more likely to get child nutrition information from siblings, extended family, dietitians, doctors, nurse practitioners, or physician assistants, and government agencies, and less likely to get information from Facebook. Mothers with limited health literacy rated information from parents, friends, Facebook, and Instagram as more credible than mothers with adequate health literacy. While perceived credibility of information from doctors, nurse practitioners, or physician assistants was high overall, mothers with limited health literacy perceived information from these health care providers as less credible. ConclusionsSources of child nutrition information and perceived credibility differ by maternal health literacy. Practice ImplicationsPediatric providers are encouraged to refer parents to engaging resources that provide evidence-based child nutrition information.

Improving access to pediatric hydrocephalus care for all: the role of maternal health literacy and socioeconomic status.

Limited research has addressed the barriers impeding access to surgical care for pediatric patients with hydrocephalus. To identify priorities for enhancing access to pediatric hydrocephalus surgical care and to address healthcare disparities, it is essential to understand the level of access to care and the influence of socioeconomic status (SES) and maternal health literacy. In this study, the authors aimed to assess the level of access to surgical care; determine the frequency of more than a 2-week delay in seeking, reaching, and receiving care; and investigate the influence of parental SES and maternal health literacy on these delays. This observational prospective cohort study involved data collection from a sample of 100 pediatric patients aged ≤ 5 years with hydrocephalus and their mothers, including information on family SES (education, occupational, and economic status). Maternal health literacy was assessed using the Brief Health Literacy Screen (BHLS) questionnaire. The Three Delays framework from the Lancet Commission on Global Surgery, categorizing delays in seeking care, reaching care, and definitive care, provided a structured approach for analyzing access delays. Statistical significance was set at p < 0.05. Among the pediatric patients, there was a male-to-female ratio of 1.7:1, with a median age of 1.5 months. None of the patients had insurance coverage that included surgical treatment. A significantly low number of patients accessed care within 2 weeks for seeking care duration (34%), reaching care duration (15%), and definitive care duration (1%). The median time to definitive surgical treatment for the entire study population was 14 weeks (upper SES: median 6.3 weeks, middle SES: median 9.8 weeks, lower SES: median 16.7 weeks). Through Cox proportional hazards regression, a hazard ratio of 0.046 (95% CI 0.010-0.210) was obtained. Multiple linear regression analysis identified BHLS Brief D (β = -0.335, p = 0.001) and SES (β = 0.389, p < 0.001) as predictor variables for delays in seeking care and definitive care, respectively. SES (β = 0.446, p < 0.001) and Evans index (β = 0.233, p = 0.010) were predictor variables for delays in reaching care. Maternal health literacy and SES were identified as factors associated with delays in accessing neurosurgical care for pediatric patients with hydrocephalus. To reduce disparities in pediatric hydrocephalus care, it is essential to implement strategies that promote education, improve healthcare infrastructure, and provide support to families encountering challenges related to low SES and limited maternal health literacy.

Adequacy of health message tailoring for ethnic minorities: Pasifika communities in Sydney, Australia, during COVID-19.

Ethnic minorities, such as Pasifika, residing in high-income countries were at higher risk of COVID-19 infection during the pandemic. To understand the experiences of Pasifika, including message dissemination and barriers to tailored public health messaging during the pandemic, a qualitative study was undertaken, underpinned by Laswell's Model of Communication and Bandura's social cognitive theory with data collected using Pasifika methods. Pasifika adults (n = 65) were recruited across Sydney from July 2020 to March 2022. Health care professionals (HCP) (n = 17) employed by four local health districts (LHDs) and Pasifika community-based organizations delivering multicultural COVID-19-related work within the study catchment, were also recruited. Five themes were constructed from the data of: (i) prevailing fear and uncertainty over COVID-19 infection and losing employment; (ii) limited knowledge of government perpetuating distrust in Government as a benevolent source of information; (iii) faith and trust as priorities for health decision-making; (iv) 'Coconut wireless'-the role of family, friends and community in disseminating public health messages through word of mouth; and (v) limited health literacy affecting compliance with public health orders. Community members identified important messages and resources had not been sufficiently distributed. Most HCPs understood the necessity of grassroots-level engagement but reported existing approaches were inadequate to navigate challenges. These findings highlight the need for public health promotion and communication strategies that consider both the social and cultural determinants of health. We propose a 7-point checklist as a cultural appropriateness lens to assist the development and rating of existing or new health promotion messaging and resources.

Clinical Evaluation of a Lay-Language Radiology Glossary Integrated into an Electronic Health Record System.

Radiology reports typically contain complex, technical language that can pose a barrier to patients, especially to those with limited educational attainment or literacy skills. PORTER-the Patient-Oriented Radiology Reporter system-incorporates a lay-language glossary to help patients understand radiology report content. The system displays illustrations and definitions of radiology terms when viewing a report. A large U.S. health system integrated PORTER into the patient portal of its electronic health record (EHR) system and evaluated its use during a 7-month study period. Of 4,664 concepts defined in its glossary, 4,607 (98%) were readable at the 8th-grade level. Of 10,859 patients who completed a single-question survey, 6,947 (64%) found the system to be helpful or very helpful. A system that integrates illustrations and lay-language definitions of medical terms into a patient portal can help patients better understand the reports of their radiology examinations. Such a system has potential to improve communication for patients with limited health literacy.

The impact of chronic disease diagnoses on smoking behavior change and maintenance: Evidence from China.

Managing chronic diseases and tobacco use is a formidable challenge in low- and middle-income countries (LMICs) with limited health literacy and access to quality healthcare. This study examines the empirical evidence from China, utilizing quasi-experimental approaches to assess the causal effect of chronic disease diagnoses on smoking behavior. Employing the diagnosis of chronic disease in the older cohorts of the population as a natural experiment, this study utilizes recent advancements in difference-in-difference estimation methods (CS-DID) to investigate the effect of a diagnosis on smoking behavior. Self-reported new diagnoses of conditions ascertained chronic disease diagnoses. CS-DID was run using the study sample from the 2011 to 2018 waves of the China Health and Retirement Longitudinal Study, comparing results with traditional two-way fixed effects and event-study models. The average treatment effect (ATT) of CS-DID is slightly greater than the effects reported using conventional difference-in-difference methods. We found that diagnoses of cancer, heart disease, and stroke reduced smoking rates by 16% (95% CI: -24 - -8), smoking intensity by 0.31 (95% CI: -0.46 - -0.15), and had lasting impacts on smoking cessation behavior (one wave after diagnosis ATT= -0.17; 95% CI: -0.34 - -0.00, two waves after diagnosis ATT= -0.17; 95% CI: -0.37-0.03). A diagnosis of a mild chronic disease, such as hypertension, diabetes, asthma, chronic lung disease, liver disease, or gastric disease, had more negligible and transient effects on smoking behavior. Efforts to enhance smoking cessation in middle-aged and elderly patients with chronic diseases are crucial to improving health outcomes. The 'teachable moment' of chronic disease diagnosis should be seized to provide smoking cessation assistance to achieve the goal of healthy ageing.

Health literacy in adult patients with atopic dermatitis: A cross-sectional study

BackgroundHealth literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate health decisions. Patients with limited health literacy are less likely to manage chronic diseases appropriately. ObjectiveTo assess the prevalence of limited health literacy in patients with atopic dermatitis (AD), and its association with other patient-reported outcomes. MethodsA cross-sectional questionnaire-based study was conducted at a tertiary referral centre for AD. Patients diagnosed with AD by a dermatologist between 2019 and 2021 were identified from medical records. Perception-based health literacy was assessed by the European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16) and performance-based health literacy by the Newest Vital Sign (NVS). Patients completed the Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and Atopic Dermatitis Control Tool (ADCT) to measure AD severity, quality of life and AD disease control, respectively. ResultsIn total, 322 patients were included (response rate 48.3%). Based on the HLS-EU-Q16, 32.4% had limited health literacy (8.4% inadequate and 24.0% problematic) which was associated with impaired quality of life. According to the NVS, 20.3% had inadequate health literacy which was associated with older age. ConclusionUp to one-third of the patients with AD showed signs of limited health literacy, which was associated with impaired health related quality of life and older age. Further research should evaluate the influence of inadequate health literacy on health outcomes and focus on strategies to improve organizational health literacy to eventually enhance patient-centered care.

Prevalence and factors associated with limited hypertensive health literacy among Myanmar migrant workers in Northeastern Thailand

Background: Regarding hypertension, limited health literacy was considerably high worldwide. Although hypertensive health literacy in general population was explored by some studies, there was no study specific for it among Myanmar migrant workers in Thailand. Objectives: Aimed to explore the prevalence of limited hypertensive health literacy and identify the associated factors among Myanmar migrant workers in Northeastern Thailand. Method: A cross-sectional analytical study was conducted among Myanmar migrant workers with the age between completed 18 years to 59 years old in Khon Kaen Province, Northeastern Thailand from June 2023 to August 2023. Multistage random sampling procedure was applied to select 406 sample. A validated and reliable structured questionnaire was used to collect the data. Descriptive statistics and multiple logistic regression were used. The association between limited hypertensive health literacy and each statistically significant factor (p-value &lt; 0.05) after controlling other covariates were described by adjusted odds ratio (AOR), 95% Confidence Interval (95% CI). Results: Of 406 participants, the overall prevalence of limited hypertensive health literacy was 54% (95% CI: 49.20-59.11). Among the participants, 56% were male and 68% of them were married. Factors associated with limited hypertensive health literacy were pre-hypertension (AOR=1.83, 95% CI: 1.12-3.01), primary and below level of education (AOR=2.26, 95% CI: 1.36-3.74), ≤48 months duration of stay in Thailand (AOR=2.24, 95% CI: 1.44-3.48), poor and fair level of knowledge (AOR=2.02, 95%CI: 1.20-3.42) and poor and fair level of attitude (AOR=2.61, 95%CI: 1.68-4.07). Conclusion: More than half of the study population was limited in hypertensive health literacy. Educational status, duration of stay in Thailand, blood pressure, knowledge and attitude towards hypertension were associated with health literacy among Myanmar migrant population. Thus, creating user-friendly resources and health programs for newcomers is essential to close health literacy disparities. Using multidisciplinary approach could be effective in promoting health literacy.

Health literacy and self-care among patients with chronic kidney disease in a primary care setting.

The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD). This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21-80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0-240, domain range 0-80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0-50, limited literacy ≤33). The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9-40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = -5.29, 95% CI -10.56 to -0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001). Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.

Silent struggles to self-manage high blood pressure among deaf sign language users: a qualitative study.

Tailored self-management support of hypertension, considering language and communication, is important for minorities, specifically in the deaf community. However, little is known about the experiences of hypertension self-management in deaf individuals who use sign language. This study aimed to explore the factors and processes of self-management in deaf sign language users with hypertension. Ten men and women who used sign language participated in this study. Data were collected using in-depth personal interviews conducted in the presence of a sign language interpreter between November 2022 and February 2023. All interviews were recorded and transcribed for conventional content analysis. Qualitative analyses identified four categories related to the self-management of hypertension among participants: personal factors (chronic hand pain, unique language and communication, and efforts to turn crisis into opportunities), family and socioeconomic factors (family support and financial burden of living), challenges (limited health literacy and alienation from health education), and desire for health education considering the deaf community. The results of this study suggest that family support, socioeconomic status, hand pain, and health literacy should be considered for the planning and development of health education on self-management of hypertension in deaf individuals. In addition, this health education requires cooperation with qualified sign language interpreters in healthcare settings.

Surrogate decision-makers from historically marginalized populations have lower levels of preparedness for care planning.

Surrogate preparedness for medical decision-making is an important part of care planning. This study examined preparedness and engagement among historically marginalized surrogates. Surrogates were included if they were named medical decision-makers by patients ≥55 years at a San Francisco safety-net and Veterans Affairs hospital. We assessed preparedness for medical decision-making by asking if surrogates had been formally asked to be the medical decision-maker, if patients had discussed medical wishes with surrogates, and if the surrogate role and these medical wishes had been documented. We assessed surrogate confidence and readiness using a modified Surrogate ACP Engagement Survey. We used Wilcoxon rank-sum tests to measure the association of engagement scores with surrogate characteristics. Of 422 surrogates, their mean age was 53 years (SD ±14.5), 73% were from minoritized groups, 38% were Spanish-speaking, and 15% had limited health literacy. For preparedness outcomes, 13% of surrogates were not formally asked to play this role, 46% reported the patient had not discussed end-of-life medical wishes, and 51% reported there had been no formal documentation of the surrogate role. Surrogates reported higher confidence 4.43/5 (SD ± 0.64) than readiness 3.70 (1.22) for decision-making (p < 0.001). Confidence and readiness scores were lower among historically marginalized participants. More resources are needed to prepare surrogate decision-makers from historically marginalized communities for discussing patient's goals of care and treatment preferences.

Perception of Physicians' Notes Among Parents of Different Health Literacy Levels.

To explore the benefits and challenges of accessing physicians' notes during pediatric hospitalization across parents of different health literacy levels. For this secondary analysis, we used semi-structured interviews conducted with 28 parents on their impressions of having access to their child's care team notes on a bedside table. Three researchers used thematic analysis to develop a codebook, coded interview data, and identified themes. Parent interviews and respective themes were then dichotomized into proficient or limited health literacy groups and compared. Nine themes were identified in this secondary analysis: 6 benefits and 3 challenges. All parents identified more benefits than challenges, including that the notes served as a recap of information and memory aid and increased autonomy, empowerment, and advocacy for their child. Both groups disliked receiving bad news in notes before face-to-face communication. Parents with proficient literacy reported that notes allowed them to check information accuracy, but that notes may not be as beneficial for parents with lower health literacy. Parents with limited literacy uniquely identified limited comprehension of medical terms but indicated that notes facilitated their understanding of their child's condition, increased their appreciation for their health care team, and decreased their anxiety, stress, and worry. Parents with limited health literacy uniquely reported that notes improved their understanding of their child's care and decreased (rather than increased) worry. Reducing medical terminology may be one equitable way to increase note accessibility for parents across the health literacy spectrum.

Health literacy among pregnant women in the United Arab Emirates: The Mutaba'ah study.

Health literacy is the degree to which individuals can obtain, process, understand, and communicate health-related information. Health literacy among pregnant women, in particular, may have a significant impact on maternal and child health. In the United Arab Emirates, no previous studies have been carried out to investigate the health literacy levels of pregnant women. This study aimed to investigate antenatal health literacy levels and identify associated factors among pregnant Emirati women in the United Arab Emirates. This analysis was based on the baseline cross-sectional data for pregnant women participating in the prospective cohort Mutaba'ah Study, recruited between May 2017 and August 2022. Participants completed a self-administered questionnaire during their antenatal visits that collected sociodemographic and pregnancy-related information. Adequacy of health literacy was assessed using the BRIEF health literacy screening tool with adequate health literacy defined as a score ⩾ 17. Regression modeling investigated the association between the pregnant women characteristics with having adequate health literacy level (ability to read and comprehend most patient education materials). A total of 2694 responses to the BRIEF health literacy screening tool were analyzed. Approximately, three-quarters (71.6%) of respondents showed adequate health literacy, followed by marginal (22.8%), and limited (5.6%) health literacy levels, respectively. Higher education levels (adjusted odds ratio (aOR) = 1.74, 95% confidence interval = 1.46-2.08), employment (adjusted odds ratio = 1.35, 95% confidence interval = 1.10-1.65), and adequate social support (adjusted odds ratio = 1.69, 95% confidence interval = 1.26-2.28) were associated with adequate health literacy levels. Participants who expressed worry about birth were less likely to have adequate literacy levels (adjusted odds ratio = 0.70, 95% confidence interval = 0.58-0.85). Nearly three-quarters of pregnant women have adequate health literacy. Nevertheless, measures including policies to sustain and enhance health literacy levels among all expectant mothers are required, with a specific focus on those having limited health literacy.

Health Literacy Among Non-Communicable Disease Service Seekers: A Nationwide Finding from Primary Health Care Settings of Bangladesh.

Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12-e20.].