Low Functional Health Literacy Research Articles

Factors Related to Treatment Non-Adherence Among Caregivers of Pediatric and Adolescent Growth Hormone Deficiency Patients in Japan.

About one-third of caregivers of pediatric or adolescent growth hormone deficiency (pGHD) patients in Japan have reported poor treatment adherence. However, few studies have examined factors related to adherence for that group. The aim of this study is to consider factors related to poor adherence to daily treatment among caregivers of pGHD patients in Japan. A cross-sectional survey was conducted among caregivers of pGHD patients in Japan. Caregivers were asked about demographic and treatment characteristics, health literacy, treatment satisfaction, opinions about treatment, and treatment adherence. Health literacy was assessed using the 14-item health literacy scale (HLS-14). Adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Statistical association with adherence was considered using Chi-square and Student's t-testing. An exploratory factor analysis (EFA) and K-means cluster analysis was conducted to consider the influence of treatment satisfaction and opinions concerning treatment on adherence. Responses were collected from 112 caregivers. The caregiver's age being 30-39 years old, the primary caregiver being male, the primary caregiver being employed, and low functional health literacy for the caregiver were associated with poor adherence. Patients being pre-elementary school age was also associated with poor adherence. Low satisfaction with drug treatment and/or their device and communication with healthcare professionals (HCPs), and lack of agreement with the importance of treatment management (eg, keeping injection records, getting informed about the disease/therapy, reporting non-adherence, and sticking to an administration schedule), were also associated with poor adherence. Strategies to improve treatment adherence among caregivers of pGHD patients in Japan should consider the age, gender, and employment status of the caregiver - as well as their functional literacy. Improvement in satisfaction with the drug or device used, better communication with HCPs, and greater awareness of the importance of treatment management, may also lead to better adherence.

Social media and health promotion: evaluation of effectiveness in promoting hypertension self-care in urban contexts of social iniquities

This paper explores the role of social media in promoting self-care for Systemic Arterial Hypertension (SAH) and addressing health inequities, emphasizing its significance in the context of the COVID-19 pandemic. It calls for a focus on social determinants of health and highlights the global impact of Chronic Non-Communicable Diseases (NCDs), with a particular focus on Brazil's healthcare system. The research, a collaboration between the University of Brasília and the research initiative Escola de Pacientes DF (EP-DF), employs Participatory Community Based Research (CBPR) to evaluate the impact of social media on SAH self-care in urban areas with social inequities. The study includes a scoping review of relevant articles, document analysis of SAH patient testimonials, and knowledge translation for community understanding. Results from the scoping review show positive changes in self-care behaviors due to social media interventions, while acknowledging challenges such as low Functional Health Literacy (FHL), age, education, and internet access. In conclusion, the paper highlights social media's potential in improving healthcare accessibility and equity for SAH and NCDs in vulnerable communities.

Functional Health Literacy Among Chinese Populations and Associated Factors: Latent Class Analysis.

Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one's health condition and its management, and higher use of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, the literature review shows that no studies of functional health literacy have been conducted among the Chinese population in China. This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy to provide some implications for health education, medical research, and public health policy making. We hypothesized that the participants' functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a four-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, the eHealth Literacy Scale, and the 6-item General Health Numeracy Test); and (4) health beliefs and self-confidence measured by the Multidimensional Health Locus of Control Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we used latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy. All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. Applying latent class analysis, we classified Chinese populations into low (n=292, 36.5%), moderate-to-adequate (n=286, 35.7%), and low-to-moderate (n=222, 27.8%) functional health literacy groups and identified five factors associated with low communicative health literacy: (1) male gender (aged 40-49 years), (2) lower educational attainment (below diploma), (3) age between 38 and 68 years, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck. We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy making.

The relationship between health literacy and internet addiction among middle school students in Chongqing, China: A cross-sectional survey study.

Internet addiction has emerged as a major global concern as a potential adverse impact of internet exposure on adolescents. Internet addiction is associated with many demographic variables; however, there is a lack of consensus on its relationship with health literacy. Therefore, the aim of the present study was to assess the rates of internet addiction and health literacy level among middle school students (grades 7 to 12) in Chongqing, China, as well as to investigate the association between them. A cross-sectional, questionnaire-based study was conducted among 8971 students who were randomly selected by using stratified cluster sampling between November and December 2019. The Internet Addiction Diagnostic Questionnaire, Adolescent Health Literacy Scale and a self-designed basic information questionnaire were used to collect data. Chi-square tests were performed to compare the differences in the distribution of internet addiction across health literacy levels as well as some sociodemographic characteristics. Multivariate logistic regression analyses were conducted to identify the association between health literacy and internet addiction. The prevalence of internet addiction among middle school students in Chongqing was 6.1%. The percentage of the students who spent more than 4 hours online every day in the past week was 14.3%. In addition, 26.7%, 26.0%, 28.3% and 26.3% of the participants reported low functional, interactive, critical and total health literacy, respectively. After adjusting for the confounding effects of demographics, multivariate regression analysis showed that critical health literacy was a protective variable for internet addiction, while functional, and interactive health literacy were the risk variable (P<0.05). Furthermore, the internet addiction rates were higher among boys, students with good peer relationships, and students without parental supervision, whereas internet addiction rates were lowest among students in grade 12. The prevalence of internet addiction among middle school students in Chongqing is relatively high. Internet addiction is strongly negatively associated with critical health literacy, but it is positively associated with functional and interactive health literacy but not total health literacy. This study provides preliminary evidence for the predictive role of health literacy in internet addiction of adolescents.

Amazon Amandaba-Sociodemographic Factors, Health Literacy, Biochemical Parameters and Self-Care as Predictors in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Health literacy (HL) and its domains (functional, critical, and communicative) appear to be related to self-care adherence in people with type 2 diabetes mellitus (DM2). This study aimed to verify if sociodemographic variables are predictors of HL, if HL and the sociodemographic factors affect biochemical parameters together, and if HL domains are predictors of self-care in DM2. We used the baseline assessment data from 199 participants ≥ 30 years in the project, "Amandaba na Amazônia: Culture Circles as a Strategy to Encourage Self-care for DM in Primary Health Care," which took place in November and December 2021. In the HL predictor analysis, women (p = 0.024) and higher education (p = 0.005) were predictors of better functional HL. The predictors of biochemical parameters were: glycated hemoglobin control with low critical HL (p = 0.008); total cholesterol control with female sex (p = 0.004), and low critical HL (p = 0.024); low-density lipoprotein control with female sex (p = 0.027), and low critical HL (p = 0.007); high-density lipoprotein control with female sex (p = 0.001); triglyceride control with low Functional HL (p = 0.039); high levels of microalbuminuria with female sex (p = 0.014). A low critical HL was a predictor of a lower specific diet (p = 0.002) and a low total HL of low medication care (p = 0.027) in analyses of HL domains as predictors of self-care. Sociodemographic factors can be used to predict HL, and HL can predict biochemical parameters and self-care.

Virtual care beyond COVID-19: Patient and physician perspectives.

389 Background: The COVID-19 pandemic catalyzed rapid implementation of virtual care (VC), resulting in new opportunities to integrate technology and a need to evaluate patient and provider experiences. To inform sustainment beyond COVID-19, we evaluated perceptions of VC at a comprehensive cancer centre in Toronto, Canada. Methods: Physicians who provided VC during the pandemic, and patients with a valid email address on file and at least one visit with centre in the preceding 12 months were eligible to participate. Survey invitations were disseminated between May and July 2021 via email using a modified Dillman approach. The survey examined the implementation outcomes of acceptability, adoption, and appropriateness. Unadjusted associations between patient demographic variables and preference for in-person visits were evaluated using univariate logistic regression models. Results: 41% (100/246) of physicians and 15% (2,343/15,169) of patients completed the survey. The majority of patients were Caucasian (77%), college or university educated (78%), had solid malignancies (73%), and were in the follow-up phase (47%); 50% were male. The median age was 66 (IQR: 58-74). A greater proportion of patients expressed satisfaction with VC than providers (81% and 53%). Conversely, a greater proportion of providers felt that care delivered virtually was worse than care delivered in-person (45% vs 26%). Interestingly, many patients (69%) and physicians (40%) reported feeling they could maintain a good relationship through VC while at the same time reporting concerns that VC would detract from the human interaction they value as part of care (patients: 60%; providers: 82%). Patients expressed relatively equal preference for phone vs video visits (40% vs 31%), but indicated concerns about wait times for VC visits. The majority of physicians (37%) estimated that 10-29% of their practice would remain virtual post-COVID, however physicians expressed concerns with increased workload (72%), decreased efficiency (40%), and increased worry about missing relevant clinical information (61%). The majority of patients and physicians reported that VC was not appropriate for first consultations and discussions of prognosis, and most appropriate for long-term follow-up. Being born outside of Canada, primary language other than English, lower income, lower functional health literacy, and greater physical mobility were associated with preferring in-person over VC visits. Conclusions: Patients and physicians were satisfied with VC but expressed concerns with the impacts on care quality and experience and highlighted the need for guidelines on appropriate use. Providers expressed greater concerns with VC than patients. More research is needed to formally evaluate the impact of VC on quality performance and clinical outcomes as well as investigate the patient, disease and system factors that are associated with effective virtual cancer care.

Health literacy dimensions among public health service users with chronic diseases in Piracicaba, Brazil, 2019

Aim: This study analyzes factors associated with dimensions of health literacy (HL) functional, communicative and critical among public health service users with chronic non-communicable diseases. Methods: A cross-sectional analytical research was carried out in Piracicaba, São Paulo, Brazil, with adults and older adults attending Family Health Units (FHU). Data were collected by oral exam (CPOD and CPI) and a questionnaire on systemic conditions, sociodemographic factors, health behaviors and HLS (HLS-14). The outcomes consisted of functional, communicative, and critical HL dimensions dichotomized by median (high and low), which were analyzed by chi-square test (p&lt;0.05) to find associations with the variables studied. Results: The study sample comprised 238 FHU users with 62.7 (± 10.55) mean age, of which 47.5% (n=113) showed high functional HL, 50.0% (n=119) high communicative HL, and 46.2% (n=110) high critical HL. High functional HL was associated with men (p&lt;0.05). Functional and communicative HL were associated with having higher education (p&lt;0.001 and p=0.018, respectively). High communicative and critical HL were associated with regular use of dental and medical services (p&lt;0.05). Individuals with low functional HL were more likely to present poor tooth brushing (p=0.020). High HL (in all three dimensions) was associated with regular flossing and having more teeth (p&lt;0.05). Conclusion: Functional, communicative and critical HL were associated with health behaviors and clinical outcomes, whereas the functional dimension was also associated with sociodemographic factors. HL dimensions allowed to differentiate health-related factors.

Abstract PO-038: Assessing Spanish health literacy and cervical cancer knowledge, attitudes, and behaviors in a student-run free clinic

Abstract It is well-established that Hispanic populations in the United States have a higher incidence of invasive cervical cancer compared to non-Hispanic populations. Variations in cancer screening utilization and socioeconomic status are thought to account for much of this observed difference, and examination of health literacy has the potential to illuminate further aspects of this disparity. In addition to an association between English health literacy and Papanicolau (Pap) test knowledge, research has shown that in the setting of Spanish health materials low Spanish health literacy is strongly associated with never having a Pap test. This indicates that even when health information is provided in Spanish, low functional health literacy limits adequate care. The objective of this project is to examine Spanish health literacy and cervical cancer screening knowledge, attitudes, and behaviors in the patient population of the BRIDGE Healthcare Clinic; a student-run free clinic that serves primarily Spanish-speaking populations in the Tampa area. Spanish health literacy will be measured by the Short Assessment of Health Literacy–Spanish (SAHL-S), a validated health literacy questionnaire. A short questionnaire examining functional cervical cancer health literacy will measure the knowledge and attitudes of BRIDGE patients. Cervical cancer screening behaviors will be measured via the electronic medical record. Patients will be approached for recruitment as they wait for their appointments. Eligibility criteria include having a cervix, speaking Spanish as a primary language, and being over 21. Spanish health literacy will be assessed using the SAHL-S followed by a Spanish questionnaire assessing cervical cancer screening knowledge and attitudes. This questionnaire will consist of simple words and short sentences, with question structure based on previous studies of cancer health literacy. Patients will be asked to agree or disagree with knowledge statements such as “HPV causes cervical cancer” as well as attitude statements such as “I think it is important to get regular Pap smears.” Data quality will be monitored as the questionnaires are completed and manually transcribed into an Excel file. All data will be managed and analyzed using SPSS. This project is not powered to test hypotheses, but to robustly describe Spanish health literacy and cervical cancer screening knowledge, attitudes, and behaviors using descriptive statistics. Results will be used to generate information on how Spanish health literacy may mediate adequacy of cervical cancer screening. Additionally, quality improvement will be pursued by creating targeted cervical cancer educational materials for BRIDGE patients. There is also potential for future projects, such as re-administering the knowledge and attitudes questionnaire after an educational intervention. Ultimately, this project will illuminate understudied aspects of the widening disparity in Hispanic cervical cancer incidence and identify future directions for addressing this disparity from a health literacy perspective. Citation Format: Anna Ulyanenkova Fusani, Nat Jones, Sage Hewitt, Valeria Pereira Martinez, Lucy Guerra, Eduardo Gonzalez. Assessing Spanish health literacy and cervical cancer knowledge, attitudes, and behaviors in a student-run free clinic [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-038.

Health Literacy Levels and Predictors Among Lebanese Adults Visiting Outpatient Clinics in Beirut.

Background:To date, there has been a dearth of research on health literacy in the Eastern Mediterranean Region and in particular Lebanon.Objectives:This cross-sectional study assessed the levels and correlates of health literacy in Lebanese adults.Methods:A total of 587 participants (54.5% women) were recruited from the outpatient clinics of five health facilities in Beirut. The questionnaire consisted of the Arabic version of the Functional Health literacy Scale, the Arabic short version of the European Health Literacy Survey, and questions on sociodemographic and health-related factors. Descriptive and inferential statistics were performed to assess the association of these factors with functional health literacy (FHL) and comprehensive health literacy (CHL) levels.Key Results:About 65.8% had inadequate or problematic FHL and 43.8% had inadequate or problematic CHL. Although FHL was negatively correlated with long-term illness, it was positively correlated with ability to pay and health status. CHL was positively correlated with education, income, ability to pay for treatment, health status, and FHL level, whereas it was negatively correlated with long-term illness. Binary logistic regression showed that low education, low socioeconomic status, and being a widow were predictive of inadequate FHL. Moreover, having inadequate FHL and low income increased the likelihood of having inadequate CHL.Conclusion:This study has identified those with risk factors for inadequate health literacy and unfavorable health outcomes. A national action plan can guide the promotion of health literacy and its embeddedness in society to instill competencies and the environment that would eliminate health inequities and sustain health in Lebanon. [HLRP: Health Literacy Research and Practice. 2021;5(4):e295–e309.]Plain Language Summary:This study examined health literacy levels and correlates in 587 Lebanese adults using two recognized screening tools. The first tool measured functional health literacy (FHL), which represents the ability of a person to acquire information on health through reading or writing. The second tool assessed comprehensive health literacy (CHL), which encompasses the ability of a person to use their social skills to acquire health information from different media and make appropriate health decisions based on this information. Close to two-thirds of the participants had inadequate or problematic FHL. More specifically, low education, low socioeconomic status, and widowhood were predictive of inadequate FHL. Nearly one-half of the participants had inadequate or problematic CHL with an increased likelihood of inadequate levels in people with low FHL and low income.

Aging and Functional Health Literacy: A Population-based Study

To investigate functional health literacy and its associated factors among older adults drawn from a disadvantaged area.Cross-sectional epidemiologic study.Population-based cohort randomly selected from the voter registration lists.Individuals aged 65+ (N=1066).The Short Test of Functional Health Literacy in Adults (S-TOFHLA); demographics; self-rated health; number of prescription drugs; modified Center for Epidemiologic Studies- Depression scale; Mini-Mental State Examination; Wechsler Test of Adult Reading; Clinical Dementia Rating; cognitive domain composite scores; independence in Instrumental Activities of Daily Living and medication management; health services utilization (emergency/urgent care visits and hospitalizations).Low (inadequate or marginal) S-TOFHLA scores were obtained by 7.04% of the sample. In unadjusted analyses, participants with low S-TOFHLA scores were significantly more likely than those with higher scores to be older, male, non-White, with lesser education and lower household income, to have lower scores on the Wechsler Test of Adult Reading, the Mini-Mental State Examination, and all cognitive domains; to be more dependent in Instrumental Activities of Daily Living and be taking more prescription drugs. In a multiple regression model including all covariates, only older age, male sex, and lower reading level were independently associated with inadequate or marginal S-TOFHLA scores.In a population-based sample of older adults, low functional health literacy was associated with age, sex, education, and reading ability. Basic functional health literacy is essential for understanding health information and instructions. Clinicians should formally or informally assess health literacy in their older patients to ensure effective communication and enhance health outcomes.

Physical health literacy of student-athletes.

Student-athletes are a vulnerable population who face many unique stressors and often engage in risky physical behaviours. Understanding that high levels of health literacy (HL) can lead to improved health knowledge and decreased negative health outcomes, the purpose of this study was to assess the HL of both student-athletes and their non-athlete peers attending NCAA Division I, II and III institutions. Specifically, guided by Nutbeam's (2000) framework of HL, we assessed functional, communicative and critical HL in 205 student-athletes and 205 non-athlete students using the All Aspects of Health Literacy Scale. Compared to non-athletes, student-athletes had lower functional HL (b=0.20; p<.001; d=0.21), lower communicative HL (b=0.12; p<.01; d=0.13) and higher critical HL (b=0.11; p<.05; d=0.11). These findings suggest that additional interventions may be needed to increase the self-sufficiency of student-athletes to care for personal physical health. As social work in sport is an emerging subspecialty of the profession, social workers may consider increased involvement in advocating for this group by working with individuals, coaches and teams to decrease stigma in requesting health services, attending to the complexity of interacting systems and stressors in student-athletes' lives in therapeutic interventions, and connecting them to empowering health education resources.

Medication self-management support for people with diabetes and low health literacy: A needs assessment.

IntroductionAn adequate level of health literacy is regarded as a prerequisite for adequate medication self-management. Low health literacy skills are relatively more common in people with Diabetes Mellitus type 2. The aim of this study was to explore the needs regarding medication self-management of people with type 2 diabetes and low (functional, communicative and critical) health literacy, and their preferences for medication self-management support.Materials and methodsA two-stage qualitative needs assessment study was performed using in-depth individual interviews and focus groups.ResultsThe participants preferred to be supported with reliable and easily understandable information, adequate interactive communication with health care professionals and fellow people with diabetes and tools for medication self-management support.DiscussionFuture interventions should be created in co-creation with people with low health literacy and fulfill the expressed needs on information, communication and tools to improve self-management.

Assessment of functional health literacy in Brazilian carers of older people.

ABSTRACT.Individuals with low health literacy have less knowledge of their own health condition. Carers play a key role in older people’s activities of daily living.Objective:to evaluate the performance of carers of older people using the S-TOFHLA (Short Test of Functional Health Literacy in Adults) and to identify caregiver characteristics associated with low functional health literacy.Methods:a cross-sectional study was conducted. The S-TOFHLA, a sociodemographic instrument, the Mini-Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 carers of older patients routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, São Paulo. The multivariate analysis used an ordinal logistic regression model with test (S-TOFHLA) scores as the dependent variable. The level of statistical significance adopted was 0.05.Results:the individuals had a mean age of 54.6 (± 11.7); 27% of the carers evaluated had inadequate levels of health literacy (S-TOFHLA ≥54). A higher proportion of individuals with low education had inadequate or marginal health literacy (p<0.001).Conclusion:nearly 1/3 of the carers had marginal or inadequate levels of health literacy. These results highlight the difficulties of many carers in understanding health information.

Functional health literacy in hypertensive elders at primary health care.

to assess the relationship between inadequate functional health literacy and inadequate blood pressure control in older people with hypertension in Primary Health Care. a cross-sectional study with sample calculated at 392. SAHLPA-18 tool was used for functional health literacy; blood pressure was measured; sociodemographic and clinical data were collected. Hierarchical logistic regression was used. (high) inadequate blood pressure and (low) functional inadequate health literacy were present in 41.6% and 54.6% of the people, respectively. Factors associated with inadequate blood pressure were: inadequate functional health literacy, black-brown skin color, overweight-obesity, hypertension diagnosis time, non-adherence to exercise/diet, drug treatment. Schooling had no association with inadequate blood pressure. hypertensive elderly people with inadequate health literacy were more likely to have inadequate blood pressure. Thus, health professionals need to value functional health literacy as a possible component to control blood pressure.

Impact of Parents' Comprehensive Health Literacy on BMI in Children: A Multicenter Cross-Sectional Study in Japan.

Low-functional health literacy (HL) of parents influences poor child health outcomes. This study aimed to assess the relationship between comprehensive HL of parents and body mass index (BMI) of their children. We enrolled 3- to 6-year-old preschool-aged children and their parents in this multicenter cross-sectional cohort study. We evaluated parents' comprehensive HL with the 14-item HL scale. Children's BMI categories were defined using International Obesity Task Force cutoffs according to age and sex. We analyzed differences in data between the high-HL group and the low-HL group and investigated the association between HL of parents and their children's BMI by multivariate logistic regression analysis. The high-HL group comprised 208 (75.1%) children and the low-HL group comprised 69 (24.9%) children of whom 23 (8.3%) were overweight and 35 (12.6%) were thin. The low-HL group had more children with poor BMI than the high-HL group. Multivariate analysis showed an association between the low HL of parents and the poor BMI of their children after adjustment for all other confounding factors. Comprehensive HL of parents appears to affect the BMI of their children independently, suggesting that interventions to improve HL in parents are necessary.

A low literacy targeted talking book about radiation therapy for cancer: development and acceptability.

To develop a low literacy talking book (written book with accompanying audio-recording) about radiation therapy and explore its acceptability with patients and caregivers. The talking book was developed iteratively using low literacy design principles and a multidisciplinary committee comprising consumers and experts in radiation oncology, nursing, behavioural sciences, and linguistics. It contained illustrations, photos, and information on: treatment planning, daily treatment, side effects, psychosocial health, and a glossary of medical terms. Semi-structured interviews were conducted with patients who self-reported low functional health literacy and caregivers to explore their views on the resource. Thematic analysis using a framework approach informed the analysis. Participants were very satisfied with the content, illustrations, and language in the resource. Most were unfamiliar with the term 'talking book', but liked the option of different media (text and audio). The resource was seen as facilitating communication with the cancer care team by prompting question-asking and equipping patients and their families with knowledge to communicate confidently. The low literacy talking book was well accepted by patients and their caregivers. The next step is to examine the effect of the resource on patients' knowledge, anxiety, concerns, and communication with the cancer care team.

Association between health literacy, communication and psychological distress among myelodysplastic syndromes patients

MDS is a complex and potentially severe disease which can trigger psychological distress. A lack of information received and understood about MDS may also arouse feelings of distress. Low health literacy (HL) might play a role particularly among older patients. Our aim was to assess MDS-related distress and to study the factors associated with it, including medical and non-medical factors such as HL.A self-administered questionnaire was mailed to all members of French and Australian patients’ national MDS associations. Data of 280 patients were analysed.A majority of patient (59.5%) reported low functional HL and 50% reported regular difficulties in asking physicians questions. Distress was not modified by gender, awareness of increased risk of developing leukaemia or MDS characteristics. French patients had a higher mean IES score (adjusted β = 5.9, p = 0.004) compared to Australian patients. Poor satisfaction with information provided about MDS, lower functional HL and difficulties in asking physician’s questions were also independently associated with distress.MDS-related distress seems more related to HL and communication with physicians than to MDS characteristics. More efforts are needed to improve health literacy, tailor information for MDS patients and support them psychologically in order to improve their emotional well-being.

Assessment of health literacy skills in family doctors' patients by two brief, self-administered Italian measures.

Health Literacy (HL) is an important health determinant: low HL skills result in less healthy choices, riskier behavior, poorer health, less self-management and more hospitalization. An observational study was conducted in a selected population, attending the waiting rooms of family general practitioners, with the aim of assessing HL capabilities through the administration of two HL screeners (IMETER and SILS-IT), and comparing the two measures. An anonymous questionnaire was administered, consisting of the Italian versions of the two tests on a single sheet. Demographic data, as well as concomitant chronic diseases and vaccines received, were also collected. HL skills were measured by the scores observed at both tests, and by the frequency of subjects with low HL levels according to the respective cut-off values. Overall, 305 questionnaires were collected and analyzed. Regarding IMETER, the observed frequency of subjects with low HL skills was 25.2% and the mean score and mean adjusted-score (26.3 ± 8.8 and 23.2 ± 9.4, respectively) were lower than those observed in previous studies. Similarly, at SILS-IT the percentage of subjects with low skills (49.9%) was higher than observed previously. IMETER showed high internal consistency (Cronbach's alpha > 0.9). The two measures were significantly correlated, although with a low Spearman's coefficient, and IMETER did not provide significant information about the probability to predict low HL according to SILS-IT. These results are explainable by the differences in assessment and domains between the two tests, both reliable and suitable to screen patients with low functional HL.

Health Literacy, Health Care Utilization, and Direct Cost of Care Among Linguistically Diverse Patients with Type 2 Diabetes Mellitus

Background:Low functional health literacy (HL) has been associated with poor self-management of chronic conditions, including type 2 diabetes mellitus (T2DM), an inefficient use of health services, and higher health care costs. Low functional HL and limited English language proficiency both independently predict poor glycemic control among Latino and Chinese immigrants in the United States, and is more common among patients with diabetes with limited HL.Objective:This study investigated the relationship between low functional HL, health care utilization, and costs of health care among a cohort of low-income patients with T2DM whose primary language was English, Spanish, or Cantonese (N = 277).Methods:Patient data were collected from Medicaid administrative health care records as part of a low-income managed care program administered by the San Francisco Health Plan between April 2009 and March 2011. HL was measured with the Brief Questions Screening Tool for Health Literacy, administered via telephone survey. We used negative binomial regression with robust standard errors to estimate the effect of low functional HL on health care utilization, adjusting for demographic, socioeconomic, and health covariates. Results were reported as rate-ratios (RRs). We used two-part regression models to estimate the marginal difference in cost per patient associated with low functional HL. Utilization and cost models were also estimated, stratified by patient language.Key Results:We observed a nonsignificant association between low functional HL and lower health care utilization, and lower total health care costs (−$1,493.53, 95% confidence interval [CI]: $3,602 to $615). While we observed a nonsignificant trend for low functional HL and lower utilization and total cost among people who speak English and Cantonese, low functional HL was significantly associated with more outpatient visits among patients who spoke Spanish (RR 1.31, 95% CI 1 to 1.72).Conclusions:The relationship between low functional HL and health care utilization among this linguistically diverse cohort of patients with T2DM varied by patient language. Further research is needed to determine if lower utilization and costs in certain linguistic subgroups is indicative of barriers to access. [Health Literacy Research and Practice. 2017;1(3):e116–e126.]Plain Language Summary:This study attempts to understand the relationship between health literacy, health care utilization, and costs of health care among an ethnically and linguistically diverse cohort of low-income patients with type 2 diabetes mellitus. We observed differences that could be due to actual differential effects of low HL by language status, or could be explained by unmeasured differences in health-seeking behaviors, access to care, degree of acculturation, or comorbidities.

일부 대학생의 기능적 구강건강문해력과 구강보건지식 및 구강보건행태에 관한 융합적 관계

본 연구는 대학생을 대상으로 기능적 구강건강문해력과 구강보건지식 및 구강보건행태의 관련성을 조사하였다. K시 대학교에 재학 중인 학생 410명을 대상으로 2015년 6월 22일 부터 26일 까지 설문조사를 하였으며, 398명의 자료를 최종 분석 대상으로 하였다. 그 결과 구강보건교육을 받은 경험이 있는 학생은 281(70.6)명, 교육 받은 경험이 없는 학생은 117(29.4)명으로 나타났으며, 구강보건교육을 받을 때 교육 내용 및 설명이 여러 번 어려웠다는 학생은 194(48.7)명, 간혹 어려웠다는 128(32.2)명으로 나타났다. 기능적 구강건강문해력 점수는 절반 이상의 대학생이 낮게 나타났다. 기능적 구강건강문해력 점수가 높을수록 구강보건지식이 높게 나타나고, 구강보건지식이 기능적 구강건강문해력에 영향을 미치는 것으로 나타났다. 따라서 대학생들의 낮은 기능적 구강건강문해력 향상을 위한 효과적인 구강보건지식 전달 프로그램이 개발되어야 한다. The research had an investigation of relevance between functional oral health literacy, oral health knowledge, and oral health behaviors of college students. Survey of 410 students in K city college done from June 22 to 26, 2015 was analyzed, and the final analysis subject was 398 students. The result were 281(70.6) students with experience of oral health education, 117(29.4) students without experience of education, and there were 194(48.7) students who had difficulty several times with the material and explanation while attending the education, and 128(32.2) students who had difficulty a few times. Scores of functional oral health literacy were low for more than half of the college students. The higher the functional oral health literacy score, the higher oral health knowledge was shown, and oral health knowledge turned out to be affecting functional oral health literacy. Therefore, an effective program for delivering oral health knowledge to improve low functional oral health literacy of college students must be developed.