Low Levels Of Health Literacy Research Articles

Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study.

This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.

IA model for the creation of automatic and personalized health literacy plans for home care services and protocol for its validation

Background: Health Literacy (HL) is considered a social determinant of health with a direct and significant impact on health-related quality of life, especially in groups of elderly, polymedicated or chronically ill persons. According to the WHO, HL implies achieving a level of knowledge, personal skills and confidence that allows the adoption of measures to improve health through a change in lifestyle. It is a concept that combines elements of health and education. HL is the result of health education. In fact, a poor understanding of health recommendations or instructions is related to poor disease self-management and limited use of preventive resources. Furthermore, a low level of HL translates into an increase in (a) avoidable hospitalizations, (b) healthcare costs and (c) mortality rates. Artificial intelligence (AI) can help create personalized HL plans for each patient automatically. Moreover, thanks to digital education platforms these plans can be delivered and monitored remotely and digitally, reducing the resource of professional hours. The application of AI in health literacy is especially interesting in home health services, where the resources of professionals are scarce and care falls mainly on the family and the patient him/herself.
 Aim: The aim of this study is to develop an IA model for the creation of automatic and personalized HL plans for home care settings that can be consumed by families through a digital tool. The protocol for validation of the HL plans created by the model is also presented.
 Method: At the beginning, (1) a comprehensive geriatric assessment is performed that identifies the needs and capabilities of the care ecosystem (patient-caregiver) in a model of comprehensive person-centered care in the home care setting. (2) After analysis of the data collected in the assessment using validated diagnostic algorithms the IA model automatically generates an individualized training itinerary HL plan adapted to each user profile. (3) Using nursing indicators defined in the NNN taxonomy (NANDA, NOC, NIC) we measure at the beginning and at the end of the HL plan: (a) the knowledge acquired; (b) the change in behavior/behavior and (c) objective results of the health status.
 Main Results: We present an AI model for automated and scalable HL plan creation for home care settings. This model has the potential to improve the HL of the 65+ population (chronicity, complexity, multi-pathology, dependency, frailty, pre-frailty or autonomy) and their informal caregiving ecosystem (non-professional caregivers) in the home setting, especially if long-term care is present. The learning programs created for the HL plan were carried out under a rigorous protocol based on criteria of accessibility and scientific evidence.
 Conclusions: Thanks to the protocol, it will be possible to validate the impact of the HL plans created by the IA model on both the patient and the caregiver. The IA model is currently in the process of validation but shows promising results in reducing the time spent on direct intervention by professionals and improving the population's accessibility to HL plans thanks to the IA model.

Patient decision aids for aortic stenosis and chronic coronary artery disease: a systematic review and meta-analysis.

Shared decision-making is recommended for patients considering treatment options for severe aortic stenosis (AS) and chronic coronary artery disease (CAD). This review aims to systematically identify and assess patient decision aids (PtDAs) for chronic CAD and AS and evaluate the international evidence on their effectiveness for improving the quality of decision-making. Five databases (Cochrane, CINAHL, Embase, MEDLINE, and PsycInfo), clinical trial registers, and 30 PtDA repositories/websites were searched from 2006 to March 2023. Screening, data extraction, and quality assessments were completed independently by multiple reviewers. Meta-analyses were conducted using Stata statistical software. Eleven AS and 10 CAD PtDAs were identified; seven were less than 5 years old. Over half of the PtDAs were web based and the remainder paper based. One AS and two CAD PtDAs fully/partially achieved international PtDA quality criteria. Ten studies were included in the review; four reported on the development/evaluation of AS PtDAs and six on CAD PtDAs. Most studies were conducted in the USA with White, well-educated, English-speaking participants. No studies fulfilled all quality criteria for reporting PtDA development and evaluation. Meta-analyses found that PtDAs significantly increased patient knowledge compared with 'usual care' (mean difference: 0.620; 95% confidence interval 0.396-0.845, P < 0.001) but did not change decisional conflict. Patients who use PtDAs when considering treatments for AS or chronic CAD are likely to be better informed than those who do not. Existing PtDAs may not meet the needs of people with low health literacy levels as they are rarely involved in their development. PROSPERO: CRD42021264700.

A Nationwide Survey on Patient Empowerment in Pediatric Inflammatory Bowel Disease in Germany.

The incidence/prevalence of pediatric inflammatory bowel disease (IBD) is increasing. IBD places a significant burden on young patients during important developmental stages and affects their families. Children and adolescents with IBD require increased support from health care services. However, little is known about the additional support needed and how to provide it. Therefore, a large survey was conducted with a focus on patient empowerment. For the anonymous survey, called CEDNA, a patient questionnaire for adolescents with IBD and a questionnaire for parents of children and adolescents with IBD were made available throughout Germany (distributed n = 2810). Questions covered various aspects of coping with the disease, utilization of care, use and need of information and communication services, and how information should be provided. From October 2021 to April 2022, 1158 (n = 708 parents (61.1%), n = 450 patients (38.9%)) questionnaires were completed. The results show a deficit in pediatric IBD care and revealed a large gap in knowledge about core IBD topics (e.g., 74.8% of patients feel poorly informed about transition, 62.4% know little about patient organizations and self-help groups, and 54.7% have little information about preventive health measures), indicating a low level of health literacy among affected children and adolescents. Pediatric IBD poses significant challenges for patients, their families, and healthcare teams. By empowering patients and families, and providing targeted information and communication tailored to the age of the child or adolescent and the needs of the parents, care can be improved and better adapted to the needs of patients. Actions would include providing quality information online through scientific societies and patient organizations and facilitating self-management in adolescents.

Abstract A064: My Choices: A multilevel, multicomponent intervention to improve informed decision-making about clinical trial participation among cancer patients

Abstract Background: Knowledge gained through cancer clinical trials (CTs) has been proven critical to preventing, diagnosing and treating the disease, and providing the evidence base for clinical practice. Major advances in cancer treatment, which are essential for improving patients’ outcomes, come from investigations of new therapeutic agents in CTs. Despite the large number of available studies and improvements in public awareness about CTs, participation of underrepresented minorities in clinical research has been persistently low, with only 2-5% of Latinos and African Americans participating in cancer treatment trials. Barriers to participation are multilevel, complex, and multifactorial, including study design, healthcare system barriers, and patient- and medical team-related factors. Structural inequities, social determinants of health (SDoH), distrust of government, patient-doctor communications, cultural and language barriers, and lower levels of health literacy are barriers for Latino and African American populations. Purpose: To improve informed decision-making about cancer CT participation among cancer patients and community members through a bilingual multilevel, multi-communication approach, including: 1) a 2-group parallel randomized controlled educational trial, and 2) a community awareness campaign. Methods: The randomized study involves 400 patients from the Mays Cancer Center. The intervention group receives 1) a bilingual educational video on CTs with patients’ testimonials, 2) a low literacy booklet, 3) support from a patient navigator (PN), and 4) Salud America! weekly emails with links to online/social media posts on CT. The control group receives a general fact sheet on CTs. Healthcare providers involved in clinical research are invited to participate in Webinars to raise awareness of implicit bias and the importance of inclusive research. The community intervention features a prospective single-group pre/post design, where participants (400) act as their own controls. They receive an educational session on CTs provided by a community health educator + a low literacy booklet. Results: Focus groups guided the development of the video script, booklet, and educational materials. The short video features real cancer patients sharing their experiences with CTs and how they overcame common barriers. Study recruitment began in February 2023. So far, we have recruited 36 cancer patients with a mean age of 51 years, 80% White and 61% Hispanic/Latino, 64% married, 44% had Medicare/Medicaid; 36% &amp;lt; high school education; and 33% earned &amp;lt;$40K. Preliminary results will be presented. Conclusions: Multilevel interventions involving culturally tailored decision aids (i.e., video, booklet) in combination with PN support can effectively address common barriers influencing patient decision-making, raise awareness of CTs, and increase positive attitudes, intentions, and participation in CTs among groups experiencing SDoH. Citation Format: Patricia Chalela, Vivian Cortez, Armida Flores, Sandra Sivak, Edgar Munoz, Cliff Despres, Callie Rainosek, Alyssa Gonzalez, Mio Kitano, Virginia Kaklamani, Kate Lathrop, Sukeshi Arora, Andrew Brenner, Deepak K. Pruthi, Amelie G. Ramirez. My Choices: A multilevel, multicomponent intervention to improve informed decision-making about clinical trial participation among cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A064.

P56: Exercising your worries away – what do older adults think about physical activity and technology interventions to reduce anxiety

Objective:Older adults have low levels of mental health literacy relating to anxiety which may contribute to delaying or not seeking help. Lifestyle interventions, including physical activity (PA), have increasing evidence supporting their effectiveness in reducing anxiety. The COVID-19 pandemic also highlighted the potential for technology to facilitate healthcare provision. This study aimed to investigate perspectives of older adults about their understanding of anxiety, possible use of PA interventions to reduce anxiety, and whether technology could help this process.Methods:The INDIGO trial evaluated a PA intervention for participants aged 60 years and above at risk of cognitive decline and not meeting PA guidelines. Twenty-nine of the INDIGO trial completers, including some with anxiety and/or cognitive symptoms, attended this long-term follow-up study including semi-structured qualitative interviews. Transcripts were analyzed thematically.Results:There was quite a diverse understanding of anxiety amongst participants. Some participants were able to describe anxiety as involving worry, uncertainty and fear, as well as relating it to physical manifestations and feeling out of control. Others had less understanding of the concept of anxiety or found it confusing. Participants generally believed that PA could potentially reduce anxiety and thought that this could occur through a “mindfulness” and/or “physiological” process. Technology use was a more controversial topic with some participants quite clearly expressing a dislike or distrust of technology or else limited access or literacy in relation to technology. Participants who were supportive of using technology described that it could help with motivation, information provision and health monitoring. Wearable activity monitors were described favorably, with online platforms and portable devices also being options.Conclusion:Our results highlight the importance of increasing information and education about anxiety to older adults. This may increase awareness of anxiety and reduce delays in seeking help or not seeking help at all. Findings also emphasize the need for clinicians to support understanding of anxiety in older adults that they are seeing and provide information and education where needed. It is likely that PA interventions to reduce anxiety, with the option of a technology component with support, will be acceptable to most older adults.

Health Literacy in Ethiopia: Evidence Synthesis and Implications.

Health literacy plays a pivotal role in healthcare utilization and health-related lifestyle choices. This makes health literacy a pressing concern, particularly in low-income countries like Ethiopia, where there are intricate health challenges. Despite its significance, there is a dearth of studies on the issue in Ethiopia. This study aimed to provide a comprehensive synthesis of the available evidence on health literacy in Ethiopia, and to discuss the implications for healthcare practice, health promotion, and research endeavors. A systematic scoping review was conducted to achieve the purpose of this study. A comprehensive search of databases such as PubMed, CINAHL, AJOL, and PLOS Global Public Health was conducted for eligible evidence. Searches were conducted from May 12 to September 9, 2022. The PRISMA flow diagram guideline was utilized to ensure transparent reporting of the reviews process. The data extraction tool used was based on the JBI methodology guidance for reviews. The search in total yielded 543 records. However, only 16 studies met the eligibility criteria after a thorough screening process. All eligible studies were conducted in health facilities and schools with limited scopes. The main findings of the eligible studies focused on health literacy levels, health information sources, and health literacy determinants among the studies participants. Many of the studies reported low health literacy levels and multiple predicting factors ranging from personal to socioeconomic conditions among the respondents. This review has provided critical insights into the state of health literacy in Ethiopia. There is a need for comprehensive research and the development of context-appropriate health literacy measurements tailored to the Ethiopian context, as well as evidence-based health literacy interventions. Prioritizing health literacy as a key research and intervention area is essential for improving the health of individuals and populations and achieving health-related Sustainable Development Goals in Ethiopia.

The Challenges of Vaccine Trial Participation among Underserved and Hard-to-Reach Communities: An Internal Expert Consultation of the VACCELERATE Consortium.

Underserved and hard-to-reach population groups are under-represented in vaccine trials. Thus, we aimed to identify the challenges of vaccine trial participation of these groups in member countries of the VACCELERATE network. Seventeen National Coordinators (NC), each representing their respective country (15 European countries, Israel, and Turkey), completed an online survey. From 15 eligible groups, those that were more frequently declared underserved/hard-to-reach in vaccine research were ethnic minorities (76.5%), persons experiencing homelessness (70.6%), illegal workers and refugees (64.7%, each). When prioritization for education on vaccine trials was considered, ethnic groups, migrants, and immigrants (5/17, 29.4%) were the groups most frequently identified by the NC as top targets. The most prominent barriers in vaccine trial participation affecting all groups were low levels of health literacy, reluctance to participate in trials due to engagement level, and low levels of trust in vaccines/vaccinations. This study highlighted population groups considered underserved/hard-to-reach in countries contained within the European region, and the respective barriers these groups face when participating in clinical studies. Our findings aid with the design of tailored interventions (within-and across-countries of the European region) and with the development of strategies to overcome major barriers in phase 2 and phase 3 vaccine trial participation.

Role of health literacy profiles in fluid management of individuals receiving haemodialysis: A cross-sectional study.

To identify health literacy profiles in individuals receiving haemodialysis and to explore how these profiles interact with individuals' self-efficacy, engagement with traditional dietary habits, self-reported fluid restriction and relative-interdialytic weight gain. A cross-sectional study engaging nephrology departments from four hospitals in Guangdong Province, China. A sample of 433 individuals receiving haemodialysis participated between December 2018 and July 2019. We assessed health literacy, self-efficacy and self-reported fluid restriction using the Health Literacy Questionnaire, the Fluid Self-efficacy Scale and the Fluid Adherence Subscale, respectively. Traditional dietary habits, including daily tea drinking, soup drinking and preserved food consumption, were measured using three yes/no questions. Relative-interdialytic weight gain was calculated by dividing the mean interdialytic weight gain (from three recent intervals) by dry weight. Latent profile analysis and structural equation modelling were performed. Three health literacy profiles were identified: low, moderate and high. Compared to those in the low health literacy profile, individuals in high and moderate health literacy profiles demonstrated an indirect association with reduced relative-interdialytic weight gain. This reduction can be attributed to their higher self-efficacy levels, decreased reliance on dietary habits and higher self-reported fluid restrictions. Most participants exhibited either low or moderate levels of health literacy. Improving health literacy has the potential to promote self-efficacy and foster effective fluid restriction, ultimately leading to a reduction in relative-interdialytic weight gain in individuals receiving haemodialysis. This study reveals heterogeneity in health literacy levels among individuals receiving haemodialysis and illuminates the connections between an individual's entire spectrum of health literacy and fluid management. These findings provide valuable insights for developing person-centred fluid management interventions, especially for individuals with diverse cultural dietary backgrounds within the haemodialysis population. We adhered to the STROBE guideline. Patients were included only for collecting their data.

Understanding health literacy of deaf persons with hypertension in South Korea: A cross-sectional study.

Health literacy is strongly associated with health inequality among persons with deafness, and hypertension (HTN) is the most prevalent chronic disease among persons with deafness in South Korea. Despite its importance, research regarding the health literacy levels of persons with deafness with HTN in South Korea is lacking. This study aimed to comprehensively assess the health literacy levels of persons with deafness with HTN in South Korea, including linguistic, functional, and internet health literacy. In this descriptive cross-sectional study, 95 persons with deafness with HTN were recruited through facilities associated with the deaf community. From August 2022 to February 2023, data were collected through face-to-face surveys attended by a sign language interpreter and online surveys. The data were analyzed using descriptive statistics and Spearman's correlation. Approximately 62.1% of the participants exhibited a linguistic health literacy level corresponding to less than that of middle school students, and the total percentage correct of functional health literacy was 17.9%. Each domain of internet health literacy was low. Significant correlations were found between some aspects of health literacy. The study's findings highlight the low health literacy levels across various facets among persons with deafness with HTN in South Korea. Based on these findings, several strategies are suggested for developing HTN self-management interventions for persons with deafness. This study contributes to the foundational understanding of health literacy among persons with deafness with HTN in South Korea and provides valuable insights and guidance for developing HTN self-management interventions.

Health literacy of women giving birth in Vilnius Perinatology Centre

Abstract The aim of the study To investigate the health literacy and associated factors of women giving birth at the Vilnius Perinatology Centre. Material and methods The study was conducted between June 2022 and September 2022 at the Vilnius University Hospital in Lithuania. Five hundred and eight women who had delivered healthy newborns were surveyed. The study instrument was the European Health Literacy Questionnaire (HLS-EU-Q47) in addition to other questionnaires to assess socio-demographic factors of the mother. The Health Literacy Questionnaire was used with the permission of the authors. The survey data was processed using IBM SPSS version 23. Results and conclusions The study showed that more than half of women who gave birth at the Vilnius Perinatology Centre had inadequate or problematic health literacy. Across all literacy indices (including health care, disease prevention, and health promotion), they particularly lack expertise in health promotion. The assessment of health information processing indices (to obtain, understand, evaluate, and apply) revealed that the evaluation of recent health information is the most challenging task for those women. The study confirmed the assumption that women with higher levels of education and who had attended maternity skills training have higher levels of health literacy. Higher rates of unplanned births are also linked to lower levels of health literacy among women.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

Background Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. Objective This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. Methods A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. Results The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. Conclusions This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. International Registered Report Identifier (IRRID) DERR1-10.2196/50798

49 Health Literacy and Well-Being in Older Adults

Objective:Although health problems are often a natural consequence of aging, many older adults struggle to manage their health care problems. Health literacy refers to the ability to access, process, and use health information to make appropriate decisions to promote good overall health. Low levels of health literacy are associated with a host of negative outcomes such as less efficient use of healthcare services, higher healthcare costs, increased mortality, and poorer self-rated health. In those with medical conditions (e.g., diabetes), lower health literacy is linked with higher levels of depression. It is important to investigate whether mental health is linked to health literacy as understanding these links has the potential to identify those at risk for negative outcomes and thus implement protective strategies. Therefore, the current study sought to determine the extent to which various mental health constructs such as happiness, well-being, anxiety and depression are related to health literacy in a community-based sample of cognitively healthy individuals. We hypothesized that higher levels of health literacy would be associated with higher self-reported well-being, happiness, and lower anxiety and depression.Participants and Methods:Design - Cross-sectional, prospective study. Setting - Community-based. 93 individuals were included with mean age=59.02 years (SD=15.12) and mean education=15.70 (SD=2.39). 60% were women, the majority were White (55%) while 38% were Black and 7% belonged to other races; 90% were non-Hispanic.Measures:Health Literacy - Health literacy was measured by an 8-item instrument in the Rush Memory and Aging Project that examined the participant’s understanding of health care, treatment, and related behaviors. Happiness - Happiness was measured by 5 items from the Satisfaction with Life Scale using a 7-point scale (1 = strongly agree; 7 = strongly disagree). Higher scores indicated lower levels of happiness. Well-being - Well-being was measured with an 18-item instrument from the Rush Memory and Aging project, with higher scores indicating better well-being. Statistics: Bivariate correlations between age, education, and mental health measures and health literacy were examined.Results:Higher level of health literacy was significantly associated with age (r = .282 p = .009) and education (r = .228 p = .039). Contrary to our hypothesis, health literacy was not significantly associated with happiness (r = .002 p = .987), well-being (r = .037 p = .742), depression (r = .005 p = .962) or anxiety (r = -.064 p = .568). Even after controlling for age and education, these associations remained significant.Conclusions:Higher level of healthy literacy was associated with older age and higher level of education. However, no significant association was found between health literacy and mental health measures of happiness, well-being, depression, and anxiety in cognitively healthy individuals, even after controlling for demographics. The lack of such associations in this study was unexpected and suggests that other factors such as the presence of health conditions (e.g., diabetes, cancer) might critically contribute to such associations. Future studies should examine these associations in a larger context to better understand how to promote healthy self-care behaviors.

Health literacy in migrants: the SPRINT2 project

Abstract Introduction Migrants generally reported lower levels of health literacy (HL) thus increasing their difficulties in accessing and interacting with the healthcare system. This study, carried out within the SPRINT2 project, aims to assess the HL level of 2 samples of asylum seekers and refugees residing in Tuscany, and to examine the relationship among HL, educational interventions, COVID-19 risk perception and preventive behaviours Materials and Methods Questionnaires were administered to a sample of refugees and asylum seekers (group A) between June and September 2021 and to another sample between April and September 2022 (group B) which participated at least in one health-related educational intervention. The Italian version of HLS-EU-Q16 was used to measure HL Results Among 171 subjects belonging to group A 25% had an inadequate HL level. Group B consisted of 102 respondents of which 37% had an inadequate HL level. Group B compared with group A had higher percentages of respondents who considered COVID-19 a serious health problem (58.8% vs 41.1%), very likely to be infected by SARS-COV-2 (58.2% vs 29.6%) and who thought quarantine compliance (89.7% vs 75.9%), the use nasopharyngeal swabs (78.4% vs 61.2%), and to get COVID-19 vaccination (89.4% vs 66.1%) were very important preventive measures. HL was found to be significantly associated (p &amp;lt; 0.05) with COVID-19 risk perception and propensity for handwashing, face mask use, and social distancing. At multivariate logistic analysis, low educational level and residing in Italy for less than 2 years were found to be predictors of inadequate HL level (OR 2,7 CI 95% 1,22-6,13; OR 3,9 CI 95% 1,93-7.79, respectively). Conclusions Our findings suggest that HL and educational interventions are important factor to improve healthy behaviours. Structured educational interventions to increase HL levels will be an important contribution in the process of inclusion and integration of migrants thus reducing health related inequalities. Key messages • The level of health literacy among migrants is most influenced by their educational level and length of stay in Italy. • Health literacy and educational interventions are important factor to improve healthy behaviours.

Health literacy, quality of life and burden of informal caregivers in Portugal

Abstract Background The process of informal caregiving may have significant impacts on physical, psychological, social and economic conditions of informal caregivers. Worldwide lower levels of health literacy are associated with worse informal care, reduced quality of life and higher burden of informal caregivers. The aim of this study is to assess the correlation between health literacy score (HL), quality of life (QoL) and informal caregiver burden in Portugal. Methods A cross-sectional study was conducted through an online survey directed to informal caregivers. Three validated scales were applied in Portuguese versions: a) European Health Literacy Survey (HLS-EU-PT-Q16); b) European Quality of Life Questionnaire (EQ-5D-5L), c) Modified Caregiver Strain Index (M-CSI). Overall statistical analysis and the Pearsońs correlation test at 5% significance level were performed in SPSS®. Results In total, 760 informal caregivers were surveyed, mean age 57 years (±9.9), 92.5% female, 62.6% married or living with a partner, 41,5% at least university level, 44.4% works full or part-time. Regarding the process of care, 78.9% takes care of one person, 85.2% have been caring for more than 1 year, 54.3% feel that are not supported at all, and 20.3% do not feel competent to care. The mean HL score of informal caregiver (n = 673) was 31.9 (+7.8), QoL (n = 733) was 0.8 (+0.2), and burden (n = 760) was 14.8 (+5.3). HL Score is directly correlated with QoL (r = 0.215; p &amp;lt; 0.001) and inversely correlated with informal caregiver burden (r=-0.150; p &amp;lt; 0.001). Conclusions A higher health literacy score is associated with better quality of life and lower informal caregiver burden. Improving health literacy may be strategic to promote health conditions and quality of life and care for both the informal caregiver and the person being cared for. Key messages • A higher health literacy score is associated with better quality of life and lower informal caregiver burden. • It is crucial to invest on the definition of an integrated strategy, between Health and Social Security, to provide better health conditions to informal caregivers.

Self-perceived and calculated health literacy score in long-term unemployed people

Abstract Introduction Recent studies show that low levels of health literacy are widespread in Germany, especially among socioeconomically disadvantaged groups such as long-term unemployed individuals. At the same time, it is unclear to what extent commonly used health literacy tools are tailored to the needs and literacy skills of socioeconomically disadvantaged populations. Therefore, we examined to what extent self-perceived and calculated health literacy scores of long-term unemployed people in Germany correlate. Methods We conducted 171 semi-structured interviews between November 2022 and February 2023 with long-term unemployed people in 11 occupational reintegration settings in Bremen, Germany. Health literacy was measured by the HLS-EU-Q16 (self-report health literacy score) and the Newest Vital Sign (calculated health literacy score). Descriptive and correlation analyses were performed with R. Results According to HLS-EU-Q16, 37% of the 171 participants (male=112, female=59) had sufficient health literacy, according to NVS only 29%. An inadequate health literacy score was shown by 19% according to HLS-EU-Q16, and by 48% according to NVS. The applied tools did not show a statistically significant correlation (r = 0.105, p = 0.17). Conclusions Self-reported health literacy data (e.g., measured by the HLS-EU-Q16) could underestimate deficits in health literacy and may be insufficient as a sole assessment tool to determine health literacy among low-literate populations as long-term unemployed people. Key messages • Various tools exist to measure health literacy. Not all measures might be suitable for all population groups. Literate skills should be considered while applying different health literacy measures. • More health literacy data on low-literate populations is needed in the literature. Health literacy tools applied in these population groups should be short and easy to understand.

Health Literacy of a Migrant community in Portugal on environmental health risks

Abstract Background Social, cultural and environmental factors are crucial for the health of migrants. Health Literacy is a fundamental contribution, giving them greater capacity and making it possible to reduce health inequalities. The aim of this study was to characterize the perception and behavior of a migrant community residing in Portugal, in view of the health risks resulting from the environmental conditions in which they live, and to identify their level of Health Literacy. Methods Cross-sectional, descriptive, exploratory study. Data collection was obtained through the application of the “Health Literacy Questionnaire” (Osborne, 2013), complemented with sociodemographic and environmental indicators referring to the physical space and social context of residence. The questionnaires were applied to a sample of the population, coming from Portuguese-speaking African countries, with 101 participants. Data analysis involved measures of descriptive and inferential statistics. Results Of the data obtained, 77.2% reported having problems with humidity in their homes, with poor behavior in terms of heat (64.4%) and cold (90.1%). 76% reported insect and rodent infestations inside their homes. The presence of stagnant water (43.6%), organic waste (29.8%) and poor electrical networks (26.9%) were the main environmental problems identified. About Health Literacy, “Feeling understood and supported by health professionals’ and “Finding good health information”, registered lower levels, with the remaining ones being generally below the average of the scale. internal consistency ranged between 0.71 and 0.92. Conclusions Data analysis showed the precariousness of housing and the inadequacy of support infrastructure, with inherent environmental risks to health. The existence of low levels of Health Literacy was found in most of the domains considered. The results supported and justified the elaboration of a community intervention project with the involvement of local partners. Key messages • Knowing the environmental determinants is essential for disease prevention and health promotion. • Health Literacy is an indispensable vehicle for reducing inequalities in migrant populations.

Health Literacy in a migrant portuguese speaking community in Portugal and healthcare use

Abstract Background Health Literacy is strongly related with barriers to accessing healthcare services. Migrants may represent a vulnerable population in this matter, usually correlated with the language barrier. We aim to answer the question “Which are the perceptions, behaviors and skills of a migrant Portuguese speaking community using and getting access to health care in Portugal?” Methods Descriptive, cross-sectional and exploratory study. The Health Literacy Questionnaire (Osborne et al.,2013) was applied with a sociodemographic and health characterization. Data were collected and processed from a sample of 101 participants from a group of 570 people from a migrant community, all native Portuguese speakers mostly born in African Countries with Portuguese as an Official Language. Results The sample represented 17,7% of the total population. Thus, a confidence level of 95% and a margin of error of 9% were assumed. In the Health Literacy Questionnaire, the Cronbach's Alpha internal consistency coefficient was calculated as between 0.714 and 0.928. The analysis dimensions were mostly positioned below the average of the scale and were influenced by education, migratory status and age. “Feeling understood and supported by health professionals” had the worst score. There were better results in those who sought primary health care services and who had chronic illnesses. Self-rated health worsened with increasing length of stay in the country. Approximately 31% never attended healthcare in Portugal because they did not feel the need or were unable to access it. Conclusions This study demonstrated the association between health literacy with migrants and healthcare use excluding the language factor. This community presented low healthcare services use and low health literacy levels despite the use of the same language. Interaction with primary healthcare services improved migrants health literacy. This study supported a community intervention with public and private stakeholders. Key messages • Migrants places potential constraints on healthcare utilisation in destination countries that are not necessarily related to language barrier. • Health Literacy is crucial to migrants health, health care access and Public Health improvement.

WhySchool mental health training programs: effective for students, teachers, and school health staff

Abstract Introduction Adolescent mental health is an increasing concern due to the high prevalence of mental disorders and low levels of mental health literacy (MHL). Enhancing MHL and promoting access to services during this critical developmental phase is essential. Teachers and other educational professionals are vital in addressing mental health issues, encouraging positive mental health, reducing the stigma associated with mental illness, and promoting help-seeking behaviors. Methods This study evaluates the WhySchool project, a mental health training program for teachers, school health professionals, and students in Portugal, consisting of two interventions. The first intervention was a prospective pre-post study for teachers and school health professionals who underwent training during 2015-2016 and 2018-2020, with three evaluation phases. The second intervention was a quasi-experimental study in 2019-2020 for students who received the intervention program in a classroom setting administered by previously trained teachers. Results The first intervention significantly improved teachers’ and school health professionals’ mental health literacy, help-seeking attitudes, stigma reduction, and confidence in referring students in case of need. These effects remained stable at the M2 follow-up. In the second intervention, MHL scores increased significantly in the intervention group, while the control group showed no significant change. Stigma reduction and help-seeking attitudes also improved significantly in the intervention group, with no significant change in the control group. Conclusions The WhySchool program significantly and positively impacted teachers’ and students’ mental health literacy, help-seeking attitudes, and stigma reduction. The results underscore the importance of incorporating mental health programs into school curricula and providing teachers and school staff with the necessary tools and knowledge to deliver these programs effectively.

Exploring Work Absences and Return to Work During Social Transition and Following Gender-Affirming Care, a Mixed-Methods Approach: ‘Bridging Support Actors Through Literacy’

PurposeResearch on return to work (RTW) following transition-related gender-affirming care (GAC) is lacking. We aim to study the RTW outcomes and experiences of transgender and gender diverse (TGD) people during social and medical transition to understand their needs better and provide tailored support.MethodsIn this convergent mixed-methods study, the questionnaires of 125 employed TGD people, who took steps in transition (social and GAC), were analyzed for personal- and work characteristics, medical work absences, RTW, support at work, and health literacy. In-depth interviews were held with twenty TGD people to explore perceived facilitators and barriers to RTW.ResultsOne hundred and nine participants reported an average of 38 sick days after GAC. The majority (90.2%) resumed their job at the same employer. Although TGD workers felt supported, their health literacy (55.1%) was lower compared to the general population. The qualitative data analysis revealed four major themes: (1) the need and access to information; (2) having multidisciplinary TGD allies; (3) the influence of the occupational position; (4) the precarious balance between work, life, and GAC. Especially participants with a low health literacy level experienced RTW barriers by struggling: (1) to find and/or apply information; (2) to navigate (occupational) health and insurance services.ConclusionOur research has shown that RTW for TGD individuals is a multifaceted process, affected by personal factors, work-related elements, and the characteristics of the healthcare and social insurance system.Enhancing support for TGD people at work and their RTW requires a high need for centralized information and promoting health literacy while engaging relevant stakeholders, such as prevention services and employers.