Low Levels Of Health Literacy Research Articles

Abstract P110: Examining Health Literacy And Medication Adherence Among African Americans With Hypertension

Introduction: It is estimated that almost 40% of American adults have limited health literacy. Adults with limited health literacy report being less knowledgeable about disease management, healthy behaviors, and they are less likely to utilize preventive services. Racial and ethnic minorities are disproportionately affected by limited health literacy. The objective of this study was to assess health literacy level and medication adherence among African Americans with hypertension receiving health care through Medicaid. Hypothesis: We hypothesize that lower health literacy may be associated with lower hypertensive medication adherence among African Americans. Moreover, we predict that African American men may have lower levels of health literacy and medication adherence in comparison to African American women. Methods: We conducted a cross-sectional case-control study. The participants were African American adults, recipients of Medicaid with hypertension living in Delaware. Data were obtained from Medicaid and secondary data sources. Variables included demographic characteristics, medication adherence, health literacy, and cardiovascular disease health outcomes. Adherence was based on the days of prescription refill controlling for the number of days eligible. Health literacy was obtained from the Health Literacy Data Map from the University of North Carolina Chapel Hill. Results: Within our sample, the mean health literacy score for those without hypertension, normotensive was slightly higher than those with hypertension. (Normotensive: 234.9 vs Hypertension: 233.7, p= .0001). Women were more likely to adhere to their medication than men (OR: 0.83, 95% CI: 0.75-0.92, p<=.001) Study participants reporting having a basic level of health literacy reported lower medication adherence than those with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, p=<0.001). Conclusion: Within our sample of African Americans with hypertension receiving health care through Medicare, lower health literacy was associated with lower adherence to medication. Our study highlights the necessity of providing literacy assistance and health education to promote healthy behaviors and lifestyle change such as medication adherence.

Health Care Needs of Deaf Signers: The Case for Culturally Competent Health Care Providers

There is a need for culturally competent health care providers (HCPs) to provide care to deaf signers, who are members of a linguistic and cultural minority group. Many deaf signers have lower health literacy levels due to deprivation of incidental learning opportunities and inaccessibility of health-related materials, increasing their risk for poorer health outcomes. Communication barriers arise because HCPs are ill-prepared to serve this population, with deaf signers reporting poor-quality interactions. This has translated to errors in diagnosis, patient nonadherence, and ineffective health information, resulting in mistrust of the health care system and reluctance to seek treatment. Sign language interpreters have often not received in-depth medical training, compounding the dynamic process of medical interpreting. HCPs should thus become more culturally competent, empowering them to provide cultural- and language-concordant services to deaf signers. HCPs who received training in cultural competency showed increased knowledge and confidence in interacting with deaf signers. Similarly, deaf signers reported more positive experiences when interacting with medically certified interpreters, HCPs with sign language skills, and practitioners who made an effort to improve communication. However, cultural competency programs within health care education remain inconsistent. Caring for deaf signers requires complex, integrated competencies that need explicit attention and practice repeatedly in realistic, authentic learning tasks ordered from simple to complex. Attention to the needs of deaf signers can start early in the curriculum, using examples of deaf signers in lectures and case discussions, followed by explicit discussions of Deaf cultural norms and the potential risks of low written and spoken language literacy. Students can subsequently engage in role plays with each other or representatives of the local signing deaf community. This would likely ensure that future HCPs are equipped with the knowledge and skills necessary to provide appropriate care and ensure equitable health care access for deaf signers.

Comparative Study between Pregnant and Non-Pregnant Women Regarding Variation of Liver Function Tests: Assessment of Health Literacy


 
 
 Context: Pregnancy is associated with normal physiological adaptive changes. Biochemical parameters reflect these changes and are distinct from the non-pregnant state. Low levels of health literacy have been shown to result in less healthy choices, riskier behavior, poorer health, less self-management, and more hospitalization among that category of adult patients. Aim: The study aimed to examine the effect of pregnancy on liver function tests among pregnant women during various trimesters of pregnancy and compare with non-pregnant and determine the patients' level of health literacy regarding the variation of liver function tests among those patients.
 Methods: A descriptive cross-sectional design was used to achieve the study aim. A random sample of 65 women was selected from an outpatient clinic in the maternity hospital; 54 out of them were pregnant women. Three tools were used to collect data, socio-demographic and clinical data assessment sheet; assessment of liver function tests by Cobas c 311; and health literacy management scale. Results: The sample's age range was between 20-40 years. This study revealed that; serum albumin levels decreased from the first trimester (3.7-4.7), and this decrease became progressively more accentuated as the pregnancy advanced (3.35-4.36 decreased significantly to 3.19-3.81). There was no significant decrease in serum AST between pregnant and non-pregnant women, but there was a significant decrease in ALT in pregnant women compared with non-pregnant women (11.90 Vs. 8.60 at p 0.017). In the current study, Serum alkaline phosphatase (ALP) was significantly higher (P˂0.0001) during the third trimester (63-171) compared with the second trimester (33-137), and the first trimester (36-129), and with the control group (48-122). Finally, it was found that a significant decrease in total serum bilirubin concentrations during the second (0.11-0.38) and third trimesters (0.12-0.42) compared to control (0.11-1.57) and the first trimester (0.12-0.85). Moreover, most of the studied sample has a low level of health literacy for all subscales and the total scores.
 Conclusion: During normal pregnancy, most values of liver function tests remain below the normal upper limits compared to non-pregnant women. Any increase in serum ALT and AST activity levels and serum bilirubin should be considered pathologic and prompt for further evaluation. Moreover, most of the studied sample has a low level of health literacy for all subscales and the total scores. The study recommended that the liver function tests should be routinely investigated during pregnancy to outline any pathologic changes. Focusing on the nurse's role, she should emphasize increasing the patient's level of health literacy regarding the variation of liver function tests. So, it is a must for nurses to develop many skills to enable them to function for this category of patients with low health literacy levels. Also, those patients should be equipped with information-seeking behavior, decision-making abilities, and problem-solving approaches along their health and illness continuum.
 
 

Abstract P5-14-12: Health literacy among long term breast cancer survivors; exploring associated factors in a nation-wide sample

Abstract Objectives: Low health literacy (HL) levels likely hamper health management and outcomes in cancer survivorship. Knowledge of associated factors is needed to identify at-risk sub-groups of survivors, but is currently scant. Here, we explore HL-levels and associated factors in a nation-wide sample of long-term BCSs. Methods: All BCSs aged 20-65 years, diagnosed with early-stage BC in 2011-2012, were identified through the Norwegian Cancer Registry and invited to participate in the Survivorship, Work and Sex (SWEET)-study. HL was measured using The European Health Literacy Survey Questionnaire-12 (HLS-EU-Q12) as a continuous and categorical variable. Associations between HL and sociodemographic-, physical- and mental health variables, including the most common LEs, were explored in uni- and multivariable linear regression models. Results: The final sample consisted of 1355 survivors (48%). Median age was 60 years and the majority of survivors had high socioeconomic status (SES). Median HL sum-score corresponded to an intermediate HL level (36.2, SD 5.4), while 19.3% reported marginal or inadequate HL. Education, income, age at diagnosis, the personality trait neuroticism and fear of cancer recurrence (FCR) remained significantly associated with HL in the multivariate model, explaining 12% of the variance in HL scores. Conclusion: Low levels of HL were prevalent, potentially affecting the provision of effective survivorship care and BCS’s self-management abilities. Identifying individuals at risk of low HL based on knowledge readily available to clinicians remains challenging and warrants further investigation. Implications for cancer survivors: Addressing survivors’ HL could be a key target for improving survivorship care. Citation Format: Kathrine Flørenes Vandraas, Kristin V Reinertsen, Cecilie E Kiserud, Synne K Bøhn, Hanne C Lie. Health literacy among long term breast cancer survivors; exploring associated factors in a nation-wide sample [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-12.

Potential Application for First Responder Organisations of Desensitisation and Reprocessing Treatment for Individuals with Post-Traumatic Stress Disorder

This literature review discusses the impact and nature of traumatic experiences of first responders, focusing on their ability to cope with the cognitive and behavioural symptoms associated with post-traumatic stress disorder (PTSD). First responders are defined as police, fire, ambulance, military, public health service workers, and state, local, and volunteer agencies, who protect and safeguard communities. First responders disproportionately suffer from PTSD; symptoms often lead to inability to continue their duties. Individuals and organisations should consider how individuals recover from PTSD. This paper reviews literature on PTSD interventions and recommends Eye Movement Desensitisation Reprocessing (EMDR) Therapy for treatment of PTSD in first responders. The literature review explored effective treatment options for overcoming PTSD and found an embedded culture in first responder organisations of cognitive avoidance, which results in reduced help seeking behaviours. Poor help-seeking behaviours correlate with high levels of PTSD and psychological distress, low levels of mental health literacy, and career issues. This paper discusses how EMDR is a potential and effective therapy to reduce symptoms of PTSD in first responders. Evidence reviewed in this paper suggests EMDR should be used as a treatment option for first responders to help reformulate negative thoughts/beliefs associated with exposure to traumatic events.

COVID-19 Vaccination Uptake and Hesitancy in a National Sample of Australian Gay and Bisexual Men

Minority groups may face additional barriers to vaccination. In April–June 2021, we assessed the level of COVID-19 vaccination and willingness to be vaccinated in a national, online survey of 1280 gay and bisexual men in Australia. Over a quarter of the sample (28.0%) had been partially or fully vaccinated, and 80.0% of the unvaccinated were willing to be vaccinated. Vaccination was independently associated with older age, being university educated, and HIV status (with HIV-positive participants being more likely and untested participants less likely to be vaccinated). Willingness to be vaccinated was independently associated with living in a capital city and being university educated. Those who had lost income or their job due to COVID-19 were less willing to be vaccinated. Our results suggest encouraging COVID-19 vaccination among those with lower levels of health literacy and supporting those who have experienced financial stress because of the pandemic.

Pregnancy in Teenage Romanian Mothers.

Background and purposeTeenage pregnancy is associated with an increased risk of adverse pregnancy outcomes. The objective of this research is to determine the profile of the pregnant teenager and the medical complications associated with pregnancy at this young age.Materials and methodsA cross-sectional study based on a 29-item questionnaire was conducted in 2019 and 2020 in Ploiești, Romania. The participants were divided into two groups, namely, Group A, consisting of 100 minor, teenage childbearing women under the age of 18, and Group B, consisting of 100 childbearing women over 18 years of age.ResultsGroup A had a mean age of 16.56 ± 1.65. The percentage of births in very young girls (13-15 years) from group A is 28%. In 65 adolescents, sexual intercourse began at the age of 14. Pregnancy monitoring, expressed by the number of medical examinations, shows significant differences between the studied groups. The Short Assessment of Health Literacy (SAHL) test applied to both groups revealed a low level of health literacy in group A. Also in this group A, teenagers gave birth to low-birth-weight children, the percentage is statistically significant (14% vs. 4%). The gestational age in this group had an average of 36.88 ± 2.13 weeks, compared to the gestational age in the control group of 38.41 ± 1.57 weeks. In Romania, there are teenagers who became mothers at an early age. There should be educational programs in rural and urban schools and communities. Poverty leads to inadequate medical supervision with significant consequences for the health of the mother and child, lack of education (school dropout, illiteracy), and inability to find a job. The midwife can play a key role in rural communities through health education conducted on specific communication channels and with different forms of presentation of messages, adapted to their needs. A good target would be the parents of adolescent mothers and better communication with them.

Association of Fear of COVID-19 and Health Literacy Among the General Public in Saudi Arabia: A Cross-Sectional Assessment.

ObjectiveThis study aims to determine the level of fear of coronavirus disease—2019 (COVID-19) among the general public in Saudi Arabia and the association of its scores with their level of health literacy.MethodsA descriptive cross-sectional study was conducted among the general population in Saudi Arabia from April 2020 to May 2020. A three-part online self-reported survey was used to assess the participants' demographic characteristics, fear of COVID-19 of the participants, and levels of health literacy.ResultsOf the 848 participants, 56.8% were in the age group of 25–34, 45.6% were females, and 57.1% had a bachelor's degree. The total mean score of the fear of COVID-19 scale of the participants was FCoV-19: mean ± SD = 19.60 ± 7.33 and the health literacy was HL index: mean ± SD = 27.57 ± 11.05. There was a significant difference in the scores of fear of COVID-19 scale in terms of age (F = 2.442, p = 0.050), representing that those aged 45 and above had higher mean fear scores than the younger participants. The analysis revealed that an increased level of fear of COVID-19 was associated with older age (B = 1.87; p = 0.020), being unemployed (B = 0.76; p = 0.023), with no formal education (B = 0.89; p = 0.001), and low level of health literacy (B = 0.02; p = 0.021).ConclusionThe study shows an above-average level of fear of COVID-19 of the general public in Saudi Arabia and its association with a low level of functional health literacy. Timely and comprehensive health interventions should be promoted to enhance the level of health literacy and further reduce the level of fear of COVID-19 in the community.

Association Between Health Literacy and Enhanced Recovery After Surgery Protocol Adherence and Postoperative Outcomes Among Patients Undergoing Colorectal Cancer Surgery: A Prospective Cohort Study.

Low health literacy (HL) adversely affects medical adherence and health outcomes in patients with chronic diseases. However, the association between HL and enhanced recovery after surgery (ERAS) adherence and postoperative outcomes has not been investigated in patients undergoing colorectal surgery. The data of all patients from a single academic institution who underwent colorectal surgery on an ERAS pathway from January 2019 to July 2020 were prospectively collected. HL levels were assessed using the Brief Health Literacy Screen (BHLS), a proven tool that was used by surgeons after recruitment. According to the HL score, the participants were categorized into low HL (≤9 points) and high HL (10-15 points) groups. The primary outcome was ERAS adherence. Adherence was measured in 22 perioperative elements, and high adherence was defined as adherence to 17 to 22 elements. Secondary outcomes included postoperative complications, hospital length of stay (LOS), hospital charges, mortality, and readmissions. Of the 865 eligible patients, the high HL group consisted of 329 patients (38.0%), and the low HL group contained 536 patients (62.0%). After propensity score matching (1:1), 240 unique pairs of patients with similar characteristics were selected. Patients with high HL levels had a significantly higher rate of high adherence to ERAS standards than those with low HL levels (55% vs 25.8%; adjusted P < .001). In terms of adherence to each item, high HL levels were significantly associated with higher adherence to preoperative optimization (90.8% vs 71.7%; adjusted P < .001), postoperative gum chewing (59.2% vs 44.6%; adjusted P = .01), early feeding (59.2% vs 31.3%; adjusted P < .001), and early mobilization (56.7% vs 30.4%; adjusted P < .001). In the overall study population, adjusted logistic regression analyses also showed that high HL levels were associated with a significantly increased rate of high adherence when compared with low HL levels (adjusted odds ratio [OR], 3.57; 95% confidence interval (CI), 2.50-5.09; P < .001). In addition, low HL levels were associated with a significantly higher incidence of postoperative complications (32.1% vs 20.8%; P < .01), longer hospital LOS (9 [interquartile range {IQR}, 7-11] vs 7 [IQR, 6-9] d; P < .001), and higher hospital charges (10,489 [IQR, 8995-11942] vs 8466 [IQR, 7733-9384] dollar; P < .001) among propensity-matched patients. However, there were no differences in the mortality and readmission rates between the HL groups. Low HL levels were associated with lower adherence to ERAS elements among propensity-matched patients undergoing colorectal surgery.

Amending Federal Regulations to Counteract Language Barriers in the Informed Consent Process

Amending Federal Regulations to Counteract Language Barriers in the Informed Consent Process

Health literacy level and related factors of students in a health vocational high school

Health literacy (HL), by definition, refers to a person's ability to obtain, interpret and comprehend fundamental health information and services in order to enhance their health. In our study, it was aimed to determine HL level of health vocational high school students. The population of this descriptive cross-sectional study consists of students attending a Health Vocational High School(n:337). In May-June 2019, questionnaire form and 'Turkey Health Literacy Scale-32' were applied to students who voluntarily agreed to participate in study. Kolmogorov Smirnov, Mann Whitney U, Kruskal Wallis tests were used in analysis of data. Sixty-eight percent of the pupils were female, while thirty-two percent were male. Study group had a THLQ score of 33.7±8.9, with 53.7 percent of male pupils and 39.5 percent of female pupils having insufficient/limited HL and the difference was significant (p&lt;0.025). Insufficient/limited HL was found in 56.4 percent of 9th-10th grade students and 37.4 percent of 11th-12th grade students and the difference was significant again (p&lt;0.0001). The HL levels did not differ from pupils' socio-demographic factors (p&gt;0.05). In study group, rate of adequate/perfect HL was higher in women than in men. According to scores of participants from sub-matrix components of scale, level of health literacy is generally sufficient, but sub-dimensions of "Treatment-Service-Evaluation of Information", "Prevention from Diseases-Health Promotion-Evaluation of Information-Using Information", "Assessment of Information about Health" are limited. The insufficiency of medical education in schools is demonstrated by the low level of HL. To enhance awareness of health-related concerns in schools, frequent activities should be planned.

Health Literacy in Patients’ Clinical Records of Hospital Settings: A Systematic Review

IntroductionHealth literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings.MethodsPubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.ResultsFive studies reported HL assessments in hospital patients’ clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs).ConclusionThis review examined how inpatients’ HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.

Information materials for colorectal cancer screening for citizens with low health literacy

For multiple reasons, certain socially disadvantaged populations are more affected by colorectal cancer but have lower screening rates than wealthier populations. The Vaud colorectal cancer screening program (CCR) provides a 20-page decision support tool for the 50-69-year-old population. Three new tools have now been designed specifically for citizens with a low level of health literacy: a simplified 6-page leaflet presenting the choice of a Fecal Occult Blood Test (FIT) and colonoscopy; a 2-page leaflet presenting the detection and screening of 4 common cancers; and a short video presenting the FIT test. By adapting our approach to each individual's level of health literacy, we can ensure a shared decision for all.

The usefulness of a checklist approach-based confirmation scheme in identifying unreliable COVID-19-related health information: a case study in Japan

Consumers are increasingly able to easily access health information online about food products. However, consumers have difficulty identifying reliable health information from diverse sources along with information about the coronavirus disease (COVID-19) pandemic because the inundation of information (both true and false) overwhelm consumers. We investigated the usefulness of a checklist confirmation scheme for identifying unreliable COVID-19-related health information. Data were collected from June 30–July 1, 2021. First, we measured 700 participants’ baseline health literacy levels by having them read unreliable health information about the efficacy of green tea intake in preventing COVID-19 based on the results of animal experimentation. Second, participants read an explanation with a five-step flowchart of how to identify reliable health information. Thereafter, we remeasured participants’ health literacy levels. To identify the factors hindering the effect of the confirmation scheme, a logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 77.9% (293/376) of those with low health literacy levels at baseline still had low literacy after the intervention. The factor that hindered the confirmation scheme’s usefulness was benefit perceptions of food ingredients (OR: 0.493; 95% CI: 0.252–0.966). Consumers with higher benefit perceptions of a target product faced more difficulties using the confirmation scheme effectively. Therefore, the most effective strategies involve filtering information at the organizational level rather than the individual level, which should help consumers correctly identify misinformation concerning food and health and promote accurate decision-making.

Examination of Mothers' Over-The-Counter-Medication (OTC) Usage at Home According to Different Socioeconomic and Health Literacy Levels

Aim: The purpose of this study was to examine mothers’ OTC medication usage at home according to different socioeconomic and health literacy levels and the effecting factors. Materials and Methods: This cross-sectional descriptive study was carried out in three family health centers from different socioeconomic levels (low-middle-high) between September 2018 and February 2019. The sample of the study consisted of 300 mothers of 0-18 year old children who met the research criteria. Data were collected through “Data Collection Form” and “Adult Health Literacy Scale”. Results: It was determined that mothers in low socioeconomic group had high level of OTC medication usage to their children at home. A significant relationship was found between the mean scores of mothers’ health literacy and socioeconomic level (p<0.000). The mean scores of mothers’ health literacy in low socioeconomic group who used OTC medication to their children at home are lower than mothers who did not use OTC medication (p: 0.041). It was determined that child’s age (OR: 1.01, p: 0.045), regular medication usage in mother (OR: 2.11, p: 0.014) and reading the prospectus before giving medication to their child (OR: 3.14, p: 0.005) effected to mothers’ OTC medication usage at home. Conclusion: This study emphasized that low socioeconomic and health literacy levels may cause mothers’ OTC medication usage to their children at home. OTC medication usage can be decreased with education programs that take into account the effecting factors to mothers’ OTC medication usage and aim to increase health literacy levels.

COVID-19 Vaccination Coverage in Low-Income Areas: Outcomes, Barriers, and Facilitators

COVID-19 Vaccination Coverage in Low-Income Areas: Outcomes, Barriers, and Facilitators

Health Literacy in the Canton of Zurich: First Results of a Representative Study.

Managing health information and services is difficult for nearly half of the population in Switzerland. Low health literacy has been shown to result in poorer health and health outcomes as well as a higher utilization of health services. To date, studies on health literacy in Switzerland have focused on a national level. However, Switzerland is a federal state with 26 cantons and a strongly decentralized health system. Therefore, the aim of this study is to understand how health literacy is distributed within the population of the canton of Zurich specifically, and to develop methods to determine whether an individual has a higher or lower level of health literacy. There were a total of 1000 participants in this representative study. Data was collected by an adapted version of the HLS-EU-Q47 and additional sociodemographic questions. The majority (56%) of the reported difficulties concerned accessing, understanding, appraising, and applying health information. The findings confirm that health literacy follows a social gradient, whereby financially deprived individuals and those with a low educational level report lower health literacy. The need for action to strengthen the health literacy of these population groups is therefore urgent. Interventions should pay particular attention to these vulnerable groups and tailor resolutions to their needs and preferences.

MISUSE OF TOPICAL CREAMS AIMED AT PREVENTING AND TREATING MELASMA AND FRECKLES AMONG WORKING WOMEN

Topical creams used to treat and prevent melasma and freckles contain corticosteroids, hydroquinone, mercury, and retinoic to lighten skin color. Misuse of these products and the rate of adverse effects have increased greatly in recent years. This study aims to assess the misuse of topical cream to prevent and treat melasma and freckles among working women in northeast Thailand. Our population consisted of 1,143 working women in the region aged 30-59 years old. The respondents were recruited from four provinces eight districts using a structured questionnaire distributed via a multi-stage random sampling method. Descriptive statistics and logistic regression were used to represent and analyze the data. Eight hundred sixty-two (75.42%) of the respondents were users, and 105 (12.18%) had misused the products. The prevalence of misuse of products containing mercury, steroids, hydroquinone, retinoic acid, and mercury plus retinoic acid was 43.8%, 11.43%, 15.24%, 12.38%, and 17.15%, respectively. Factors associated with misuse of this product were age 30-44 years, education level less than a bachelor’s degree, working as a housekeeper or freelancer, presence of melasma and freckles, average monthly income ≤ 15,000 THB and low levels of knowledge and health literacy. Misuse of medication to treat pigmentary disorders is a growing public health concern. Social media and nonprofit campaigns should be implemented to create awareness of these products' misuse and adverse effects.

Health literacy in phases of health information processing in the Czech population

Abstract Background Low level of health literacy (HL), defined as an individual's ability to process health information, is strongly associated with higher mortality and morbidity. In earlier analysis of cross-sectional survey in Czechia in 2014, 59% of subjects showed a low level of HL, with particularly worrying results in area of health promotion (64% with low levels of HL). The levels of HL in phases of health information processing, however, were not included. Aim To describe the level of HL in phases of obtaining, understanding, evaluating, and applying health information, and to assess social determinants of HL in these phases. Methods 18 to 65 years old subjects from a random population-based Czech sample from 2014 were evaluated using a cross-sectional design. The level of HL was determined by Health Literacy Index (HLI, range 0-50). A low level of HL was defined as HLI &amp;lt;33. Logistic regression was used to assess the association between a low level of HL and social status. Results In total, 996 participants (51% females) were included. The prevalence of low level of HL was 64% in obtaining, 56% in understanding, 70% in evaluating and 64% in applying. A low level of HL was associated with a low perceived social status in all phases of information processing even after adjustment for age, gender, education, self-reported health condition, physical activity, BMI and smoking status (ORs 3.2, 2.0, 3.4 and 2.8, respectively, for obtaining, understanding, evaluating and applying, all p-values&amp;lt;0.05). Conclusions People with lower social status have a higher risk of a low level of HL in all phases, with the highest risk in the phase of health information evaluation which was determined as the most problematic. Further intervention should aim to support individual skills in decision making and actions in fields of healthcare, disease prevention, and health promotion including the availability of relevant understandable information for all social groups in the population. Key messages The most problematic area of health literacy is health information evaluation. People with lower social status have a higher risk of a low level of health literacy.

Health literacy needs among unemployed adults: Triangulating interview and scoping review data

Abstract Disadvantaged populations, including unemployed adults, often exhibit low levels of health literacy. Exploring subjectively perceived health literacy needs in these populations can serve as an entry point for participatory intervention development. We aimed to assess health literacy needs of unemployed adults by triangulating qualitative interviews data and a scoping review. Using a parallel approach, we combined results of an interview study with 10 participants of a job-reintegration program in Germany and a scoping review. The interviews, conducted in early 2021, focused on health topics of interest to the participants and their sources of health-related information. Data were analysed using thematic analysis. For the scoping review, we searched MEDLINE, CINAHL, PsycInfo and SCOPUS up to January 2021 for studies containing “unemployed” AND “health literacy” in titles/abstracts. Study selection and data extraction were done independently by two researchers. Nutrition and physical activity emerged as core themes during the interviews, with some participants referring to the importance of both for mental health. Doctors and the institution running the job-reintegration program were the sources of health-related information often mentioned. The Corona pandemic was reported to have limited physical activity and affected psycho-social well-being. Five out of 2696 studies were included in the review. Four focused on mental health literacy, the fifth assessed information seeking practices in unemployed adults. The qualitative analysis revealed that health literacy needs of unemployed adults go beyond mental health literacy. As nutrition and physical activity impact mental health, interventions targeting such topics might also improve mental health literacy in unemployed adults. Study findings will be discussed with unemployed persons and social workers in co-production workshops that aim to identify and prioritize health literacy needs for intervention development. Key messages Health literacy programs for unemployed adults should target nutrition and physical activity. Workforce re-integration programs play a pivotal role in improving health literacy of unemployed adults.