Marginal Health Literacy Research Articles

The Influence of Health Literacy among Undergraduates on Health-Promoting Lifestyles mediated by Health Behavior Self-Efficacy: Evidence from Jiangxi Province,China

Purpose This study aims to investigate the relationship between undergraduates' health literacy, health behavior self-efficacy, and health-promoting lifestyles. Method In April 2021, a survey was conducted with 1050 undergraduates from 9 universities in Jiangxi Province, utilizing Health Literacy Scales, Health Behavior Self-efficacy Scales, and Health-Promoting Lifestyle Revision Scales. Results (1) The average health literacy score among undergraduates was (66.17±10.01), with 81.6% of students having high or marginal health literacy. The average score for health-promoting lifestyles was (101.34±16.09), indicating an above-average level. The total score for health behavior self-efficacy was (89.23±18.43), indicating a general level of self-efficacy. (2) Positive correlations were found between undergraduates' health literacy, health behavior self-efficacy, and health-promoting lifestyles (r=0.259 ~ 0.759, P < 0.05). (3) Health behavior self-efficacy was found to mediate the relationship between undergraduates' health literacy and health-promoting lifestyles. Conclusion To promote a healthy lifestyle among undergraduates, it is crucial to not only improve their health literacy but also enhance their health behavior self-efficacy.

Relationship between health literacy and generalized anxiety disorder during the COVID-19 pandemic in Khuzestan province, Iran.

During the COVID-19 pandemic, many changes occurred in various cultural, social, and economic fields, leading to the creation of psychological effects, especially anxiety, in the community. Fear and anxiety about emerging diseases (COVID-19) and less participation in preventive behaviors reduce individual resistance and ultimately lower one's quality of life. Therefore, we aimed to investigate the relationship between health literacy and generalized anxiety disorder during the COVID-19 pandemic in Khuzestan province, Iran. This was a descriptive-analytical (cross-sectional) study conducted among participants aged 18-65 in Khuzestan province during the years 2020-2021 through online sampling. Due to the prevalence of COVID-19 and the impossibility of face-to-face communication, the questionnaire was designed on the Porseline Survey website and the questionnaire link was provided to participants through WhatsApp and Telegram. The data collection tool includes the Iranian Health Literacy Questionnaire, which includes 33 items, and the Generalized Anxiety Disorder-7 scale, which has 7 items based on a Likert scale. Data analysis was performed using STATA14 software and descriptive and analytical statistical tests at a significant level less than 0.05. The mean (standard deviation) score for health literacy was 52.9 ± 9.3 and for generalized anxiety disorder was 5.2 ± 3.1. A significant negative correlation was found between the mean of anxiety disorder and health literacy (p < 0.05). The frequency of health literacy in individuals included 427 (37.8%) with inadequate health literacy, 628 (55.6%) with marginal health literacy, and 75 (6.6%) with sufficient health literacy. There was a statistically significant difference between the mean of generalized anxiety disorder among individuals with different levels of health literacy (p < 0.05). As the level of health literacy increases, the prevalence of generalized anxiety disorder caused by fear of COVID-19 decreases. Therefore, increasing awareness and health literacy about this virus, its transmission, and prevention methods is very effective in managing anxiety and stress caused by COVID-19. Paying attention to the issue of health literacy and generalized anxiety disorder, and promoting preventive behaviors can be effective tools for planners, health officials, and policymakers to promote health literacy for any type of disease.

Caregiver health literacy and health task performance: Findings from the LitCog caregiver cohort study

ObjectiveMany older adults receive assistance in managing their chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in older adults' health management at home. We examined associations between caregiver health literacy and performance on health tasks. MethodsCaregivers to older adults enrolled in a cognitive aging cohort were recruited to participate in a supplemental interview (n = 97). Caregivers completed one structured interview that included assessments of health literacy and health task performance. ResultsCaregivers demonstrated a range of health literacy skills (44% adequate, 36% marginal, 20% low health literacy). In adjusted analyses, caregivers with marginal and low health literacy demonstrated worse overall performance on the health tasks, and poorer interpretation of health information presented on print documents and recall of spoken communication (p's < 0.05). ConclusionCaregivers with marginal or low health literacy demonstrated poorer performance on everyday health tasks that they commonly assist older adults with. The application of health literacy best-practices to support better training and capacity-building for caregivers is warranted. InnovationFew studies have considered the health literacy skills of caregivers and its application to caregivers' abilities to carry out common supportive tasks.

Health Support for At-Risk Older Adults during COVID-19.

Older adults are highly susceptible to COVID-19 infection and at the highest risk for severe disease and death. Yet, older adults lacked access to accurate and easy-to-use COVID-19 information and support early in the pandemic. This prospective, experimental cohort study sought to examine whether older adults could be engaged during the pandemic through a community partner and if a low-touch intervention, designed with health literacy best practices, could positively impact COVID-19 knowledge, mitigation behaviors, telehealth/doctor visits, exercise, and loneliness. A senior resource kit was distributed to older adults sheltering at home through food assistance program agents from October 2020 to February 2021; the kit was developed using health literacy best practices. Simple random assignment was used to divide program participants into treatment and control groups. Both groups received senior kits, but the treatment group also received telephonic health coaching. The primary outcome was COVID-19 knowledge and mitigation behaviors as derived from self-reported surveys at baseline and after four months. Secondary outcomes included a telehealth or doctor visit, exercise frequency, and a loneliness score (3-Item Loneliness Scale). Health literacy was assessed using the BRIEF screening tool. Ninety-eight older adults consented to participate in the study and 87 completed the study (88.7% completion rate). Participants had moderate clinical risk, one-third preferred the Spanish language, and 52% were categorized as having inadequate or marginal health literacy. Significant changes were found for increasing COVID-19 mitigation behaviors and the frequency of exercise across the cohort, but not for COVID-19 knowledge, telehealth visits, or decreasing loneliness. Conclusions: Partnering with a trusted entity in the community is a feasible and important strategy to reach older adults during a lockdown and provide them with easy-to-read health information and resources. If the time horizon had been longer, improvements in other outcome variables may have been achieved.

Prevalence of health literacy and its correlates from a national survey of older adults

Health literacy (HL) is an important determinant of health. Sub-optimal HL can have profound consequences for individuals and health systems. However, little is known about the HL of older Singaporeans. This study determined the prevalence, socio-demographic and health-related correlates of limited and marginal HL among older Singaporeans (≥65 years). Data from a national survey were analysed (n=2327). HL was measured using the 4-item BRIEF with a 5-point response scale (range 4-20), and classified as limited, marginal, and adequate. Multinomial logistic regression models were applied to identify correlates of limited and marginal HL versus adequate HL. The weighted prevalence of limited HL was 42.0%, marginal HL was 20.4% and adequate HL was 37.7%. In adjusted regression analysis, older adults in advanced age groups with lower education and those living in 1-3 room flats had higher risk of limited HL. Furthermore, having ≥3 chronic diseases (Relative Risk Ratio [RRR]=1.70, 95% Confidence Interval [95% CI]=1.15, 2.52), poor self-rated health (RRR=2.07, 95% CI=1.56, 2.77), vision impairment (RRR=2.08, 95% CI=1.55, 2.80), hearing impairment (RRR=1.57, 95% CI=1.15, 2.14) and mild cognitive impairment (RRR=4.87, 95% CI=2.12, 11.19) were also associated with limited HL. The likelihood of marginal HL was higher among those with lower education, ≥2 chronic diseases, poor self-rated health (RRR=1.48, 95% CI=1.09, 2.00), vision impairment (RRR=1.45, 95% CI=1.06, 1.99) and hearing impairment (RRR=1.50, 95% CI=1.08, 2.08). Over two-thirds of older adults faced difficulties in reading, understanding, exchanging, and using health information and resources. There is a pressing need to create awareness about the issues that could result from the mismatch between healthcare system demands and the HL of older adults.

Development of the Canadian Food Intake Screener to assess alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations.

The Canadian Food Intake Screener was developed to rapidly assess alignment of adults' dietary intake over the past month with the Food Guide's healthy food choices recommendations. The screener was developed and evaluated through an iterative process that included three rounds of cognitive interviews in each of English and French, along with ongoing feedback from external advisors and face and content validity testing with a separate panel of content experts. The 16-question screener is intended for use with adults, aged 18-65 years, with marginal and higher health literacy in research and surveillance contexts in which comprehensive dietary assessment is not possible.

Abstract P642: Assessment of Health Literacy in Colombia: A First Step for a Cardiovascular Education Program for the Community

Introduction: Adequate health literacy enables patients and caregivers to make appropriate decisions and achieve better health outcomes. However, much information about health literacy comes from developed and English-speaking countries. There is very little information about health literacy levels in countries such as Colombia and these data, therefore, cannot be used as an input in the development of cardiovascular education programs for the community. Our objective was to optimize and adapt the Spanish validation of the short version of the Test of Functional Health Literacy in adults (s-TOFHLA) to the context of the Colombian health system. This test was chosen because its multiple questions and sections can guide the skills that should be emphasized in a health education course for patients and caregivers (i.e. navigation in the health care system, interpretation of medical instructions, understanding of doses and forms of drug dispensing). This test consists of two parts: numerical and reading comprehension (Readings A and B). The TOFHLA is graded using a score between 1 and 100 points, which classifies the participant into categories of adequate, marginal or inadequate health literacy. Methods: The validation process was carried out in the following steps 1) cultural and language adaptation, 2) expert consensus (n=7), 3) a cognitive survey (n=10), 4) piloting (n=40), and 5) application in the community (n=148). The study was conducted in 6 cities, from 5 departments (equivalent to an state) in Colombia. Results: In the piloting (n=40) Cronbach's α was 0.76 for numerical comprehension, 0.58 for reading A, and 0.95 for reading B. In the broader sample (n=148) the Cronbach's α for numerical comprehension, reading A and reading B was 0.84, 0.89, and 0.95, respectively. Most of the sample had an adequate level of literacy (77.1%), however, the percentages in the marginal (6%) and inadequate (16.7%) categories can still be considered high. Health literacy levels are lower in people with the lowest level of schooling and socioeconomic strata. In addition, there seem to be differences between urban and rural populations. No differences have been observed according to the sex of the participants. Conclusions: It is critical to assess health literacy with instruments that have been adequately validated and adapted to the conditions of each health system. This process requires the participation of health and language experts. The piloting and cognitive surveys provide a good idea of how communities interpret psychometric tests. Our results confirm differences in health literacy among populations with different levels of income and schooling. Health literacy assessment can guide the instructional design of community-directed health education programs.

Health literacy among members of the Nepalese immigrant population in Canada

Background: Health literacy is an important public health concern and can be defined as ‘the degree or extent to which the individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions’. Research on health literacy among recent immigrants to Canada is not that extensive. Objective: The purpose of this paper was to describe health literacy status among Nepalese immigrants residing in Calgary, Alberta, Canada. Methods: In 2019, a cross-sectional study, using a self-administered questionnaire, was conducted among Nepalese immigrants in Calgary. The questionnaire comprised 38 questions including sociodemographic information, self-rated health status, having a chronic disease or not, health literacy, sources of health information and preference to gain health information. Results: We received 401 responses: 49.63% were from women, 51.37% were aged 36–55 years, 37.00% had graduate-level education, 44.96% had immigrated to Canada less than 5 years ago and 81.05% were employed full-time/part-time or self-employed. Findings revealed that 17.21% of survey participants had limited health literacy, followed by 40.15% who had marginal health literacy. The majority of the survey participants (71.82%) either always or often got health information from healthcare professionals, followed by online resources (56.61%). Conclusion: Noteworthy levels of limited health literacy and marginal health literacy were observed among the Nepalese immigrant population. Multidirectional, culturally tailored, community-led, collaborative initiatives are needed to improve health literacy among the immigrant population, to lessen health disparities and to promote better health outcomes.

Evaluation of Health Literacy Levels and Associated Factors Among Patients with Acute Coronary Syndrome and Heart Failure in Qatar.

To determine the prevalence of inadequate health literacy and its associated risk factors among patients with acute coronary syndrome (ACS) and/or heart failure (HF) in Qatar. This cross-sectional observational study was conducted among patients with ACS and/or HF attending the national Heart Hospital in Qatar. Health literacy was assessed using the abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Three-item Brief Health Literacy Screen (3-item BHLS). Three hundred patients with ACS and/or HF, majority male (88%) and non-Qatari (94%), participated in the study. The median (IQR) age of the participants was 55 (11) years. The prevalence of inadequate to marginal health literacy ranged between 36% and 54%. There were statistically significant differences in health literacy level between patients based on their marital status (p=0.010), education (p≤0.001), ability to speak any of Arabic, English, Hindi, Urdu, Malayalam, or other languages (p-values ≤0.001 to 0.035), country of origin (p≤0.001), occupation (p≤0.001), and receiving information from a pharmacist (p=0.008), a physiotherapist (p≤0.001), or a nurse (p=0.004). Inadequate health literacy is common among patients with ACS and/or HF. This study suggests a need for developing strategies to assist healthcare professionals in improving health literacy skills among patients with ACS and HF. A combination of interventions may be needed to improve patients' understanding of their disease and medications, and ultimately overall health outcomes.

ORAL HEALTH LITERACY OF PATIENTS VISITING PRIVATE DENTAL HOSPITAL IN RURAL PUNJAB

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; This study aimed to explore the incidence of oral health literacy of people living in rural areas of Punjab, Pakistan. This quantitative study was crossectional in nature. Data was collected&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; from 66 dental patients coming to the dental hospital of rural areas in districts of Punjab. Descriptive&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; statistics were used to analyze data in frequencies and percentages to assess the incidence of oral health literacy among dental patients visiting the dental hospital of rural areas in Punjab, Pakistan for their dental treatment. Results revealed Oral health literacy was found at a marginal level among the majority of the participants (49.90%) followed by 38.84% participants who had an inadequate level of Oral health literacy whereas only 21.20% of participants showed adequate level. In conclusion, marginal oral health literacy was found among the dental patients visited rural area hospital for treatment.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Health literacy, health outcomes and community health worker utilization: a cohort study in HIV primary care

BackgroundPeople with HIV (PWH) have complex needs, and those with limited health literacy consistently have poorer HIV-related knowledge and health outcomes. One strategy to facilitate better outcomes for PWH is the inclusion of community health workers (CHWs) into care teams. This cohort study examines the effect of health literacy on clinical outcomes and utilization of CHW services among PWH enrolled in a CHW intervention. The secondary aim is to characterize most common purposes of CHW encounters.MethodsPWH (n = 209) enrolled in a CHW intervention with completed 6-month follow-up evaluation visits were included. Health literacy level was measured at baseline with the BRIEF tool and categorized into inadequate, marginal, and adequate health literacy. Adjusted logistic regressions assessed the effect of health literacy on viral load suppression, HIV primary care visits at 6-month follow-up, CHW utilization and purpose of CHW encounter. Purpose of CHW encounters included logistical support, accompany to appointment, transportation coordination, concrete services, coaching, and emotional support. Linear regression assessed the association between purpose of CHW encounters and CHW utilization.ResultsIndividuals with inadequate health literacy were more likely to receive coaching from CHWs (p = 0.029), and individuals with marginal health literacy were more likely to have an HIV primary care visit at 6 months (p = 0.044). Individuals receiving transportation coordination, concrete services, coaching, and emotional support had more total CHW encounters.ConclusionsPurpose of encounter was highly correlated with frequency of CHW encounters, while health literacy status was not. This suggests individuals receiving these services require more assistance from CHWs, regardless of health literacy level. Training CHWs to conduct comprehensive social needs assessment and screening for risk factors at the initial visit with clients can identify resources and guide CHW service delivery as part of the care team.

Sustained effect on diet quality of a self-care intervention to reduce cardiovascular disease risk among informal rural caregivers of people with chronic illnesses: does health literacy matter?

Abstract Background/Introduction Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. However, interventions are often not constructed with health literacy in mind. We previously found a moderation effect of health literacy on short-term (4-month) diet quality from a self-care intervention to reduce cardiovascular disease risk (RICHH) among rural caregivers. The RICHH intervention was designed to be equally effective in caregivers with marginal or adequate health literacy. Purpose To compare the impact of RICHH intervention on 12-month diet quality in rural caregivers with marginal versus adequate health literacy. Methods A total of 296 rural caregivers (54.5±13.7 years old, 76% female) of individuals with chronic illnesses participated. The newest vital sign (NVS) and Healthy Eating Index-2015 (HEI-2015) were used to determine health literacy and diet quality, respectively. The NVS was dichotomized using a cutoff score of 4. The HEI-2015 was computed based on food frequency questionnaires at baseline, 4-month, and 12-month. The RICHH intervention was delivered using video conferencing technology by nurse interventionists once a week for 12 weeks followed by bi-weekly and monthly booster sessions. A piecewise linear mixed-effect model, controlling for age, education, smoking status, and perceived stress, was used to evaluate the impact of the intervention on diet quality between the two health literacy groups. Results There was a significant difference in improvement in the HEI-2015 total scores at 4 months between control and intervention in the marginal health literacy group (beta estimate = 1.56, SE=0.74, P=0.039) but not in the adequate health literacy group (beta estimate = 0.27, SE=0.38, P=0.475). The improvement in the marginal health literacy group was sustained at 12-months (beta estimate = 8.12, SE=3.57, P=0.022). Conclusions The results of our study indicate that an intervention designed to address health literacy is effective in producing a sustained improvement in diet quality to reduce CVD risk in rural caregivers with marginal health literacy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health National Institute of Nursing Research

Using a co-designed, self-delivered, Avatar-based patient discharge education application to improve acute coronary syndrome patient knowledge

Abstract Background 30-day rehospitalisation following heart event among acute coronary syndrome (ACS) patients remains high and is largely contributed by poor disease-related knowledge and self-management, especially in the disadvantaged patient groups such as those with low education levels and inadequate health literacy. Traditional patient education methods fail to address these issues. Purpose This study aimed to test a unique consumer co-designed discharge education application (app) on patients' knowledge and its acceptability. Methods ACS patients (unstable angina, non-STEMI or STEMI) were recruited from Royal Adelaide Hospital at South Australia during admission, provided with the app via tablet for one-month self-delivered education. The app has undergone a rigorous development process with the substantial engagement of consumers (Figure 1). App content includes the Heart Foundation Six Steps to Cardiac Recovery including disease-related knowledge, risk factor management, and ACS responses, assessed at baseline, followed by first use at discharge and one month later. Patients and cardiac nurses rated the acceptability of the app. Results Among 22 Participants 81.8% were male (n=18), with a mean age of 59.7 (10.3) years, 45.5% (n=10) had not completed high school and nearly a quarter of the participants had marginal or below marginal health literacy. The diagnosis included STEMI (n=16, 72.7%) and non-STEMI (n=5, 22.7%). The majority of participants underwent percutaneous coronary intervention (PCI) (n=21, 95.5%) Significant improvements were observed for overall coronary artery disease knowledge at one month (p=0.003) and the exercise and nutrition domains at discharge (p=0.029; p&amp;lt;0.001) and one month (p=0.02; p=0.003) (Figure 2). Significant improvements were also observed for ACS knowledge and beliefs at discharge (p=0.008; p=0.038) and one month (p&amp;lt;0.001; p=0.025) when ACS response attitude was also significantly improved at one month (p=0.036). Overall acceptability was high at 7.7/10 (n=22 nurses) and 8.3/10 (patients). The participants described the app as `clear, simple, easy to understand, as well as stimulating and interactive, better than a live person'. Conclusion This novel, self-delivered Avatar-based ACS discharge education App has the potential to provide discharge education for ACS patients even for those who have low education levels or inadequate health literacy. Results need to be confirmed in a randomised controlled trial. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The National Heart Foundation Australia

The Relationship Between Health Literacy and Outcomes Before and After Kidney Transplantation.

Background.Limited health literacy (HL) is associated with decreased kidney function and death in patients with chronic kidney disease. Less is known about the impact of HL on kidney transplant (KT) outcomes. The aim of this study was to examine the relationship between HL and KT outcomes, including rates of waitlisting, healthcare utilization, acute rejection, renal allograft function, renal allograft failure, and death.Methods.We performed a retrospective review of HL data previously collected at our center. HL was assessed in a convenience sample of consecutive, English-speaking patients age ≥18 y who were evaluated for KT at Mayo Clinic in Minnesota between June 2015 and March 2017 as part of a practice improvement feasibility project (n = 690). HL was assessed using the 4-item Brief Health Literacy Screening Tool modified for the outpatient KT evaluation process. The 4 items assess confidence completing forms, reading comprehension, and oral literacy.Results.Overall, 30.4% of patients had limited or marginal HL. Patients with limited or marginal HL were less likely than those with adequate HL to be waitlisted for KT (hazard ratio = 0.62 and 0.69, respectively), even after adjusting for age, marital status, body mass index, Charlson comorbidity index, or dialysis dependency. Patient HL was not associated with post-KT healthcare utilization, acute rejection, or renal allograft function. Patients with limited or marginal HL appeared to experience a higher risk of renal allograft failure and post-KT death, but the number of events was small, and the relationship was statistically significant only for marginal HL.Conclusions.Inadequate HL is common in KT candidates and independently associated with decreased waitlisting for KT. We observed no statistically significant relationship between HL and posttransplant outcomes in our cohort. Further efforts to improve communication in patients with inadequate HL may improve access to KT.

Impact of low health literacy on patients’ health outcomes: a multicenter cohort study

BackgroundThis study aims to assess the health literacy of medical patients admitted to hospitals and examine its correlation with patients’ emergency department visits, hospital readmissions, and durations of hospital stay.MethodsThis prospective cohort study recruited patients admitted to the general internal medicine units at the two urban tertiary care hospitals. Health literacy was measured using the full-length Test of Functional Health Literacy in Adults. Logistic regression analyses were performed to examine the correlation between health literacy and the desired outcomes. The primary outcome of interest of this study was to determine the correlation between health literacy and emergency department revisit within 90 days of discharge. The secondary outcomes of interest were to assess the correlation between health literacy and length of stay and hospital readmission within 90 days of discharge.ResultsWe found that 50% had adequate health literacy, 32% had inadequate, and 18% of patients had marginal health literacy. Patients with inadequate health literacy were more likely to revisit the emergency department as compared to patients with adequate health literacy (odds ratio: 3.0; 95% Confidence Interval: 1.3–6.9, p = 0.01). In patients with inadequate health literacy, the mean predicted probability of emergency department revisits was 0.22 ± 0.11 if their education level was some high school or less and 0.57 ± 0.18 if they had completed college. No significant correlation was noted between health literacy and duration of hospital stay or readmission.ConclusionsOnly half of the patients admitted to the general internal medicine unit had adequate health literacy. Patients with low health literacy, but high education, had a higher probability of emergency department revisits.

Short message service usage may improve the public's self-health management: A community-based randomized controlled study.

Background and AimsThe last decade has witnessed unprecedented growth in mobile phone use. It links millions of previously unconnected people. The ubiquity of mobile phones, which allows for use of the short message service (SMS), offers new and innovative opportunities for disease prevention and health education. SMS usage appears to be a feasible, popular, and effective way of improving health literacy. This study measured the effect of SMS health education on the improvement of health management in Shenzhen, China.MethodsThis was a community‐based randomized controlled study. A total of 32 communities were randomly chosen out of 320, then about 200 participants were randomly sampled from each selected community. The subjects were equally divided into two groups at random. About half of the participants received health intervention messages via Internet‐based SMS for almost a year. The data were analyzed by descriptive and inferential statistical methods.ResultsThe proportion of participants involved in self‐health management increased from 30.92% to 38.68% over the year (χ 2 = 42.49, p < 0.001) in the intervention group. People with marginal health literacy reported the highest increase (10.92%), while people with low health literacy reported the smallest (5.25%). The control group showed no difference in baseline and final health management proportions (28.02% and 29.64%, p > 0.05). No statistical difference in the prevalence of chronic disease (15.16% and 13.89%, p > 0.05) was found before and after the intervention in the intervention group. The prevalence in the intervention group was lower after the intervention than it was in the control group (17.33%, χ 2 = 14.45, p < 0.001).ConclusionsSMS may be a powerful tool for improving the public's health literacy and health management because it is widely available, popular, affordable, and instant.

The Association of Health Literacy with Health-Related Quality of Life in Youth and Young Adults with Spina Bifida: A Cross-Sectional Study

The objective of the study was to determine if health literacy is associated with health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with spina bifida. Between June 2019 and March 2020, the Patient-Reported Outcome Measurement Information System Pediatric Global Health-7 (PGH-7), a measure of HRQOL, and the Brief Health Literacy Screening Tool (BRIEF) were administered to patients ≥12years old with a diagnosis of spina bifida seen in our multidisciplinary spina bifida center. Questionnaires were completed at scheduled clinic visits. The primary outcome was the PGH-7 normalized T-score. The primary exposure was the BRIEF score. Demographic and clinical characteristics were obtained from the medical record. Nested, multivariable linear regression models assessed the association between health literacy and the PGH-7 score. Of 232 eligible patients who presented to clinic, 226 (97.4%) met inclusion criteria for this study. The median age was 17.0years (range: 12-31). Most individuals were female (54.0%) and had myelomeningocele (61.5%). Inadequate, marginal, and adequate health literacy levels were reported by 35.0%, 28.3%, and 36.7% of individuals. In univariable analysis, higher health literacy levels were associated with higher PGH-7 scores. In nested, sequentially adjusted multivariable linear regression models, a higher health literacy level was associated with a stepwise increase in the PGH-7 score. In the fully adjusted model, adequate health literacy and marginal health literacy, compared with inadequate health literacy, were associated with increases in a PGH-7 score of 3.3 (95% CI: 0.2-6.3) and 1.1 (95% CI: -2.0 to 4.2), respectively. Health literacy was associated with HRQOL after adjusting for demographic and clinical factors. Strategies incorporating healthliteracy are needed to improve HRQOL in AYAs with spina bifida.

Health Literacy of Migrant Workers in Saudi Arabia: A Cross-sectional Survey

Background: Gulf nations employ large numbers of migrant workers. In Saudi Arabia, for example, migrant workers comprise 30% of its total population. However, the health literacy levels of these workers are reported to be low, and studies focusing on this topic are limited. Objective: The aim of this study is to assess the level of health literacy of migrant workers in Saudi Arabia. Methods: A convenience sample of 127 migrant workers in Saudi Arabia were surveyed using the Brief Health Literacy Screening Tool (BHLST) from September 2019 to November 2019. A comparison of the BHLST scores of the participants was performed. This study adhered to the STROBE checklist. Key Results: Out of the 127 respondents, 28 reported experiencing health problems, such as hypertension, diabetes mellitus, back pain, hepatitis A, rheumatic disorders, allergy, headache, kidney disease, and colitis. The majority of the participants (55.12%) had inadequate overall health literacy levels, 31.50% had marginal health literacy levels, and only 13.38% had adequate health literacy levels. Among the 13.38% participants who had adequate health literacy, more Arabic-speaking individuals than their non-Arabic-speaking counterparts had adequate health literacy by percentage. Conclusion: Overall, the findings of the study revealed that most migrant workers had inadequate or low health literacy levels, as indicated by their BHLST scores. The health authorities in Saudi Arabia and other Arab countries need to develop health literacy interventions geared toward increasing the health literacy levels of their migrant workers. Keywords: Brief health literacy screening tool; Expatriate workers; Health literacy; Migrant workers; Saudi Arabia

Health literacy among long-term survivors of breast cancer; exploring associated factors in a nationwide sample

BackgroundPoor health literacy may hamper health management and long-term outcomes in breast cancer survivorship. Knowledge of factors associated with poor health literacy is needed to identify survivors in need of additional support and to improve the quality of health care, but is currently scant. Here, we explore health literacy and associated factors in a nationwide sample of long-term survivors of breast cancer.Material and methodsAll survivors aged 20–65 years when diagnosed with stage I–III breast cancer in 2011 or 2012 were identified through the Norwegian Cancer Registry, and invited to participate in the Survivorship, Work and Sexual Health (SWEET) study. Health literacy was measured using The European Health Literacy Survey Questionnaire-12 (HLS-EU-Q12) and analyzed as a continuous and categorical variable. Associations between health literacy and socioeconomic, physical, and mental health variables, including the most common late effects after cancer treatment, were explored in uni- and multivariable linear regression models.ResultsThe final sample consisted of 1355 survivors (48%) with a mean age of 60 years at survey (SD 8.7). Eight years had passed since diagnosis (SD.0.7), and the majority of survivors had high socioeconomic status. Advanced judgment calls concerning treatment and health risks were reported to be the most difficult for survivors to handle. Mean health literacy sum score was 36.2 (range 12–48, SD 5.4). Thirty-nine percent had intermediate, while 19.3% reported marginal or inadequate health literacy. Education, income, age at diagnosis, the personality trait neuroticism, and fear of cancer recurrence were significantly associated with health literacy in the multivariate model, explaining 12% of the variance in health literacy scores.ConclusionLow levels of health literacy were prevalent in this population-based sample of long-term survivors of breast cancer, despite high socioeconomic status. Communicating and interpreting risks seem to be especially challenging. Attention to health literacy at a societal and individual level is necessary in order to provide survivorship care of high quality.

Using 3 Assessment Tools to Measure Patient Health Literacy in Rhode Island at Federally Qualified Community Health Centers

ABSTRACT Background The link between limited health literacy (HL), an often forgotten social determinant of health, inadequate access to health care, and poor health outcomes demonstrates the need for better patient education. Understanding HL supports patient education on multiple levels. Purpose Our objective was to measure HL and its association with sociodemographic variables. Methods A cross-sectional study with 328 patients was completed in 2 health centers. Three instruments, the Brief HL tool (BRIEF), Short Assessment of HL Spanish and English (SAHL-S&E), and the All Aspects of HL Scale (AAHLS), were administered. Participants also reported sociodemographic characteristics and perceptions. Results Limited and marginal HL existed in 49% (BRIEF) and 20% (SAHL-S&E) of participants. Differences in HL were identified by race, ethnicity, and education (p-values < .05) for the BRIEF and SAHL-S&E. Limited functional and critical HL existed in 23% and 25% of participants (AAHLS). Ninety percent reported confidence accessing health information, and 33% and 41% perceived their health as being poor and good. Discussion Results provide evidence of limited HL and merit in assessing HL in multiple ways. Translation to Health Education Practice Measuring HL provides a background for designing multilevel patient education efforts, reducing health inequalities, and informing the healthcare workforce.