Children with medical complexity (CMC) are a high-risk population for many reasons including polypharmacy, which predisposes to medication errors. Parental comprehension of discharge medications is essential to reducing the risk for medication errors in CMC. The aim of this study was to determine whether parental health literacy is associated with comprehension of discharge medications among CMC. This was an observational cross-sectional study of English- and Spanish-speaking parents (n = 60) of CMC younger than 18years admitted to the pediatric intensive care unit or acute care floor of 2 affiliated hospitals. Surveys were self-administered at time of discharge. Newest vital sign is a validated tool that identifies patients at risk for low health literacy. A score less than or equal to 3 indicated low health literacy. Comprehension was a composite score encompassing 6 domains (medication name, indication, dose, frequency, duration, and side effects) and was measured as a continuous variable. Simple and multiple linear regression models assessed the association between health literacy and comprehension, accounting for covariates. The unadjusted parental comprehension score was 1.16 higher (SE 0.33) in caregivers with appropriate health literacy (P < .01). Health literacy explained 17% of the variance in comprehension. Once adjusting for income, the association between health literacy and comprehension was no longer significant (P = .05). Low parental health literacy is associated with worse comprehension of discharge medications for parents of CMC, but the relationship is confounded by income. Initiatives to improve medication comprehension with special attention to health literacy and social determinants of health may help address this problem.

HighlightsPublic health relevance—How does this work relate to a public health issue?This study examines health literacy and health information access among chronically ill adults living in rural, unincorporated communities, populations that face long standing structural, linguistic and socioeconomic health inequities.Findings highlight how inadequate health literacy abilities and systemic barriers to information access compound chronic disease burden in communities with limited healthcare infrastructure and minimal local governance.Public health significance—Why is this work of significance to public health?The study provides one of the first quantitative assessments of health literacy in chronically ill individuals living in rural Southern California unincorporated communities, revealing pervasive low health literacy across demographic groups.Results of this study underscore that limited health literacy in these settings is likely shaped less by individual deficits and more by structural disadvantages, including low educational attainment, language barriers, poverty, and geographic isolation.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?Public health interventions must go beyond simple translation of materials and prioritize culturally tailored, linguistically accessible, and community-driven approaches that address underlying educational and structural inequities.Policies and programs should invest in system-level solutions, such as improved digital infrastructure, mobile health services, community health worker integration, and trust-building strategies, to enhance health literacy, chronic disease self-management, and healthcare access in rural, unincorporated communities.Rural and unincorporated communities (UCs) experience persistent health disparities driven by limited healthcare infrastructure, geographic isolation, and socioeconomic inequities. Health literacy (HL), the ability to obtain, understand, and use health information, is a critical yet underexplored determinant of health outcomes in these settings. This study examined HL and barriers to healthcare and health information access among low-income adults living with chronic conditions in nine rural UCs in Southern California. A descriptive cross-sectional survey was administered in English or Spanish to 222 respondents during community food distribution events. The questionnaire included demographics, self-reported health status, chronic disease history, perceived access to care and health information, trust in information sources and HL assessment using the Newest Vital Sign (NVS). Over four-fifths (82.7%) of respondents demonstrated limited or possibly limited HL. Although Spanish-speaking respondents scored significantly lower than English speakers on the NVS, language was not a significant predictor of HL after adjusting for age, gender, education and Hispanic origin. Lower education and older age were associated with reduced HL. One in four respondents reported barriers to healthcare access, primarily due to distance and appointment availability. Over half of the respondents reported difficulty accessing or understanding health information, regardless of HL or demographic characteristics. Doctors were the most trusted source of health information, while trust in government and religious organizations was lowest. Findings reveal pervasive low HL and broad challenges accessing care and health information across rural UCs, highlighting the structural and educational inequities underlying these disparities. Addressing these gaps requires community-driven, bilingual, and culturally resonant strategies that build trust, enhance communication, and strengthen health system accessibility for residents of unincorporated rural regions.

Objectives Limited ability to obtain, process, and understand health information that enables patients to make health decisions (low health literacy) is associated with worse health and an increased risk of hospitalization. There is evidence that patients’ word choice can reflect illness behavior and care experience. Correlation of linguistic tones and health literacy could help identify opportunities to ensure patient understanding and participation in decision-making during outpatient visits among patients with musculoskeletal illness. Methods A secondary analysis of transcripts of video and audio recordings of 65 adult patients seeking musculoskeletal specialty care was performed. Patients also completed questionnaires quantifying symptoms of depression (PROMIS [Patient-Reported Outcomes Measurement Information System] Depression computerized adaptive test [CAT]), PROMIS Pain Interference CAT (PI), PROMIS Upper Extremity CAT (UE), the Newest Vital Sign (NVS) health literacy questionnaire, and a basic demographics survey. Linguistic Inquiry and Word Count ( LIWC) was used to detect the relative strength of various emotional tones, cognitive processes, and core drives and needs. We tested for associations between health literacy and patient demographics, each of the LIWC domains, and PROMIS Depression, PROMIS PI, and PROMIS UE. Results Accounting for potential confounding in multivariable analysis, higher health literacy was associated with greater years of education, greater tones reflecting anxiety, and greater tones describing risk. There were correlations between more limited health literacy and greater pain interference and greater symptoms of depression, but not with upper extremity-specific capability. Conclusion The observation that patient linguistic tones are associated with health literacy can be used to develop effective health strategies consistent with what matters most to patients.

BackgroundHealth literacy (HL) is a key determinant of health outcomes, especially in chronic neurological diseases such as multiple sclerosis (MS). Insufficient HL may impair the ability of patients to manage their condition, reduce treatment adherence and increase the use of healthcare.ObjectiveTo identify factors influencing HL among individuals with MS and to explore its association with illness perception and medication-related behaviours.MethodsBetween April and September 2023, we consecutively enrolled 330 patients with MS from a single outpatient clinic. We included individuals aged 18–65 years with functional literacy, and we did not exclude participants based on MS subtype, education level, disability status or treatment characteristics. We assessed HL using the Newest Vital Sign, cognition using the Montreal Cognitive Assessment (MoCA), emotional status using the Hospital Anxiety and Depression Scale, and illness perception using the Brief Illness Perception Questionnaire (BIP-Q). We also evaluated self-reported medication adherence and perceived treatment benefits. After excluding 11 participants with incomplete data, we analysed 319 complete responses in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines.ResultsOverall, 49.7% of participants demonstrated adequate HL. The HL correlated positively with MoCA scores and education (path coefficients: 0.117, 0.114) and negatively with disease duration, age and depression (−0.023,–0.029, −0.085). HL was positively associated with illness perception (BIP-Q coefficient: 1.558). The model explained 35.6% of the variance in HL and 5.7% in illness perception (R²=0.356; 0.057).ConclusionOur findings suggest that routine HL assessment and targeted educational interventions may enhance understanding, adherence and informed decision-making, ultimately improving disease management and outcomes in MS.

Background/Objectives: This study aims to investigate the association between health literacy (HL) and stress among family caregivers of older adults with dementia. Methods: Older adults and their caregivers were recruited from the geriatric outpatient memory clinic of an Italian hospital. Caregiver stress was assessed using the General Health Questionnaire-12 items (GHQ-12). HL was measured using the Newest Vital Sign (NVS) and the Short Form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Results: A total of 170 (71% females) caregivers, including spouses and offspring, were included in the analysis. According to the NVS, 53% demonstrated adequate HL, while 83% achieved adequate scores on the S-TOFHLA. The median GHQ-12 score was 15, with 48% presenting a score above 14, indicating higher stress levels; women reported significantly higher GHQ-12 scores than men. In a multivariate linear regression analysis adjusted for sex, education, and number of care tasks provided, the S-TOFHLA score showed a borderline association with the GHQ-12 score (B = −1.45; p = 0.064). When characteristics of the care-recipient were added to the model, the S-TOFHLA score emerged as an independent predictor of the GHQ-12 score (B = −1.41; p = 0.048), along with female caregiver sex and behavioral and psychological symptoms in the care-recipients. Exploratory analysis suggested that the association between HL and stress was present among male but not female caregivers. Conclusions: HL was associated with psychological stress in caregivers of older adults with dementia, with the relationship appearing more pronounced among male caregivers.

Hispanic/Latino populations experience high rates of preventable conditions like heart disease and diabetes, emphasizing the importance of health literacy in promoting informed health decisions and reducing existing disparities. This systematic review aimed to identify frequently used health literacy measures used with Hispanic/Latino adults in the United States, describe the psychometric properties of these measures, and examine the medical contexts and health conditions of the included studies. A comprehensive search across four databases yielded 2,431 studies; After screening, 168 studies met inclusion criteria. Eleven health literacy measures were identified, and the Short Test of Functional Health Literacy (STOFHLA), Newest Vital Sign (NVS), and Brief Health Literacy Screener (BHLS) were the most frequently used. Study medical context and health conditions included general health (23%), diabetes (15%), cancer (14%), among others. While several health literacy measures demonstrated acceptable to good reliability and validity, gaps were identified regarding cultural appropriateness and tailoring to Hispanic/Latino communities. Enhancing health literacy measures is critical to help inform interventions and improve health outcomes in this population.

Introduction: Rural-dwelling adults with cardiovascular disease and failure have high rates of depression. However, delivering interventions that are both effective and accessible remains a challenge. Given the lower health literacy levels in rural areas, like Appalachia, existing interventions should be tested. In the COMBAT-DS study, we compared two online methods of delivering cognitive behavioral therapy (CBT) to lower depressive symptoms in areas where providers are scarce, like rural Appalachia. Purpose: To determine whether health literacy moderates the impact of the COMBAT intervention on depressive symptoms. Methods: In a secondary data analysis for a large comparative effectiveness randomized controlled trial comparing cognitive behavioral therapy (CBT) via video-conferencing with a therapist vs. self- directed CBT online program. We used OLS regression with the PROCESS macro in SPSS to determine whether health literacy moderated the effect of the intervention on depressive symptoms. Depressive symptoms were measured using the Patient Health Questionnaire – 9 (PHQ-9). Health literacy was measured using the Newest Vital Sign (NVS) and converted into two groups (limited health literacy and adequate health literacy) based on the published cutpoint (0-3 inadequate health literacy, 4-6 adequate health literacy). Results: In our sample of 303 individuals (age 58 ± 12; 49% were women), both interventions resulted in statistically and clinically significant reductions in depressive symptoms scores, and level of health literacy did not moderate the effect of the interventions on depressive symptoms over time (p = 0.642; Figure). Conclusions: Health literacy levels did not moderate the relationship of the COMBAT interventions with depressive symptoms in rural participants with cardiac diseases. Online CBT with or without a therapist is equally effective in reducing depressive symptoms regardless of health literacy level. This makes both types excellent interventions to use in rural areas.

Background: Sleep disturbances are prevalent in individuals with cardiovascular disease (CVD) and can have a substantially negative impact on daily functioning (e.g., reading, working, driving, and decision-making), also known as sleep-related functional outcomes. However, the relative contribution of demographic and clinical factors, cognitive function, health literacy, and depressive symptoms on sleep-related functional outcomes remains poorly understood. Objective: To examine the influence of demographic and clinical factors, cognitive function, health literacy, and level of depressive symptoms on sleep-related functional outcomes in depressed rural patients with CVD. Methods: We conducted secondary analyses using data from a large longitudinal randomized controlled trial and developed a hierarchical multiple linear regression model in depressed rural patients with CVD (N = 257; mean age 57±13; 47% women). Predictors of sleep-related functional outcomes were entered in five blocks, 1) demographic (age, sex, marital status, financial status), 2) New York Heart Association (NYHA) functional class, 3) cognitive function (Montreal Cognitive Assessment), 4) health literacy (Newest Vital Sign), and 5) depressive symptoms, (Patient Health Questionnaire-9). Sleep-related functional outcomes were measured using the Functional Outcome of Sleep Questionnaire-10 (FOSQ-10). Results: The final model significantly predicted sleep-related functional outcome (R 2 = 0.135, adjusted R 2 = 0.108, p &lt; .001). Among all predictors, only depressive symptoms were independently associated with sleep-related functional outcomes (B = -0.363, p &lt; .001), indicating that greater depressive symptom burden was independently associated with worse sleep-related functioning. Demographic characteristics, NYHA class, cognitive scores, and health literacy were not significant predictors in the final model. Conclusion: Depressive symptoms were the strongest and only significant predictors of sleep-related functional outcomes in rural depressed patients with CVD. These findings underscore the importance of integrating routine mental health screening and intervention, particularly for depressive symptoms, into cardiovascular care to address sleep-related functional outcomes.

Caregiver new diagnosis education is understudied in pediatric oncology. Caregiver health literacy (HL) and social determinants of health (SDoH) may affect the caregiver-reported educational experience (CREE) of receiving new diagnosis education. Our purpose was to determine relationships between HL, SDoH, and CREE by surveying caregivers who received new diagnosis education for their children undergoing cancer treatment. HL was assessed using the Newest Vital Sign (limited HL: 0-3; adequate HL: 4-6). Five SDoH domains (economic stability; education access/quality; healthcare access/quality; neighborhood/built environment; social/community context) were assessed (adverse SDoH: ≥1 adverse factor). CREE was assessed using items adapted from the Agency for Healthcare Research and Quality (AHRQ) Health Literacy Supplemental Items (possible range: 6-36; unfavorable: <33). Multivariable logistic regression was used to identify associations between unfavorable CREE score (outcome), SDoH, and HL, adjusting for caregiver sociodemographic and child clinical factors. Of 67 caregivers, 77.6% were mothers, 65.7% non-Hispanic White, median [range] age was 34 [20-69] years. Among the patients (N = 67): males were 56.7%, leukemia 55.2%, and median [range] age 4.4 [0.2-17.5] years. Over one-third (35.8%) of caregivers had limited HL, 71.6% had one or more adverse SDoH, and 40.3% reported unfavorable CREE. In multivariable logistic regression, adverse SDoH was associated with 6.3-fold higher odds of unfavorable CREE (adjusted odds ratio [aOR] = 6.3, 95% confidence interval [CI] = 1.4-28.7, p = 0.017); adequate HL was associated with 8.0-fold higher odds of unfavorable CREE (aOR = 8.0, 95% CI = 1.9-34.4, p = 0.005). SDoH and HL are important factors to consider when providing new diagnosis education to pediatric oncology caregivers.

ABSTRACTObjectiveTo investigate the association between health literacy levels and biochemical control of hypothyroidism, measured by serum TSH and free thyroxine (FT4) levels, in patients receiving levothyroxine (L‐T4) therapy.MethodsWe conducted a cross‐sectional study at the Thyroid Disorders Outpatient Clinic, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), between April and December 2024. The protocol was approved by the institutional ethics committee (CAAE: 76540423.5.0000.5505), and all participants provided written informed consent. Adult patients aged 18–65 years with primary hypothyroidism on levothyroxine (L‐T4) therapy were screened; 274 met eligibility criteria after exclusions. Health literacy was assessed using the Brazilian‐Portuguese Newest Vital Sign (NVS), administered face‐to‐face by trained staff. Demographic and clinical data, including comorbidities, L‐T4 dose, TSH, and FT4 levels, were extracted from electronic records. Biochemical analyses were performed using electrochemiluminescence immunoassays. Statistical analyses included ANOVA, χ² tests, and generalised linear regression, with significance set at p < 0.05.ResultsAmong 274 patients included in the final analysis, health literacy was inversely associated with serum TSH levels, and this association remained significant in fully adjusted models. A marginal trend was observed for FT4, but it did not reach statistical significance after adjustment. Patients with lower literacy scores required higher levothyroxine doses per kilogram, suggesting less efficient treatment control. No significant differences in comorbidities were observed across literacy strata.ConclusionsLimited health literacy was independently associated with poorer biochemical control of hypothyroidism, reflected by higher TSH concentrations and greater levothyroxine dose requirements. These findings reinforce health literacy as a modifiable determinant of treatment success. Incorporating literacy‐sensitive strategies—such as plain‐language counselling, teach‐back techniques, and visual aids—into routine care may help stabilise TSH, optimise levothyroxine therapy, and improve long‐term outcomes in this population.

Telemedicine use has surged since the COVID-19 pandemic, offering a convenient way for patients to access health care. Whereas digital literacy (general comfort with and ability to use digital tools) is necessary to utilize telemedicine, digital health literacy is a subset of this, focusing on the ability to use digital tools to seek out, understand, and utilize health information. Barriers such as the lack of high-speed internet and limited digital health literacy can hinder telemedicine's effectiveness, particularly for historically marginalized populations with lower technological access.This study aims to characterize the relationship between baseline digital health literacy, appointment no-shows, and telemedicine usage in a Bronx population.In a Bronx-based cohort, we assessed digital health literacy using eHealth Literacy Scale (eHEALS) and eHealth Literacy Objective Scale-Scenario Based (eHeLiOS-SB), and health literacy with the Newest Vital Sign (NVS) instrument. Baseline sociodemographic characteristics (e.g., age, insurance type) were collected, and appointment no-show rates and telemedicine usage were calculated. Linear regression models were used to assess associations.Higher digital health literacy, private insurance (compared to Medicaid), and older age were associated with fewer no-shows. Higher video visit usage was also associated with fewer no-shows. Individuals at high risk of housing insecurity were less likely to use video visits, and higher phone visit usage was associated with patients experiencing financial resource strain. Digital health literacy was positively associated with White race and negatively associated with Medicare usage (compared to Medicaid).Higher digital health literacy correlates with increased appointment attendance, indicating the need to address digital barriers in health care. Increasing telemedicine use may help reduce no-shows, and patient-specific strategies are needed to enhance digital health literacy and telemedicine effectiveness.

BackgroundChronic respiratory diseases significantly impact patients’ quality of life and health outcomes. Health literacy was pivotal for effective disease management. This study evaluated the efficacy of a visual intelligent medical health education (VIMHE) model versus routine health education (RHE) on health literacy, pulmonary function, and quality of life in patients with chronic respiratory conditions.MethodsA retrospective case-control study was performed involving 139 patients aged 40–70 years with stable chronic respiratory diseases admitted to our hospital between January and December 2023. Participants were divided into two groups: the RHE Group (n=68) and the VIMHE Group (n=71). Health literacy was assessed using the Newest Vital Sign (NVS), Test of Functional Health Literacy in Adults (TOFHLA), Health Literacy Survey-European Union (HLS-EU), and Electronic Health Literacy Scale (eHEALS). Pulmonary function tests and Short Form 36 (SF-36) Quality of Life assessments were performed pre- and post-intervention.ResultsThe VIMHE Group demonstrated significantly higher health literacy scores across all metrics compared to the RHE Group: NVS (5.2±0.6 vs. 4.6±0.7, P<0.001), TOFHLA (68.8±8.1 vs. 65.2±7.2, P=0.006), HLS-EU (33.1±4.7 vs. 30.5±4.3, P<0.001), and eHEALS (45.7±6.2 vs. 42.5±5.8, P=0.002). Post-intervention, the VIMHE Group showed significant improvements in pulmonary function: forced expiratory volume in the first second (FEV1) (2.71±0.46 vs. 2.52±0.49 L, P=0.01), forced vital capacity (FVC) (3.68±0.69 vs. 3.45±0.65 L, P=0.03), and FEV1/FVC (78.18%±4.96% vs. 75.42%±5.19%, P=0.002). Quality of life scores also significantly increased in the VIMHE Group: physical functioning (73.68±6.95 vs. 70.32±7.21, P=0.006), social functioning (74.75±7.68 vs. 71.25±7.92, P=0.009), and mental health (69.74±6.18 vs. 66.63±6.34, P=0.004).ConclusionsThe VIMHE model significantly enhances health literacy, pulmonary function, and quality of life in patients with chronic respiratory diseases compared to RHE. Implementing VIMHE may improve patient outcomes in this population.

HeartHealth is a multi-component cardiovascular disease (CVD) risk reduction intervention developed for rural Appalachia participants. Its effectiveness in reducing CVD risk factors has been demonstrated, and although HeartHealth was developed to address the negative impact of social determinants of health (SDOH), it remains unclear whether its impact is modified by key SDOH. The aims of the study were to evaluate whether the intervention effect on the Framingham CVD Risk Score (FRS) differs by financial status, education level, sex, depressive symptoms, and health literacy. A secondary analysis was conducted using data from a randomized controlled trial involving 349 participants (mean age: 43 ± 13, female 78%) from rural Appalachian Kentucky. Financial status, education level, and sex were measured using standard questionnaires, depressive symptoms were measured using the Patient Health Questionnaire-9, and health literacy was measured using the Newest Vital Sign. Repeated measures mixed modeling was employed to assess the impact of each SDOH while simultaneously evaluating the effects of time, intervention, and their interaction on FRS. The interaction between time and intervention was significant, indicating a sustained reduction in FRS among intervention participants. None of the SDOH had moderating effects on the intervention's impact on reducing CVD risk factors. This demonstrates that the HeartHealth intervention remains effective despite the impact of selected SDOH. The HeartHealth intervention effectively reduces CVD risk factors in rural Appalachia populations. This remains true regardless of SDOH that are commonly seen in rural areas.

Objectives:This study aimed to describe the health literacy of caregivers ofpatients with new onset diabetes mellitus (NODM) presenting to a large,pediatric medical center and to describe the association between caregiverhealth literacy and patient characteristics.Study design:This was a retrospective, cohort study. Caregiver health literacy wasassessed using the Newest Vital Sign (NVS). NVS is scored 0–6:adequate literacy (AL) (4–6); possibility of limited literacy (PLL)(2–3); and high likelihood of limited literacy (HLLL)(0–1).Methods:Bivariate and multivariable analyses were performed with caregiverhealth literacy as the predictor. P < 0.05 was consideredsignificant.Results:Between January 1, 2016 and December 31, 2023, there were 1832 NODMpatients [mean age 10.2 (4.8) years, 46 % female]; 1701 (92.8 %) caregiverscompleted NVS: 92.3 % AL, 5.2 % PLL, and 2.5 % HLLL. Among 1091 diagnosedbefore January 1, 2023, 561 (51.4 %) and 136 (12.5 %) utilized a continuousglucose monitor (CGM) and insulin pump, respectively, within 12 months.Lower health literacy was associated with higher odds of interpreter use(PLL p < 0.001; HLLL p < 0.001), of tailored diabeteseducation (PLL p < 0.001; HLLL p < 0.001), and longer lengthof stay (PLL p < 0.001; HLLL p < 0.001). HLLL (adjusted oddsratio [aOR] 0.25, 95 % confidence interval [CI] 0.06, 0.94) but not PLL (aOR1.06, 95% CI 0.44, 2.57) was associated with lower odds of CGM use within 12months.Conclusions:Patients with NODM whose caregivers have lower health literacyrepresent a high-risk population associated with increased resourceutilization, longer hospitalization, and risk for decreased uptake ofdiabetes technology. A health-literacy informed approach to initialeducation may offer opportunities to support the individual needs ofcaregivers.

Background/Objectives: Nutrition in inflammatory bowel disease (IBD) is a central concern for both patients and healthcare professionals, as it plays a key role not only in daily life but also in disease outcomes. The Mediterranean diet represents a healthy dietary pattern that may be suitable in many cases of IBD. Among other factors, health literacy (HL) influences patients' dietary habits and their ability to follow nutritional recommendations. The aim of this study was to assess HL and dietary patterns in adolescent and pediatric patients with IBD. Methods: We conducted a cross-sectional study that included a total of 99 participants (36 patients with IBD receiving biological therapy recruited from a single center and 63 healthy controls). HL was assessed using the Newest Vital Sign (NVS) tool regardless of disease activity, whereas diet quality was evaluated by the KIDMED questionnaire exclusively in patients in remission. Linear regression models were used to evaluate the effects of sex, age and group (patients vs. control) on NVS and KIDMED scores. Results: Most participants (87.9%) had an adequate HL, which was positively associated with age. While the most harmful dietary habits (such as frequent fast-food consumption) were largely absent in the patient group, KIDMED scores indicated an overall poor diet quality. Conclusions: Although HL increased with age and was generally adequate in this cohort, it did not translate into healthier dietary patterns as measured by the KIDMED score. Further research with larger, more diverse samples is needed to clarify the relationship between HL and dietary adherence in adolescents with IBD.

Sociodemographic disparities in health literacy among American adults: A national survey study

Health Literacy and Physical Function Among Older Black and Hispanic Individuals With Heart Failure.

Objective: Continent urinary diversion is a quality-of-care metric for patients undergoing cystectomy for nonmetastatic muscle-invasive bladder cancer. However, Hispanic patients seem less likely to receive continent diversion than non-Hispanic patients, and the reasons for this remain unclear. This study aimed to identify the factors underlying this disparity in surgical decision-making. Methods: We conducted a single-institution, qualitative, prospective observational cohort study of 54 patients (31 non-Hispanic, 23 Hispanic) who underwent radical cystectomy between November 2019 and August 2024. Semistructured interviews explored decision-making, physician communication, and patient satisfaction. Health literacy was assessed using the Brief Health Literacy Screener (BHLS) and Newest Vital Sign (NVS). Qualitative data were analyzed using thematic analysis, and quantitative comparisons were performed using paired t tests and χ2 tests. Results: Although the mean age was similar between the Hispanic and non-Hispanic cohorts, patients with continent diversion were significantly younger than those who received an ileal conduit. Nearly one-third of those receiving continent diversion were Hispanic. The level of education did not differ by diversion type but was lower among Hispanic patients overall. Although the BHLS did not detect differences in health literacy, the NVS revealed that Hispanic patients scored lower than non-Hispanic patients, correlating with a higher likelihood of choosing an ileal conduit. Thematic analysis identified 5 main themes: understanding bladder cancer and urinary diversion, lifestyle implications, education and counseling, physician communication, and barriers to care. Hispanic patients more often reported limited autonomy in selecting a diversion and experienced gaps in the comprehension of surgical options, despite expressing high satisfaction with the care process. Conclusions: Lower health literacy, rather than the education level, emerged as a potential key factor associated with choosing incontinent urinary diversion in patients with bladder cancer. Hispanic patients were less likely to understand the difference between the procedures and more likely to choose the diversion decided by the treating physician. Improving health literacy screening and physician-patient dialogue may help at-risk populations better understand complex procedures and make autonomous decisions regarding urinary diversion.

Development and evaluation of the patient engagement questionnaire (PEQ).

Effective patient education is critical to an individual's treatment plan when living with diabetes, a debilitating disease requiring extensive knowledge and skills to effectively manage and prevent future morbidity. This descriptive, cross-sectional study assessed the appropriateness of commercially developed patient education materials for rural adults with diabetes. Using electronic health record data from patients (n = 132) with documented health literacy levels (HLL), their HLL scores were reviewed for suitability of educational materials provided by a single rural-border hospital. HLL was measured using the Newest Vital Sign, while educational materials were assessed by two independent reviewers using the Patient Education Materials Assessment Tool for Printable Materials to measure understandability and actionability, and the Simple Measure of Gobbledygook to measure the readability level of documents in both English and Spanish. The mean HLL for Spanish speakers (n = 77) was 2.01 (±1.56), while the mean HLL for English speakers (n = 55) was 2.09 (±1.46), indicating a high likelihood of low health literacy. The materials were evaluated with the English materials achieving an understandability score of 83.33% and an actionability score of 60.00%. By contrast, the Spanish materials scored lower, 61.54% and 20.00%, respectively. In addition, the readability of the materials measured a 9.0 grade level for English materials and a slightly higher 10.8 for Spanish materials. These findings highlight a significant discrepancy between the HLL and the appropriateness of educational materials for the sample population. Although commercially available educational products may provide a budget-concise solution to patient education, particularly in low-resourced organizations, they fail to address the health education needs of the individuals who receive them. Despite the project's limited sample size and single geographical location, it underscores the importance for healthcare organizations to address the health education needs of their communities.