Health Literacy Levels Of Patients Research Articles

Health literacy in patients with gout: A latent profile analysis

Objectives Understanding the health literacy status of patients with gout diagnosis is essential for improving the health of this population. Our study aimed to investigate the latent profiles of health literacy in patients with gout and to analyze differences in characteristics across potential profiles. Methods This was a cross-sectional study. Eligible participants attended the Shandong Gout Medical Center, from March 2023 to May 2023 and self-reported gout diagnosis. We used the Health Literacy Scale for Patients with Gout designed and validated by our team. The scale had good reliability and validity among patients with gout. 243 patients completed the Demographic Information Questionnaire and the Health Literacy Scale for Patients with Gout. We used latent profile analysis to identify the latent profiles of gout patients’ health literacy. We used Chi-square tests with Bonferroni correction to analyze differences in demographics and illness characteristics across identified profiles. Results Three profiles of patients with gout emerged (prevalence): the low literacy-low critical group (21.81%), the moderate literacy group (42.79%), and the high literacy-stable group (35.39%). The three groups differed in age, education level, monthly income, disease duration, and place of residence (P<0.01). Conclusions The health literacy of patients with gout was heterogeneous. Healthcare professionals should adopt targeted interventions based on the characteristics of each latent health literacy profile to improve the health literacy level of patients with gout.

Influencing factors of hospitalization cost of hypertension patients in traditional Chinese medicine hospitals.

This study aimed to analyze the influencing factors of hospitalization cost of hypertensive patients in TCM (traditional Chinese medicine, TCM) hospitals, which can provide a scientific basis for hospitals to control the hospitalization cost of hypertension. In this study, 3,595 hospitalized patients with a primary diagnosis of tertiary hypertension in Tianshui City Hospital of TCM, Gansu Province, China, from January 2017 to June 2022, were used as research subjects. Using univariate analysis to identify the relevant variables of hospitalization cost, followed by incorporating the statistically significant variables of univariate analysis as independent variables in multiple linear regression analysis, and establishing the path model based on the results of the multiple linear regression finally, to explore the factors influencing hospitalization cost comprehensively. The results showed that hospitalization cost of hypertension patients were mainly influenced by length of stay, age, admission pathways, payment methods of medical insurance, and visit times, with length of stay being the most critical factor. The Chinese government should actively exert the characteristics and advantages of TCM in the treatment of chronic diseases such as hypertension, consistently optimize the treatment plans of TCM, effectively reduce the length of stay and steadily improve the health literacy level of patients, to alleviate the illnesses pain and reduce the economic burden of patients.

The effect of health literacy on early postoperative recovery of patients undergoing outpatient surgery.

The measurement of the health literacy level of patients undergoing outpatient surgery has become a major challenge in perioperative nursing of outpatient surgery. To analyze the effect of health literacy on early postoperative recovery of patients undergoing outpatient surgery by developing a health literacy assessment tool for this population. A scale for the assessment of health literacy was established based on Nutbeam's health literacy model. From April to September 2021, 264 patients were selected in the daytime operating rooms of six Class A tertiary hospitals in Kunming, Yunnan Province to investigate health literacy and early postoperative rehabilitation quality, and the influencing factors of the two variables were analyzed. An assessment scale of health literacy of patients undergoing outpatient surgery was developed, including 3 dimensions and 24 items. The Cronbach's α coefficient of the total scale was 0.944, the split-half reliability was 0.902, and the content validity was 0.920. Exploratory factor analysis showed that the cumulative variance contribution rate was 66.37%, and the scale had good structural validity. Multiple linear regression analysis showed that age, functional health literacy, interactive health literacy, and critical health literacy could explain 60.4% of the variation (adjusted R2= 0.583) of postoperative recovery quality of patients undergoing outpatient surgery. Health literacy of patients undergoing outpatient surgery is an important factor that affects the quality of early postoperative recovery. The health literacy assessment scale can assist medical staff in implementing personalized perioperative nursing and health education.

Predictors of Health Literacy Levels in Patients Attending Anesthesia Outpatient Clinics for Preoperative Evaluation.

Health literacy significantly impacts healthcare outcomes, particularly in preoperative settings where patients' understanding of medical procedures, adherence to instructions, and surgical outcomes are influenced. Despite accessibility to medical information, challenges persist in comprehending healthcare details, affecting active patient participation in care. This study aims to assess health literacy among patients attending anesthesia outpatient clinics for preoperative evaluation and analyze associated factors. A sample size of 240 patients was determined using power analysis. The inclusion criteria encompassed informed, consenting patients with adequate mental capacity and primary education, aged 18-65 years, according to the American Society of Anesthesiologists (ASA I-II). Data were collected through a descriptive characteristics form and the Health Literacy Scale (HLS). The mean health literacy score was 29.37±6.22, indicating a moderate level. Marital status, education level, employment status, book reading preference, comorbidities, and reason for clinic visits significantly influenced health literacy (p<0.001). Regression analysis revealed marital status (β=-1.915, p=0.047), employment (β=1.187, p=0.039), and book reading preference (β=3.76, p<0.001) as independent predictors of health literacy. Health literacy levels were associated with various socio-demographic and health-related factors. Notably, being single or divorced, employed, and enjoying reading predicted higher health literacy. This underscores the impact of social support, occupation, and reading habits on health literacy. However, longitudinal studies with objective measures are warranted to further explore these associations. This study underscores the importance of addressing health literacy levels in anesthesia outpatient clinics, highlighting key predictors such as marital status, education, and employment. While contributing to our understanding of preoperative health literacy, further research using longitudinal designs and objective measures is essential. Bridging the health literacy gap is crucial for empowering patients, refining decision-making, and elevating the quality of overall surgical experiences.

Anxiety and Health Literacy Levels of Patients Undergoing Colonoscopy.

This descriptive, correlational study was conducted to determine the anxiety and health literacy levels of patients undergoing colonoscopy and the variables affecting them. The study population consisted of individuals who presented for colonoscopy to the endoscopy department of a state hospital. The sample consisted of 160 individuals who met the inclusion criteria. Three data collection tools (Identifying Information Form, State-Trait Anxiety Inventory, and Health Literacy Scale) were used to determine anxiety and health literacy levels. Findings show that the state-trait anxiety of individuals who would undergo colonoscopy for the first time was moderate, and their health literacy scores were inadequate, problematic, and weak. There was a positive and significant relationship between patients' anxiety and health literacy levels. Variables such as age, gender, marital status, education level, employment status, disease-related symptoms, a family history of cancer, and fear of colonoscopy influenced anxiety and health literacy. Based on these findings, we recommend that individuals' anxiety and health literacy status be determined before a colonoscopy procedure to improve gastroenterology nurses' management of these patients.

Psychometric properties of the Health Literacy Knowledge and Experience Survey-2 for Turkish nursing students.

Nursing students should be able to assess the health literacy levels of patients and enable patients to understand important health information. No scale has been developed to measure the health literacy knowledge and experience of Turkish nursing students. The Health Literacy Knowledge and Experience Survey-2 (HLKES-2) is a measurement tool with excellent psychometric properties that can be used to assess the health literacy knowledge and experience of nursing students. In this study, we aimed to determine the validity and reliability of the Turkish version of the Health Literacy Knowledge and Experience Survey-2 (HLKES-2-T) among Turkish nursing students. The study sample consisted of 510 undergraduate nursing students. The psychometric properties of the HLKES-2-T were analysed in terms of internal consistency, item-total score correlations, content validity, discriminant validity and known-group comparison. The HLKES-2-T total mean ± SD score was 11.69 ± 3.32. The Kuder-Richardson 20 coefficient of the knowledge subscale of the HLKES-2-T was 0.67, and its item-total score correlations ranged between 0.20 and 0.50. The Cronbach's alpha coefficient of the experience subscale of the HLKES-2-T was 0.73, and its item-total score correlations ranged between 0.75 and 0.78. The content validity index for the overall HLKES-2-T was 0.98. The HLKES-2-T is thus a reliable and valid tool that can be used to assess the health literacy knowledge and experience levels of Turkish nursing students.

Determination of Diabetes Health Literacy Levels of Patients Followed Up With Diabetic Foot Diagnosis: A Cross-Sectional Descriptive Study.

The number of studies on the diabetes health literacy of patients with diabetic foot is very limited. The aim of this study was to determine the diabetes health literacy levels of patients with diabetic foot. The data in this cross-sectional, descriptive study were collected using a sociodemographic data collection form and the Health Literacy Scale (HLS). Data were analyzed using SPSS for Windows Version 25.0 software. The HLS total score was 35.96 ± 10.70, and the Functional, Interactive and Critical subscale scores were 11.90 ± 5.04, 13.10 ± 4.80, and 10.96 ± 4.19, respectively. The diabetic health literacy level of the patients was seen to be affected by general education level, the status of having received education about diabetes, and family history of diabetes (P < .05). The diabetes health literacy level of patients with diabetic foot can be said to be low. This demonstrates the necessity of determining and increasing the health literacy levels of patients diagnosed with diabetes before the development of diabetic foot.

Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country

IntroductionCardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10–15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management.MethodsA nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression.ResultsOf 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8–57.4), P < 0.001). There was no correlation between education and health literacy levels.ConclusionThe inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.

Development and validation of a Systemic Sclerosis Health Literacy Scale.

Health literacy levels are strongly associated with clinical outcomes and quality of life in patients with chronic diseases, and patients with limited health literacy often require more medical care and achieve poorer clinical outcomes. Among the large number of studies on health literacy, few studies have focused on the health literacy of people with systemic sclerosis (SSc), and there is no specific tool to measure health literacy in this group. Therefore, this study plans to develop a health literacy scale for patients with SSc. This study included 428 SSc patients from the outpatient and inpatient departments of the Department of Rheumatology and Immunology, the first affiliated Hospital of Anhui Medical University and the first affiliated Hospital of University of Science and Technology of China. The formulation of the scale was completed by forming the concept of health literacy of SSc patients, establishing the item pool, screening items, and evaluating reliability and validity. Classical measurement theory was used to screen items, factor analysis was used to explore the construct validity of the scale, and Cronbach's alpha coefficient was used to assess the internal consistency. Our study population was predominantly middle-aged women, with a male to female ratio of 1:5.7 and a mean age of 51.57 ± 10.99. A SSc Health Literacy scale with 6 dimensions and 30 items was developed. The six dimensions are clinic ability, judgment/evaluation information ability, access to information ability, social support, treatment compliance and application information ability. The Cronbach's alpha coefficient of the scale is 0.960, retest reliability is 0.898, split-half reliability is 0.953, content validity is 0.983, which has good reliability and validity. The Systemic Sclerosis Health Literacy Scale may become a valid tool to evaluate the health literacy level of patients with SSc.

Health literacy levels in patients with type 2 diabetes in an affluent Gulf country: a cross-sectional study

ObjectivesTo identify health literacy levels in patients with type 2 diabetes mellitus in the United Arab Emirates (UAE).InterventionNationwide cross-sectional survey.Setting and participantsIndividuals with type 2 diabetes mellitus attending outpatient diabetes...

Relationship of Oral Health Literacy with Decision-making in Dental Treatment Planning among Urban Population of Lahore

In clinical settings, dentists frequently come across patients with variable oral health literacy, and they are not always able to tell which patients might comprehend with health-related explanations and instructions. Objective: To calculate oral health literacy level of patients reporting for dental treatment and correlation of the aforementioned with patients’ decision-making capacity regarding dental treatment. Methods: A quantitative cross-sectional study was conducted with a pilot study on 60 patients in University Dental Hospital, University of Lahore through non-probability purposive sampling technique. Sample of 200 patients was collected over a period of five months (June 2022-October 2022). Data were analyzed using SPSS version 25. Study was divided into two phases; in Phase I, REALD-30 scale was used. Phase-II involved individuals scoring 11-30 points on REALD-30 scale and who had to complete a self-administered 5-point Likert scale questionnaire with eleven closed-ended items in order to determine their level of decision-making. Results: Study revealed that there was significant association between Oral Health Literacy Level with getting prior information concerning dental issue (p=0.032), ability to appraise the decided treatment plan (p=0.033) and opinion regarding follow up visits (p=0.026). Conclusions: The results of the current study revealed a tenuous link between education, employment position, oral health literacy, and decision-making regarding dental treatment strategy. Effective patient-dentist communication generates strong link between the two leading to compliance of patients with treatment plan suggested by experts

Development of the health literacy assessment instrument for chronic pain patients: A Delphi study.

To develop health literacy assessment instrument for patients with chronic pain. Qualitative methods based on Delphi technique, assessed against the CREDES checklist. A 2-round Delphi method was adopted in this study. The panel consisted of 19 experts. The health literacy assessment instrument for chronic pain patients was constructed, which contained 3 dimensions (functional health literacy, interactive health literacy and critical health literacy) and 41 items. The positive coefficients of two rounds Delphi were 100.00% and 89.5%, respectively. The authority coefficient of experts was 0.848 and 0.858, respectively. The coordination coefficients of dimension and items were 0.222 and 0.364, respectively. The health literacy assessment instrument dimensions and items for patients with chronic pain based on a Delphi method are valid. This instrument is suitable for investigating the health literacy level of patients with chronic pain.

Investigation of health literacy by gender in individuals receiving physiotherapy and rehabilitation services

Purpose: Health literacy is important for the science of physiotherapy, which includes treatment methods based on understanding and practice. To increase the health literacy level of patients, individual characteristics should be considered. The aim of this study is to investigate the health literacy level of individuals who received physiotherapy and rehabilitation services and identify the role of gender on the health literacy level.Methods: The health literacy levels of patients who received physiotherapy and rehabilitation services due to an orthopedic injury or musculoskeletal problem were examined. Health literacy was evaluated with the Turkey Health Literacy Questionnaire (THLQ). Age, body mass index, disease duration, number of physiotherapy sessions, physiotherapy history and education level were questioned. Whether the data obtained differed according to gender was analysed with appropriate statistical methods.Results: Average health literacy overall score found as 34.02±8.56. The mean health literacy score of females was found to be significantly better than that of males (p&amp;lt;0.01). No difference was found between genders in terms of excellent health literacy status (p=0.008).Conclusion: The health literacy level of patients who received physiotherapy and rehabilitation services was found to be sufficient. The health literacy level of females was found to be higher than males. Since our study reveals the health literacy level of patients receiving physiotherapy, it is also expected to contribute to future studies on public health.with the Turkey Health Literacy Questionnaire (THLQ). Age, body mass index, disease duration,number of physiotherapy sessions, physiotherapy history and education level were questioned.Whether the data obtained differed according to gender was analysed with appropriate statisticalmethods.Results: Average health literacy overall score found as 34.02±8.56. The mean health literacy score offemales was found to be significantly better than that of males (p&amp;lt;0.01). No difference was foundbetween genders in terms of excellent health literacy status (p=0.008).Conclusion: The health literacy level of patients who received physiotherapy and rehabilitationservices was found to be sufficient. The health literacy level of females was found to be higher thanmales. Since our study reveals the health literacy level of patients receiving physiotherapy, it is alsoexpected to contribute to future studies on public health.

Health Literacy-Based Self-Management Intervention for Patient-Family Caregiver Dyads Undergoing Hemodialysis.

The aim of this study was to determine the effect of a health literacy-based self-management intervention for patient-family caregiver dyads undergoing hemodialysis. A quasi-experimental design was used. The intervention group ( n = 20) received a health literacy-based self-management intervention for patient-family caregiver dyads, whereas the control group ( n = 23) received standard informational messages through a short messaging service for 8 weeks. All participants were assessed for hemodialysis knowledge, self-efficacy, family support, self-management, the ratio of interdialytic weight gain to dry weight, and serum phosphorus and potassium levels at pretest and posttest. Participants in the intervention group exhibited higher scores on hemodialysis knowledge, self-efficacy, family support, and self-management than those in the control group. In addition, the ratio of interdialytic weight gain to dry weight decreased significantly in the intervention group. The health literacy-based self-management intervention for patient-family caregiver dyads undergoing hemodialysis was effective in improving hemodialysis knowledge, self-efficacy, family support, self-management, and the ratio of interdialytic weight gain to dry weight. Because health literacy is an important factor influencing self-management, interventions for patients undergoing hemodialysis should consider the health literacy level of patients and their family caregivers.

Is Health Literacy Clue on the Self-Efficacy of Diabetes Patients?

Objective: This research was conducted to evaluate the relationship between health literacy level and self-efficacy in patients with diabetes mellitus. Methods: This cross-sectional study was conducted inpatient and outpatient clinic of internal medicine at the city hospital. The sample of the study consisted of 700 conscious patients diagnosed with diabetes mellitus for at least one year. The data of the study were collected using the Health Literacy Questionnaire-European Union Scale and Type 2 Diabetes Self-Efficacy Scale. Data were analyzed using regression analysis and correlation analyses. Results: In this study, the level of health literacy general index was sufficient level, and the average of the self-efficacy scale was high. It was observed that health promotion and health service literacy level were effectived in estimating the self-efficacy level of diabetes patients. As the health literacy level of patients for health service and health promotion increased, general self-efficacy level increased. Conclusion: Health promotion and health service literacy level are effective in estimating the self-efficacy level of diabetes patients.

Health literacy levels of patients who applied to a district outpatient clinic in Malatya city center and related factors

This research was carried out to determine the health literacy levels and the factors affecting to the knowledge level of the patients of a district outpatient clinic at the city center of Malatya. It is a descriptive cross-sectional study where the data is obtained from a socio-demographic data set and Turkish Health Literacy Questionnaire -32 (THLQ-32). The data analysis was performed using SPSS 22.0 statistical software. The Kolmogorov-Smirnov normality test was used to determine whether the quantitative data is normally distributed. With the observation of the data not showing a normal distribution Mann Whitney U and Kruskal Wallis variance analysis were used for the statistical analysis. Chi-squared test is used to determine whether there is a statistically significant difference within the qualitative data for a significance level of p&lt;0.05. 49.9% of the patients were male and 50.1% were female. The mean age is 35.94±13.8 years. 24% of the patients had completed secondary school or below while 40.4% had completed higher education. The average index score of the patients according to THLQ-32 is 15.85±11.07. According to THLQ-32 health literacy categories 78.1% of the patients identified as “inadequate”, 14% as “limited-problematic”, 6.3% as “adequate” and 1.6% as “excellent”. We conclude that there is a significant correlation (p&lt;0.05) between gender, marital status, age and education level with health literacy levels respectively. On the other hand there is no statistically significant correlation (p&gt;0.05) among patients with chronic illnesses and their health literacy levels.

Continuity of Caregivers’ Ensuring Medical Care and Care-Transition Preparedness: A Mediation Model

Studies show that informal support provided during hospitalization is essential for communicating with the healthcare team and explaining medical care. Less is known about factors explaining family caregivers' Ensuring and Explaining Medical Care (EEMC) during hospitalization and its impact on care-transition-preparedness of patients in terms of their understanding of the explanations and instructions for continued care. This study examined whether EEMC during the current hospitalization mediates the association between involvement of the caregiver in ensuring and explaining medical care prior the current hospitalization and patients’ care-transition-preparedness for discharge. A prospective cohort study includes 456 internal-medicine-patients at a tertiary medical center in Israel, who were accompanied by an informal caregiver. Involvement in EEMC prior and during the hospitalization, covariates such as health literacy (HL) levels, demographic, health, and functional status were reported by the patients during the hospitalization; and care-transition-preparedness was reported by the patients in a week after discharge. After controlling for covariates, only high HL levels of patients and their caregivers were positively associated with EEMC during hospitalization and care-transition-preparedness (P<0.05). Moreover, mediation analysis indicated significant direct (B(unstandardized)=1.69; p=0.003) and indirect effect (Mediated effect (ME)=1.28; CI= 0.81 to 1.87) of prior involvement in EEMC on care-transition-preparedness through high EEMC during the current hospitalization, controlling for baseline characteristics of patients and their caregivers (total effect: B=2.95; p<0.001). These findings suggest that caregivers' experience and involvement prior the hospitalization may be an essential factor in improving EEMC during the current hospitalization, and in turn improve transition outcomes.

Development and Validation of the Health Literacy Assessment Instrument for Patients with Chronic Pain.

A suitable health literacy assessment instrument for patients with chronic pain (HLCP) in China with good instrument's psychometric properties is required. A theoretical framework for the HLCP was developed by adopting the hierarchical model of health literacy proposed by Nutbeam. The reliability and validity of the HLCP were tested in a cross-sectional survey of 237 chronic pain patients from three pain clinics and wards of Grade-3A hospitals in Zhejiang Province, China. The discriminant degree method, correlation analysis method, factor analysis method (exploratory factor analysis), half reliability, and other methods were utilized to screen items for inclusion in the final version of HLCP, and the fitness of the model was subsequently evaluated by confirmatory factor analysis. Cronbach's alpha value and test-retest with two-week intervals were used to test the internal consistency and retest reliability of the HLCP. In the exploratory factor analysis, three domains, functional health literacy (10 items), interactive health literacy (14 items), and critical health literacy (7 items), comprising 31 items in total, were finally loaded; the model was determined to explain 70.9% of the total variance. HLCP's effective assessment of the health literacy level of patients with chronic pain and its acceptable reliability and validity were revealed through the results.

Differences in health literacy level of patients from public and private hospitals: a cross-sectional study in Turkey

ObjectivesPolicy-making based on a health literacy approach makes it a priority to develop people-centered public health strategies and programs, particularly in the time of COVID-19 across the world. This is the first study to assess health literacy levels of patients visiting public and private hospitals in Turkey and also compares these levels with sociodemographic and health-related variables by hospital type to suggest health policies aimed at improving the health literacy skills for patients with different socio-economic backgrounds. Study designThis is a cross-sectional study. MethodsThe study was conducted on 948 outpatients from both hospital types in 2018. Health literacy was assessed using the validated Turkish version of the European Health Literacy Survey Questionnaire with 47 items. The level of health literacy and sociodemographic factors influencing it were analyzed using correlation and binary logistic regression tests. Patients from private hospital had better health literacy index score compared with the public hospital. ResultsThe health-related variables, such as self-reported health and the presence of long-term illness, and sociodemographic characteristics, including education, age, and gender, were associated with health literacy for both public and private hospitals. Age and education were important predictors, whereas gender, long-term disease condition, self-reported health, and perceived income status were statistically significant variables for adequate health literacy in both hospital types. ConclusionsParticipants from private hospital had better health literacy than that of public hospital. These findings could be used to help health policy makers to improve the current health literacy policy for patients and develop strategies by stakeholders for reducing barriers to obtaining health-related information.

The Effect of Health Literacy Levels on Successful of Smoking Cessation Therapy: A Survey Study

Aim: In this study, it was aimed to evaluate the effect of the health literacy levels of patients given smoking cessation treatment on the success of smoking cessation treatment. Methods: In this study, 152 participants between the ages of 18-70 applied to a tertiary hospital smoking cessation outpatient clinic. The Fagerström Test for Nicotine Dependence was used to determine the level of cigarette addiction of the participants, and the European Health Literacy Scale was used to evaluate the levels of health literacy. Results: When the health literacy levels of the participants with cigarette addiction were evaluated, 38 (25%) were inadequate, 64 (42.1%) were problematic. When the participants' smoking cessation status and general health literacy levels were compared, it was found to be statistically significant. It was determined that as the health literacy level increased, the success rates of individuals increased in smoking cessation therapy. Conclusions: We have shown that increasing the level of health literacy is effective in increasing the success of smoking cessation treatment. Increasing health literacy should be part of the fight against smoking. This effect should be demonstrated by future studies on large populations. Keywords: smoking cessation, health literacy, addiction