Prevalence Of Health Literacy Research Articles

Public Health Literacy and Emergency Department Utilization in Saudi Arabia: A Cross-Sectional Study.

Health literacy (HL) is the degree in which individuals are able to access, comprehend, and use publicly available health resources and services. A previous study was done in the Kingdom of Saudi Arabia (KSA) assessing the prevalence of HL, the study shows that almost half of KSA residents had limited HL. Most studies that show the level of HL and its relationship to emergency department (ED) utilization were conducted outside KSA. This study aims to assess the association between HL and utilization of ED services and to estimate the prevalence, factors, and outcomes of low HL in KSA. A cross-sectional study was conducted among 903 participants in KSA over a period of 2 months (April and May 2023) using an online survey. Participants were asked about sociodemographic characteristics (age, sex, nationality, marital status, education, work status, income), associated factors (chronic diseases, psychiatric disorders, Covid-19 infection, Covid-19 vaccination, ED visits), and Health Literacy (read, access, understand, evaluation, decision). A health literacy instrument for adults (HELIA), which consists of the previously mentioned five subscales, was used to estimate the level of HL and its association with the risk factors. Almost 529 (58.58%) and 374 (41.42%) had limited HL and adequate HL, respectively. Participants with limited HL were mostly aged 35-45 years (61.7%), men (p < 0.05) (68.9%), divorced (65.9%), non-Saudi (69.6%), and had elementary level of education (66.7%). Participants with adequate HL had master's and PhD degree (48.1%), were healthcare students or graduates (62.8%, p < 0.05), had an income >30 thousand riyals (55.6%, p < 0.05), were previously infected with COVID-19 (43%), and did not visit ED in the preceding year (42.3%). A high prevalence of low HL among KSA residents was observed. There was no significant difference in ED utilization between participants who had adequate and limited HL.

Prevalence and determinants of health literacy among the adult population of Qatar.

Health literacy (HL) is both a direct determinant and a mediator of health outcomes. Research on the prevalence and determinants of HL in terms of its functional, communicative, and critical domains is scarce in the state of Qatar and its surrounding regions. Thus, this study aims to fill the knowledge gap in this area, estimate the levels of functional, communicative, and critical health literacy among the general adult population, and identify its determinants in the state of Qatar. An analytical cross-sectional study with a disproportionate stratified random sampling technique was conducted in 2022. A representative sample of phone numbers was obtained from the Cerner database at Hamad Medical Corporation and approached via well-trained data collectors. A socio-demographic and health-relevant factor questionnaire and the validated All Aspects of Health Literacy scale (AAHLS) were used to collect the data on functional, communicative, and critical HL and their determinants. Descriptive analysis, independent sample t-test, ANOVA, and linear regression were used and yielded the outcomes on HL levels as low, adequate, and high in percentages and the HL determinants. A total of 770 participants were included. The study found that 41.5%, 29.3%, and 29.2% of them have adequate, high, and low overall HL levels consecutively. People who participated in the study are older adult, are of Arabic ethnicity, are of Qatari ethnicity, have a lower level of education, have close relatives with a lower level of education, have a lower income, are non-migrants, are not living within a family, sought medical care within the last week, and who do not know if they have a chronic disease or do not have lower overall HL levels compared to the other groups. After linear regression analysis, only the participant's level of education and "last time sought medical care within last week" variable predict the overall HL score. Almost half of Qatar's adult population has an adequate HL level, comparable to the HL levels in other regions, despite the limitation in comparison due to variation in context and the HL measurement tools used. The possible determinants are amenable factors to focus on while designing HL interventions and providing healthcare.

Abstract 17353: Health Literacy and Hypertension: A Systematic Review

Introduction: Low health literacy (HL) is highly prevalent in the United States. Despite the potential for low HL to be a major barrier to effective self-management of blood pressure (BP), data on HL among adults with hypertension (HTN) is scarce. Goals: We conducted a systematic review to examine the prevalence and factors associated with low HL among adults with HTN. Additionally, we examined intervention trials which sought to modify the impact of low HL among participants with HTN. Methods: A comprehensive search of 6 databases was performed to identify studies which measured HL using a validated survey and included adults with HTN. After removing duplicate citations, two authors independently reviewed the references for eligibility, data extraction, and risk of bias assessment. Results: A total of 1,046 studies were identified of which 44 met eligibility criteria. The prevalence of low HL was 33% among the 31,507 participants included across the 44 studies. In the studies that reported associations between social determinants of health factors and HL, lower education levels, non-white race, and lower HTN knowledge were found to be significantly associated with lower HL among adults with HTN. Among the 15 observational studies which examined BP, lower HL was associated with higher BP in 8 studies. Six randomized control trials included an intervention to modify HL and measure its effect on BP control. Two of these trials demonstrated significant reductions in BP among the intervention group compared to control. Conclusion: Among studies which measured HL in adults with HTN, education, HTN knowledge and race were associated with HL; however, interventions to address HL were not consistently associated with improvements in BP control. A more detailed examination of methods to address HL among adults with HTN is warranted.

Awareness of Nutrition and Supplements Among Pregnant and Preconception Women: A Real-World Study in Vietnam.

Few studies have addressed relationships between health literacy (HL) and nutritional awareness in preconception/pregnancy populations, especially within Asia. We explored the rationale for nutrition-related education and/or HL interventions to improve nutritional intake among preconception/pregnant women. A cross-sectional questionnaire-based real-world study was conducted among 100 preconception and 200 pregnant women in Vietnam in January/February 2022. The questionnaire included a validated screening tool for HL (Newest Vital Sign [NVS]), and questions on preconception/pregnancy-related nutritional knowledge and behavior, prenatal supplementation, sources of nutritional advice. Most respondents (62%) had limited HL and only 5% had adequate HL. Respondents with limited HL (NVS 0-1) showed less awareness of benefits of healthy eating before/during pregnancy, such as reduction in risk of birth defects. Most (94%) considered prenatal supplements beneficial, yet 64% were not convinced of supplement safety. The limited HL group reported the lowest use of supplements, including multivitamins, iron, and folic acid/folate. The prevalence of limited HL and the low awareness of preconception/pregnancy-related nutrition suggest an urgent need to invest in nutrition-specific education and improving HL in maternal populations. This will help support adequate maternal nutrition and appropriate micronutrient supplementation before conception and throughout the "first 1000 days" of life.

Health Literacy of Candidates Undergoing or Submitted to Kidney Transplantation: An Integrative Literature Review

Objective: To describe the repercussions of health literacy (HL) in patients with Chronic Kidney Disease (CKD) candidates for or undergoing kidney transplantation (TxR). Methodology: Integrative review, carried out with the systematic selection of articles in the PubMed, Portal BVS and SciELO databases in August 2021. 62 articles were identified, of which 17 were selected for synthesis. Results: Most of the analyzed studies developed an observational or qualitative design. The limited HL has several impacts on patients’ decision-making processes, resulting in the postponement of insertion on the waiting list for TxR, refusal to perform this therapy and, in some situations, the death of the patient. Adequate HL is protective in several aspects of CKD patients’ lives, especially in the psycho-emotional and cognitive domains. Educational strategies, provided in the form of routine recommendations in dialysis centers or in addition to them, are essential for increasing HL. Conclusion: Patients who were candidates for or submitted to TxR had a high prevalence of limited HL, negatively impacting decision-making processes. Complementarily, the appropriate HL is recognized as essential for the conscious and shared decision-making process of the patient, as it empowers and enables the development of self-management in health.

Determinants of Inadequate Health Literacy Among Faculty of Medical Technical Sciences Students in Albania: Cross-Sectional Survey.

Health literacy (HL) refers to people's ability to find, understand, and use health information in order to make appropriate health decisions. Health literacy among students is important so that tomorrow's health professionals can deliver high-quality health care and enhance patient education and communication. In this context, the aim of this study was to assess the HL level of Faculty of Medical Technical Sciences (FMTS) students in order to shed light on this underresearched topic in Albanian settings. A cross-sectional study involving 193 FMTS students of various study branches (nursing, midwifery, physiotherapy, and laboratory technician) was carried out during June 22-29, 2022, on the premises of the FMTS Faculty in Tirana, Albania. The international European Health Literacy Survey Questionnaire (HLS-EU-Q) standardized questionnaire, validated in Albanian, was used to collect information about FMTS students' general HL through a face-to-face interview. Basic sociodemographic information was collected as well. Binary logistic regression was used to assess the factors associated with inadequate, problematic, or limited HL. The mean level of general HL was 37.2 (on a scale from 0 [minimum HL] to 50 [maximal HL]). About one-quarter of FMTS students had inadequate (9/193, 4.7%) or problematic (38/193, 19.7%) HL, 51.3% (99/193) had sufficient HL, and 24.4% (47/193) had excellent HL. The prevalence of limited HL (inadequate and problematic HL) was higher among male than female students (6/12, 50% vs 41/181, 22.6%, respectively) and those with lower social and economic status. Upon adjusting for confounding effects, the only factor significantly increasing the likelihood of limited HL was male gender (odds ratio 8.13, 95% CI 1.68-39.39). Findings suggested that low social and economic status also increased the likelihood of limited HL, but such associations did not reach statistical significance. To our knowledge, this is the first study exploring the level of HL and its associated factors among FMTS students in Albania. The prevalence of limited HL was relatively high among FMTS students. There is a need for targeted interventions to increase the HL of nursing and midwifery students, such as the inclusion of HL subjects in the nursing curriculum.

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.

Predictors of Inadequate Health Literacy among Patients with Type 2 Diabetes Mellitus: Assessment with Different Self-Reported Instruments.

Obtaining, understanding, interpreting, and acting on health information enables people with diabetes to engage and make health decisions in various contexts. Hence, inadequate health literacy (HL) could pose a problem in making self-care decisions and in self-management for diabetes. By applying multidimensional instruments to assess HL, it is possible to differentiate domains of functional, communicative, and critical HL. Primarily, this study aimed to measure the prevalence of inadequate HL among type 2 diabetes mellitus patients and to analyze the predictors influencing health literacy levels. Secondly, we analyzed if different self-reported measures, unidimensional instruments (Brief Health Literacy instruments (BRIEF-4 and abbreviated version BRIEF-3), and multidimensional instruments (Functional, Communicative and Critical health literacy instrument (FCCHL)) have the same findings. The cross-sectional study was conducted within one primary care institution in Serbia between March and September 2021. Data were collected through Serbian versions of BRIEF-4, BRIEF-3, and FCCHL-SR12. A chi-square test, Fisher's exact test, and simple logistic regression were used to measure the association between the associated factors and health literacy level. Multivariate analyses were performed with significant predictors from univariate analyses. Overall, 350 patients participated in the study. They were primarily males (55.4%) and had a mean age of 61.5 years (SD = 10.5), ranging from 31 to 82 years. The prevalence of inadequate HL was estimated to be 42.2% (FCCHL-SR12), 36.9% (BRIEF-3) and 33.8% (BRIEF-4). There are variations in the assessment of marginal and adequate HL by different instruments. The highest association was shown between BRIEF-3 and total FCCHL-SR12 score (0.204, p < 0.01). The total FCCHL-SR12 score correlates better with the abbreviated BRIEF instrument (BRIEF-3) than with BRIEF-4 (0.190, p < 0.01). All instruments indicated the highest levels for the communicative HL domain and the lowest for the functional HL domain with significant difference in functional HL between the functional HL of FCCHL-SR12 and both BRIEF-3 and BRIEF-4 (p = 0.006 and 0.008, respectively). Depending on applied instruments, we identified several variables (sociodemographic, access to health-related information, empowerment-related indicators, type of therapy, and frequency of drug administration) that could significantly predict inadequate HL. Probability of inadequate HL increased with older age, fewer children, lower education level, and higher consumption of alcohol. Only high education was associated with a lower probability of inadequate HL for all three instruments. The results we obtained indicate that patients in our study may have been more functionally illiterate, but differences between functional level could be observed if assessed by unidimensional and multidimensional instruments. The proportion of patients with inadequate HL is approximately similar as assessed by all three instruments. According to the association between HL and educational level in DMT2 patients we should investigate methods of further improvement.

Limited Health Literacy and Its Associated Health Outcomes Among Adults With at Least 2 Atopic Diseases

Health literacy (HL) is essential for patients with multiple atopic diseases to improve their health, given the complexity of their disease and treatment regimens. To estimate the proportion of adults with multiple atopic diseases (at least 2 of atopic dermatitis, asthma, allergic rhinitis, and food allergy) in the Dutch general population and to evaluate the prevalence of limited HL, and its association with socioeconomic status (SES), lifestyle factors, and health-related quality of life (HR-QoL) in this patient population. This cross-sectional study was conducted within the Lifelines Cohort Study via sending an add-on digital questionnaire, including (among others) questions on atopic dermatitis, to all adult participants (n= 135,950) between February and May 2020. Data on asthma, allergic rhinitis, lifestyle factors, HR-QoL, and SES were extracted from baseline assessment between 2006 and 2013. Functional, communicative, and critical HL were measured by validated items from Chew and the Dutch Functional Communicative and Critical Health Literacy questionnaires between 2012 and 2016. Food allergy was measured by the Food Allergy Questionnaire between 2014 and2016. In total, 11.8% of the overall study population reported ever having multiple atopic diseases; of those, 23.6% reported having limited functional HL, with a higher prevalence among those with a low SES. Limited functional HL showed positive associations with smoking, obesity, chronic stress, a low diet quality, and decreased HR-QoL among subjects with multiple atopic diseases. We identified an HL deficit, and its association with a low SES and poor health outcomes among patients with multiple atopic diseases. Further research is warranted to utilize a more extensive assessment to measure HL and include more health outcomes, such as treatment adherence and disease control.

The association of limited health literacy with frailty, health-related quality of life (HRQoL), and health care utilization among older adults with cancer: The CARE Registry.

157 Background: Health literacy (HL) is a patient’s ability to obtain, process, and understand health information. Limited HL can act as a barrier to communication and access to medical treatment and lead to poor identification and management of comorbid conditions, resulting in frailty and impaired HRQoL; these issues remain unstudied in the geriatric oncology populations. We aimed to (1) describe the prevalence of limited HL; (2) examine the association between limited HL and frailty, HRQoL and healthcare utilization in older adults with cancer. Methods: The CARE registry prospectively enrolls older adults (≥60y) with cancer seen at UAB. Patients complete a patient-reported geriatric assessment. A single-item screening measure of HL (Stagliano et al. JABFM 2013) was also completed by the participants. Frailty was defined using the 44-item CARE frailty index (based on deficit accumulation). Multivariable analysis examined association of limited HL with CARE frailty index, HRQoL, and health care utilization, adjusting for age, race, sex, education, cancer type/stage and treatment phase. Results: The cohort included 475 participants with a mean age at enrollment of 69.4y; 61.9% were male; 18.9% were non-Hispanic Black. The most prevalent cancer types included colorectal (34.9%), pancreatic (17.5%) and hepatobiliary (11.4%) cancers. The prevalence of limited HL was 33.3%. Participants with limited HL were less educated (&lt; HS: 23.4% vs. 4.7%, p= 0.01), older (71 vs. 68.5 years, p&lt; 0.001), more likely to self-report as Black (26.6% vs. 15.1%, p= 0.009), and disabled (19.6% vs. 11.7%, p&lt; 0.001). Patients with limited HL had a higher prevalence of frailty (57.6% vs 22.1%, p&lt; 0.001) and hospitalizations (57.0% vs 45.4%, p= 0.036), as well as lower physical (39.5 vs. 46.4 p&lt; 0.001) and mental (42.9 vs. 49.2 p&lt; 0.001) HRQoL. In multivariable analysis, older patients with limited HL had 3.9 higher adjusted odds (aOR) of frailty (95% CI 2.4-6.3), worse physical (aOR 2.2, 95%CI 1.4-3.6) and mental (aOR 3.2 95%CI 2.0-5.2) HRQoL, and increased hospitalizations (aOR 1.8 95% CI 1.2-2.8), compared to those with adequate health literacy. Conclusions: Older cancer patients with limited HL had higher adjusted odds of frailty, lower physical and mental HRQoL scores, and higher odds of a recent hospitalization. Interventions to address limited HL should be explored in this vulnerable and growing cancer population.

Impact of Health Literacy on Patient-Reported Outcomes in Benign Gynaecology: A Systematic Review

Health literacy (HL) is a person’s capacity to obtain, process and understand the basic health information needed to make appropriate health decisions. Poor HL has been linked to several negative patient outcomes: inferior disease-specific knowledge, reduced self-reported health, higher mortality and increased hospitalizations. Managing benign gynaecologic disorders requires advanced HL skills, which includes understanding relevant anatomy and clinical presentations, recognizing symptom severity, managing medications, and comprehending treatment options. The objective is to evaluate the relationship between low HL and patient-reported outcomes (PROs) in patients with benign gynaecologic conditions. In this specific population, we also seek to determine the current reported prevalence of low HL; examine demographic characteristics that may be related to low HL; and collate any HL interventions described in the literature.

Prevalence of Limited Health Literacy in the Philippines: First National Survey.

Background:Health literacy (HL) is the ability to access, understand, appraise, and apply health information across the three domains of the health continuum: health care, disease prevention, and health promotion. It is needed for people to effectively manage their health. Information on population HL level is useful for crafting appropriate and targeted interventions to improve HL.Objective:The aim of this study was to describe the HL level of Filipino people at the national and subnational levels.Methods:A cross-sectional survey was conducted between 2018 and 2019 with 2,303 randomly selected Filipino people age 15 to 70 years, using an adapted Asia version of the European Health Literacy Survey Questionnaire-47. Prevalence estimates for limited HL and the corresponding 95% confidence interval (CI) were computed at the national and subnational levels.Key Results:The nationwide prevalence of limited HL was 51.5% (95% CI, [49.5%, 53.6%]), while sub-national prevalence estimates ranged from 48.2% to 65.4%. The prevalence varied across HL dimensions, with difficulty in access to information having the highest level. Similarly, prevalence across domains was variable; health care-related HL had the highest prevalence of limited HL. The HL levels for different dimensions and domains also varied across subnational groups.Conclusion:Many Filipino people had limited HL, and prevalence estimates varied across HL dimensions, HL domains, subnational groupings, and sociodemographic characteristics. The results highlight the need for targeted interventions focusing on subgroups with limited HL and on dimensions and domains where Filipino people have limited HL. [HLRP: Health Literacy Research and Practice. 2022;6(2):e104–e112.]Plain Language Summary:The National Health Literacy Survey is the first nationwide survey on the prevalence of HL in the Philippines, involving 2,303 randomly selected Filipino residents age 15 to 70 years. Many Filipino people have limited HL, and the prevalence of HL varies across the components of HL, subnational groupings, and sociodemographic characteristics, highlighting the need for targeted interventions.

Abstract P190: Health Literacy And Cardiovascular Health: The Multi-Ethnic Study Of Atherosclerosis

Background: Limited health literacy (HL) is associated with individual cardiovascular risk factors and poor risk factor control. The association of HL to composite indices of cardiovascular health (CVH) has not been documented. Hypothesis: Limited HL is associated with suboptimal achievement of ideal CVH as identified by Life’s Simple 7 (LS7). Methods: Included in this analysis are 3766 participants of the Multi-Ethnic Study of Atherosclerosis who completed four HL questionnaire items via follow-up phone calls (2016-2018). Item scores were summed and dichotomized into adequate (≤10) or limited HL (&gt;10). Clinical measures of BMI, total cholesterol, blood pressure, and fasting blood glucose, along with self-reported smoking status, physical activity, and healthy diet were measured at baseline (2000-2002) and categorized by LS7 achievement criteria (poor, inadequate, ideal). LS7 metrics were incorporated into overall CVH (low, medium, high). Poisson regression with robust variance estimation was used to compute prevalence risk ratios and 95% confidence intervals (PRR[95% CI]) of high/medium CVH as well as intermediate/ideal LS7 comparing limited HL to adequate HL. Results: Participants were on average(SD) 59.4(9.13) years old at baseline, 46.0% male, and 58.0% non-white. Prevalence of limited HL was 15.0%. Compared to adequate HL, participants with limited HL were less likely to have medium CVH (0.90[0.84-0.97]) and high CVH achievement (0.53[0.39-0.73]) after adjusting for age, sex, race/ethnicity and field center ( Table ). These associations attenuated with further adjustment for education and income, to 0.94[0.88-1.02] for medium and 0.68[0.50-0.94] for high CVH. Of individual LS7 metrics, limited HL was significantly associated with high glucose levels. Conclusion: Limited HL was associated with suboptimal overall CVH as well as elevated blood glucose levels independent of education. Clinical trials are needed to assess whether improving health literacy enhances CVH.

The Prevalence of Limited Health Literacy and Its Associated Factors among Elderly Patients Attending an Urban Academic Primary Care Clinic in Malaysia.

Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence of limited HL levels and its associated factors among elderly patients in an urban academic primary care clinic in Selangor, Malaysia. A cross-sectional study was conducted among 413 elderly patients (≥60 years old) who attended this academic primary care clinic between January 2020 and January 2021. Sociodemographic data, clinical characteristics, and health literacy scores were collected. Descriptive statistics (median with interquartile ranges (IQR), frequency, and percentages) and multiple logistic regression were utilized. The prevalence of limited HL in our population was 19.1% (95% CI: 15.3, 23). The middle-old (70–79 years) and very-old (≥80 years) age groups were more likely to have limited HL (aOR 4.05; 95% CI: 2.19, 7.52 and aOR 4.36; 95% CI: 1.02, 18.63, respectively). Those with at least secondary school education (aOR 0.06; 95% CI: 0.02, 0.24) and those who found medical information via the internet/television (aOR 0.21; 95% CI: 0.05, 0.93) had lower odds of having limited HL. In conclusion, having limited HL levels was not common among elderly patients in this primary care clinic. Further studies involving rural and larger primary care clinics in Malaysia are required to support these findings.

Health Literacy Among Adults With Multiple Chronic Health Conditions.

Low health literacy (HL) is associated with poorer health outcomes. We examined HL among adults with multiple chronic conditions (CCs), using 2016 Behavioral Risk Factor Surveillance System data. Health literacy was measured by 3 subjective questions about difficulty with the following tasks: (1) obtaining health information or advice; (2) understanding spoken health information; and (3) understanding written health information. We estimated the prevalence of low HL (difficulty with ≥1 HL tasks) and used multiple logistic regression analysis to examine associations between HL and number of CCs. The prevalence of low HL was 13.8% overall and increased with the number of CCs from 10.6% among those with no CC to 24.7% among those with 3 or more CCs, with the latter having more than twice the adjusted odds of low HL compared with the former (adjusted odds ratio = 2.65; 95% confidence interval, 2.36-2.97). Efforts to improve HL in this population are needed.

Level of literacy and clinical outcomes in patients with Chagas disease: SaMi-Trop project

Abstract Background Chagas disease (CD) is a neglected tropical disease that affects mainly vulnerable population, whose majority has low ability to understand health information. This study aimed to assess the prevalence of health literacy (HL) and its association with sociodemographic, quality of life, health care aspects and worse clinical outcomes. Methods This is a cross-sectional study developed inside a cohort study (SaMi-Trop) including 1959 patients. It has been conducted in an endemic region to CD in Brazil. The eligible criteria for HL evaluation was the ability to read. The HL was assessed with SALPHA-18 scale and literacy was categorized in inadequate HL; adequate HL and; illiterate. Multiple models were adjusted using binary logistic regression, multinomial and beta regression models using the gamlss framework. Results Of the patients included, 1136 (74.1%) are illiterate. For HL assessment, only 397 managed to complete the HL evaluation. The prevalence of inadequate HL was 85.1% (338), only 59 patients (14.9%) had adequate HL. Our results are as following: 1) being illiterate increases the chance of using more drugs when compared to individuals with adequate HL - 1 or 2 drugs (OR: 1.96; CI: 1.06-3.62) and 3 to 4 medications (OR: 3.06; CI:1.44-6.52), to have hypertension (OR: 2.24; CI: 1.29-3.90), report an average self-perceived health (OR: 2.97; IC: 1.63-5.42) and report poor self-perceived health (OR: 3.67; CI: 1.71-7.89); 2) inadequate literacy increases the chance of using 3 to 4 medications (OR: 2.26; CI: 1.04-4.93) and report an average self-perceived health (OR: 2.48; CI: 1.34-4.62); 3) Illiterate patients present worst quality of life scores in Physical (OR: 0,730; CI: 0,583-0,914), Psychological (OR: 0,671; CI: 0,544-0,828) and Environmental (OR: 0,727; CI: 0,601-0,880) domains. Conclusions We found a high prevalence of inadequate HL; it was associated with worse clinical outcomes and poor self-perceived health. Key messages Our findings reinforce the importance of improving health communication in CD patients seeking to avoid unfavorable outcomes. A high prevalence of inadequate health literacy was observed in our study, which can impact the self-care ability of patients with CD.

Health literacy and optimizing education materials in a surgical population

Objective: The aim is to examine and compare the level of health literacy (HL) amongst surgical vascular and abdominal patients and measuring the understandability and actionability of current and optimized education materials.Methods: A cross-sectional design was utilized. Patients undergoing abdominal or vascular surgery, were included for measuring HL with the Newest Vital Sign Dutch (NVS-d) tool. The Dutch version of the Patient Education Materials Assessment Tool (PEMAT) was used to measure the understandability and actionability of current and optimized patient education materials.Results: A total of 101 patients were included, of those 54 (53.5%) have limited HL. Patients with limited HL were significantly older (p &lt; .001), lower educated (p &lt; .001), and had a higher ASA status (p = .005) and Charlson Comorbidity Index score (p &lt; .001). The occurrence of limited HL differed significantly (p = .046) between abdominal versus vascular patients. The understandability varied between 24%-59% and the actionability between 40%-67% of the current education materials. The optimized education materials had a understandability score of 86% and a actionability score of 100%.Conclusions: The high prevalence of inadequate HL emphasizes the importance of nursing and medical staff providing clear information to enable shared decision-making. Besides, it is necessary to evaluate current education materials and optimize these materials according to the level of health literacy to provide health information that is understandable.

0705 High Incidence Of Inadequate Health Literacy In Adults With Obstructive Sleep Apnea Is Not Associated With Positive Airway Pressure Use

Abstract Introduction Inadequate health literacy (HL) is associated with 1.5 - 3 times increased risk for poor health outcomes, nonadherence and lack of skills needed to manage one’s own health. Inadequate HL prevalence in adults with obstructive sleep apnea (OSA) may be as high as 30%. The relationship between HL and positive airway pressure (PAP) adherence has been rarely examined. Methods A secondary analysis of prospective observational data was conducted to: 1) examine the prevalence of inadequate HL in adults with newly-diagnosed OSA and 2) determine if inadequate HL is associated with 1-wk and 1-mo PAP use. HL was measured using a 3-item Health Literacy Screening Questionnaire. Descriptive statistics, multiple linear regression, and logistic regression were used. Results Participants (n=67) were white (85%), males (52%) and females (48%), middle-aged (50±12 yrs), 64.2% had a middle to high school education and severe OSA (mean AHI 38.2±21 events/hr). Mean PAP use was 4.62±2.43 hrs/night at 1-wk and 4.33±2.27hrs/night at 1-mo. Using a threshold of ≥4 hrs/night, 64% were adherent at 1-wk and 60% at 1-mo. Sixty two percent (n=42) screened positive for inadequate HL. A positive screen for inadequate HL (by individual screening items or by cumulative number of items screened positive) was not associated with PAP use (mean hr/night) at 1-wk or 1-mo (not retained in the final model). HL was also not associated with PAP non-adherence (&amp;lt;4hrs/night) or PAP failure (&amp;lt;2hrs/night) by logistic regression. Conclusion Inadequate HL may be prevalent in adults with OSA. OSA and PAP patient education content and design should align with HL abilities and skills. Disease and treatment education are influential on PAP adherence. Future research should consider adequacy of three generalized items to assess HL and disease-specific HL as more robust measures are available. Larger, heterogeneous sample sizes are needed to precisely estimate the relationship between HL and PAP adherence. Support Lead author receives support from NIH/NHLBI Award T32 HL07953.

Prevalence of non-adequate health literacy in Europe: a systematic review and meta-analysis

Abstract Background Many studies show that a low level of health literacy (HL) is associated with several adverse outcomes. The aim of this systematic review was to estimate the prevalence of non-adequate HL (NAHL) in European countries and outline the main needs for interventions. Methods The systematic search was performed in April 2019 and updated in June 2019. PubMed, Embase and Scopus were searched. Articles were considered eligible if they were cross-sectional studies published in English after 2000 and estimating the NAHL prevalence in European countries. Globally, 15490 articles were retrieved. Adapted Newcastle-Ottawa Scale was applied for the quality assessment. Several stratified meta-analyses were carried out. We also performed a meta-regression analysis to test the association between variables and NAHL. Results In total, 59 articles of heterogeneous quality were included, providing data for 98 studies to include in the proportion meta-analysis. Overall, quantitative analysis yielded a pooled NAHL prevalence of 40% (95%CI, 36%-43%). Despite the prevalence varied considerably by country, it seemed to follow a geographic gradient, with the northern countries clearly having a lower prevalence than the other European counterparts. The pooled prevalence estimates (PEs) varied significantly according to the different type of HL assessment method applied. Also, high study quality was found to be significantly associated with a reduction of NAHL in the PEs. Grouping the sample in general population, oncology patients, chronic disease patients and refugees, the meta-regression analysis showed a significantly lower prevalence of NAHL in oncology patients. Conclusions Although the PEs varied in relation to several factors (e.g. either among population groups, or depending on the HL assessment method), this study shows that more than one in every three surveyed participants had NAHL. Targeted strategies and coordinated policies aiming at improving HL in the Region are needed. Key messages Despite several variations, a significant proportion of European population has non-adequate health literacy. Targeted public health strategies of intervention are crucial to address this deficit.

Low Health Literacy Prevalence's Study in Patients With Chronic Cardiovascular Disease

Low Health Literacy Prevalence's Study in Patients With Chronic Cardiovascular Disease