Prevalence Of Limited Health Literacy Research Articles

Health literacy in adult patients with atopic dermatitis: A cross-sectional study

BackgroundHealth literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate health decisions. Patients with limited health literacy are less likely to manage chronic diseases appropriately. ObjectiveTo assess the prevalence of limited health literacy in patients with atopic dermatitis (AD), and its association with other patient-reported outcomes. MethodsA cross-sectional questionnaire-based study was conducted at a tertiary referral centre for AD. Patients diagnosed with AD by a dermatologist between 2019 and 2021 were identified from medical records. Perception-based health literacy was assessed by the European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16) and performance-based health literacy by the Newest Vital Sign (NVS). Patients completed the Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and Atopic Dermatitis Control Tool (ADCT) to measure AD severity, quality of life and AD disease control, respectively. ResultsIn total, 322 patients were included (response rate 48.3%). Based on the HLS-EU-Q16, 32.4% had limited health literacy (8.4% inadequate and 24.0% problematic) which was associated with impaired quality of life. According to the NVS, 20.3% had inadequate health literacy which was associated with older age. ConclusionUp to one-third of the patients with AD showed signs of limited health literacy, which was associated with impaired health related quality of life and older age. Further research should evaluate the influence of inadequate health literacy on health outcomes and focus on strategies to improve organizational health literacy to eventually enhance patient-centered care.

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.

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.

Patients with limited health literacy have worse preoperative function and pain control and experience prolonged hospitalizations following shoulder arthroplasty.

Patients with limited health literacy (LHL) may have difficulty understanding and acting on medical information, placing them at risk for potential misuse of health services and adverse outcomes. The purposes of our study were to determine (1) the prevalence of LHL in patients undergoing inpatient shoulder arthroplasty, (2) the association of LHL with the degree of preoperative symptom intensity and magnitude of limitations, (3) and the effects of LHL on perioperative outcomes including postoperative length of stay (LOS), total inpatient costs, and inpatient opioid consumption. We retrospectively identified 230 patients who underwent elective inpatient reverse or anatomic shoulder arthroplasty between January 2018 and May 2021 from a prospectively maintained single-surgeon registry. The health literacy of each patient was assessed preoperatively using the validated 4-item Brief Health Literacy Screening Tool. Patients with a Brief Health Literacy Screening Tool score ≤ 17 were categorized as having LHL. The outcomes of interest were preoperative patient-reported outcome scores and range of motion, LOS, total postoperative inpatient opioid consumption, and total inpatient costs as calculated using time-driven activity-based costing methodology. Univariate analysis was performed to determine associations between LHL and patient characteristics, as well as the outcomes of interest. Multivariable linear regression modeling was used to determine the association between LHL and LOS while controlling for potentially confounding variables. Overall, 58 patients (25.2%) were classified as having LHL. Prior to surgery, these patients had significantly higher rates of opioid use (P=.002), more self-reported allergies (P=.007), and worse American Shoulder and Elbow Surgeons scores (P=.001), visual analog scale pain scores (P=.020), forward elevation (P<.001), and external rotation (P=.022) but did not significantly differ in terms of any additional demographic or clinical characteristics (P>.05). Patients with LHL had a significantly longer LOS (1.84±0.92 days vs. 1.57±0.58 days, P=.012) but did not differ in terms of total hospitalization costs (P=.65) or total inpatient opioid consumption (P=.721). On multivariable analysis, LHL was independently predictive of a significantly longer LOS (β, 0.14; 95% confidence interval, 0.02-0.42; P=.035). LHL is commonplace among patients undergoing elective shoulder arthroplasty and is associated with greater preoperative symptom severity and activity intolerance. Its association with longer hospitalizations suggests that health literacy is an important factor to consider for postoperative disposition planning.

Prevalence of and factors associated with limited health literacy in spine patients

Limited health literacy exacerbates health inequity and has serious implications for patient care. It hinders successful communication and comprehension of relevant health information, which can lead to suboptimal care. Despite the evidence regarding the significance of health literacy, the topic has received little consideration in orthopedic spine patients. To investigate the prevalence of and factors associated with limited health literacy among outpatients presenting to a tertiary urban academic hospital-based orthopedic spine center. Cross-sectionals. Patients 18 years of age or older seen at a tertiary urban academic hospital-based multi-surgeon outpatient spine center. The Newest Vital Sign (NVS) health literacy assessment. Between December 2021 and March 2022, 447 consecutive English-speaking patients over the age of 18 years and new to the outpatient spine clinic were approached for participation in a cross-sectional survey study, of which 405 agreed to participate. Patients completed the Newest Vital Sign (NVS) health literacy assessment tool, the Rapid Estimation of Adult Literacy in Medicine Short Form (REALM-SF), and a sociodemographic survey (including race/ethnicity, level of education, employment status, income, and marital status). The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy. REALM-SF scores were classified into reading levels below ninth grade (0-6) or at least ninth grade (7). Additional demographic data was extracted from patient records. Online mapping tools were used to collect the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI) for each patient. Subsequently, multivariable regression modeling was performed to identify independent factors associated with limited health literacy. The prevalence of limited health literacy in patients presenting to an urban academic outpatient spine center was 33% (135/405). Unadjusted analysis found that patients who were socioeconomically disadvantaged (eg, unemployed, lower household income, publicly insured and higher SVI) and had more unfavorable social determinant of health features (eg, housing concerns, higher ADI, less years of education, below ninth grade reading level, unmarried) had high rates of limited health literacy. Adjusted regression analysis demonstrated that limited health literacy was independently associated with higher ADI state decile, living less than 10 years at current address, having housing concerns, not being employed, non-native English speaking, having less years of education and below ninth grade reading level. This study found that a substantial portion of the patients presenting to an outpatient spine center have limited health literacy, more so if they are socially disadvantaged. Future efforts should investigate the impact of limited health literacy on access to care, treatment outcomes and health care utilization in orthopedic patients. Neighborhood social vulnerability measures may be a feasible way to identify patients at risk of limited health literacy in clinical practice and offer opportunities for tailored patient care. This may contribute to prioritizing the mitigation of disparities and aid in the development of meaningful interventions to improve health equity in orthopedics.

Practices and perspectives of patients and healthcare professionals on shared decision-making in nephrology

BackgroundGiven the complexity and variety in treatment options for advanced chronic kidney disease (CKD), shared decision-making (SDM) can be a challenge. SDM is needed for making decisions that best suit patients’ needs and their medical and living situations. SDM might be experienced differently by different stakeholders. This study aimed to explore clinical practice and perspectives on SDM in nephrology from three angles: observers, patients and healthcare professionals (HCPs).MethodsAn explanatory sequential mixed methods design was used. First, in the quantitative part of the study, outpatient consultations with patients with advanced chronic kidney disease (eGFR < 20 ml/min) were video recorded and SDM was assessed using the OPTION5 instrument. Subsequently, in the qualitative part, patients and HCPs reflected on their own SDM behaviour during individual stimulated recall interviews which were analysed using deductive thematic content analysis.ResultsTwenty nine consultations were recorded and observed in seven hospitals. The mean SDM score was 51 (range 25–80), indicating that SDM was applied to a moderate extent. The stimulated recall interviews with patients showed that they rely on the information provision and opinion of HCPs, expect consistency and support, and desire a proactive role. They also expect to be questioned by the HCP about their SDM preferences. HCPs said they were willing to incorporate patients’ preferences in SDM, as long as there are no medical contraindications. They also prefer patients to take a prominent role in SDM. HCPs ascribe various roles to themselves in supporting patients’ decision-making.ConclusionsAlthough SDM was applied by HCPs to a moderate extent, improvement is needed, especially in helping patients get the information they need and in making sure that every patient is involved in SDM. This is even more important given the complex nature of the disease and the relatively high prevalence of limited health literacy among patients with chronic kidney disease.

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.

Health literacy, behavioral and psychosocial characteristics in coronary artery patients: A hospital-based study in Turkey

Objective: To investigate health literacy, behavioral and psychosocial characteristics in coronary artery patients.Methods: Between March 2019 and 2020 years, 275 coronary artery patients aged ≥50 years were included in the study. Turkish Health Literacy Scale-32 and Beck Depression Inventory were used to collect the data.Results: General health literacy index score was 31.7 and the prevalence of limited health literacy was 59.3%. Adequate health literacy was 2.8 fold higher in the 50-64 age group, 3.1 fold higher among men, 3.4 fold higher among married and 5.3 fold higher among those who believed in the necessity of individual protective practices (P<0.05). Significant differences were also found in different working status, living places, perceived economic situation, perceived general health status, comorbidities, family history of coronary artery disease, angiography history, material skills on reading and understanding, level of depressive syptom, commitment to individual protective practices health check-ups, utilizing health services, cigarette and alcohol use, and exercise and nutrition between limited and adequate health literacy (P<0.05). Logistic regression analysis showed that adequate health literacy was significantly higher among younger patients (OR: 2.81; 95% CI: 1.46-5.62), male gender (OR: 3.10; 95% CI: 1.46-6.58), married (OR: 3.42; 95% CI: 1.39-8.44) and those with belief in individual protective practices (OR: 5.3; 95% CI: 1.93-14.96).Conclusions: Health literacy is poor among coronary artery patients and behavioral and psychosocial variables differ with health literacy levels. To keep cardiovascular health among these patients, health literacy-based interventions should be adopted in coronary artery clinics, especially for risky population.

Prevalence of limited health literacy and its associated factors in patients with type 2 diabetes mellitus in Perak, Malaysia: a cross-sectional study

ObjectiveLimited health literacy in patients with type 2 diabetes mellitus (T2DM) led to poorer diabetes knowledge, less medication adherence and increased healthcare cost. The purpose of this paper was to...

Health literacy experiences of multi-ethnic patients and their health-care providers in the management of type 2 diabetes in Malaysia: A qualitative study.

BackgroundPatients with type 2 diabetes mellitus (T2DM) require adequate health literacy to understand the disease and learn self‐management skills to optimize their health. However, the prevalence of limited health literacy is high in patients with T2DM, especially in Asian countries.ObjectiveThis study aimed to explore experiences related to health literacy in Asian patients with T2DM.DesignThis is a qualitative study using in‐depth interviews and focus group discussions. A framework analysis was used to analyse the data.Setting and participantsarticipants (n = 24) were multi‐ethnic patients with T2DM (n = 18) and their primary health‐care providers (n = 6). This study was conducted in four primary health‐care clinics in Malaysia.ResultsNine subthemes were identified within the four dimensions of health literacy: accessing, understanding, appraising and applying information.DiscussionMotivated patients actively sought information, while others passively received information shared by family members, friends or even strangers. Language and communication skills played important roles in helping patients understand this information. Information appraisal was lacking, with patients just proceeding to apply the information obtained. Patients' use of information was influenced by their self‐efficacy, and internal and external barriers.ConclusionIn conclusion, the experiences of multi‐ethnic patients with T2DM regarding health literacy were varied and heavily influenced by their cultures.

OP0257-PARE USING PATIENT HEALTH LITERACY PROFILES TO IDENTIFY SOLUTIONS TO CHALLENGES FACED IN RHEUMATOLOGY CARE

Background:The prevalence of limited health literacy (i.e. cognitive and social resources of individuals to access, understand and apply health information to promote and maintain good health) in the Netherlands is estimated to be over 36% [1]. Access to and outcomes of rheumatological care may be compromised by limited patient health literacy, yet little is known about how to address this, thus action is required. As influencing individual patients’ health literacy in the rheumatology context is often unrealistic, it is paramount for the health system to be tailored to the health literacy needs of its patients. The OPtimising HEalth LIteracy and Access (Ophelia) process offers a method to inform system change [2].Objectives:Following the Ophelia approach:a. Identify health literacy profiles reflecting strengths and weaknesses of outpatients with RA, SpA and gout.b. Use the health literacy profiles to facilitate discussions on challenges for patients and professionals in rheumatological care and identify possible solutions the health system could offer to address these challenges.Methods:Patients with RA, SpA and gout attending outpatient clinics in three centres in the Netherlands completed the Health Literacy Questionnaire (HLQ) and questions on socio-demographic and health-related characteristics. Hierarchical cluster analysis using Ward’s method identified clusters based on the nine HLQ domains. Three researchers jointly examined 24 cluster solutions for meaningfulness by interpreting HLQ domain scores and patient characteristics. Meaningful clusters were translated into health literacy profiles using HLQ patterns and demographic data. A patient research partner confirmed the identified profiles. Patient vignettes were designed by combining cluster analyses results with qualitative patient interviews. The vignettes were used in two two-hour co-design workshops with rheumatologists and nurses to discuss their perspective on health literacy-related challenges for patients and professionals, and generate ideas on how to address these challenges.Results:In total, 895 patients participated: 49% female, mean age 61 years (±13.0), 25% lived alone, 18% had a migrant background, 6.6% did not speak Dutch at home and 51% had low levels of education. Figure 1 shows a heat map of identified health literacy profiles, displaying the score distribution per profile across nine health literacy domains. Figure 2 shows an excerpt of a patient vignette, describing challenges for a patient with profile number 9. The workshops were attended by 7 and 14 nurses and rheumatologists. Proposed solutions included health literacy communication training for professionals, developing and improving (visual) patient information materials, peer support for patients through patient associations or group consultations, a clear referral system for patients who need additional guidance by a nurse, social worker, lifestyle coach, pharmacist or family doctor, and more time with rheumatology nurses for target populations. Moreover, several system adaptations to the clinic, such as a central desk for all patient appointments, were proposed.Conclusion:This study identified several distinct health literacy profiles of patients with rheumatic conditions. Engaging with health professionals in co-design workshops led to numerous bottom-up ideas to improve care. Next steps include co-design workshops with patients, followed by prioritising and testing proposed interventions.

Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review.

BackgroundHealth literacy (HL) skills are essential to enable self-management and shared decision-making in patients with type 2 diabetes mellitus (T2DM). Limited HL in these patients is associated with poorer outcomes. It is not clear what the burden of limited HL in patients with T2DM across countries and what factors influence it.MethodsA systematic review was conducted according to the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42017056150). We searched MEDLINE, EMBASE, PsycINFO, CINAHL and ERIC for articles published up to January 2017. Articles that measured HL levels in adult patients with T2DM; that used validated HL tools; and that were reported in English were included. Two reviewers assessed studies for eligibility and quality, and extracted the data. Prevalence of limited HL is calculated from the number of patients with less than adequate HL over the total number of patients with T2DM in the study. Meta-analysis and meta-regression analysis were conducted using the Open Meta-analyst software.ResultsTwenty-nine studies involving 13,457 patients with T2DM from seven countries were included. In total, seven different HL measurement tools were used. The prevalence of limited HL ranged from 7.3% to 82%, lowest in Switzerland and the highest in Taiwan. Meta-regression analysis of all included studies showed the country of study (p<0.001), HL tool used (p = 0.002), and the country’s region (p<0.001) contributed to the variation findings. Thirteen studies in the USA measured functional HL. The pooled prevalence of inadequate functional HL among patients with T2DM in the USA was 28.9% (95% CI: 20.4–37.3), with high heterogeneity (I2 = 97.9%, p <0.001). Studies were done in the community as opposed to a hospital or primary care (p = 0.005) and populations with education level lower than high school education (p = 0.009) reported a higher prevalence of limited HL.ConclusionThe prevalence of limited HL in patients with T2DM varied widely between countries, HL tools used and the country’s region. Pooled prevalence showed nearly one in three patients with T2DM in the USA had limited functional HL. Interactions with healthcare providers and educational attainment were associated with reported of prevalence in the USA.

Health Literacy of Pre-Service Teachers from Farhangian University: A Cross-Sectional Survey

Background: Teachers play a critical role as health promoters. However, relatively little knowledge is available to date about health literacy of pre-service teachers in Iran. Objectives The aim of this study was to determine the health literacy level of pre-service teachers from Farhangian University in Tehran, Iran. Methods: A cross-sectional study was conducted on a representative random sample of pre-service teachers stratified by major and gender from May to June 2015. Health literacy was measured using the health literacy for adults (HELIA) questionnaire, with 33 items on the domains of access to health information, reading, understanding, appraisal, and behavioral intention. SPSS version 20 was employed to analyze data using statistics including mean, standard deviation, and frequency, t-test and ANOVA. Results: In total, 704 pre-service teachers participated in the study. The mean age of the participants was 20.88 ± 1.43 and 65.8% were female. The health literacy score was 66.30 ± 12.66. Inadequate health literacy was found in 7.3% of the participants, problematic health literacy in 43.3%, sufficient health literacy in 38.5%, and excellent health literacy in 10.9%. Health literacy was significantly associated with age, gender, and marital status. Conclusions: As the high prevalence of limited health literacy in teachers is a barrier to enhancing the health literacy of students at schools, there is a need to design, implement, and evaluate different educational interventions to address health literacy among pre-service teachers.

Limited health literacy is associated with reduced access to kidney transplantation

Limited health literacy is common in patients with chronic kidney disease (CKD) and has been variably associated with adverse clinical outcomes. The prevalence of limited health literacy is lower in kidney transplant recipients than in individuals starting dialysis, suggesting selection of patients with higher health literacy for transplantation. We investigated the relationship between limited health literacy and clinical outcomes, including access to kidney transplantation, in a prospective UK cohort study of 2,274 incident dialysis patients aged 18-75 years. Limited health literacy was defined by a validated Single Item Literacy Screener (SILS). Multivariable regression was used to test for association with outcomes after adjusting for age, sex, socioeconomic status (educational level and car ownership), ethnicity, first language, primary renal diagnosis, and comorbidity. In fully adjusted analyses, limited health literacy was not associated with mortality, late presentation to nephrology, dialysis modality, haemodialysis vascular access, or pre-emptive kidney transplant listing, but was associated with reduced likelihood of listing for a deceased-donor transplant (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.51-0.90), receiving a living-donor transplant (HR 0.41; 95% CI 0.19-0.88), or receiving a transplant from any donor type (HR 0.65; 95% CI 0.44-0.96). Limited health literacy is associated with reduced access to kidney transplantation, independent of patient demographics, socioeconomic status, and comorbidity. Interventions to ameliorate the effects of low health literacy may improve access to kidney transplantation.

Health literacy of parents of very preterm infants at NICU admission and discharge: a prospective cohort study.

To determine the prevalence of limited health literacy in parents of infants born ≤32 and 0/7 weeks and if health literacy changes during hospitalization. Multi-site, prospective cohort study measuring health literacy using the Parent Health Literacy Activities Test, which estimates caregivers' ability to complete tasks such as reading prescription labels and preparing bottles. Data were analyzed using parametric and nonparametric comparison tests and multivariable regression to control for confounders. Of the 137 participants, 31% missed ≥3 questions of 8. Scores were not associated with admission characteristics or NICU complications. Lower scores were associated with lower nurses' (rho 0.20, p = 0.04) but not parents' (rho -0.12, p = 0.22) ratings of discharge readiness. Scores improved slightly from admission to discharge (p = 0.049). Many parents have difficulty answering questions related to basic infant care tasks. NICUs should ensure that communication and discharge planning are mindful of health literacy.

Universal Measures of Support Are Needed: A Cross-Sectional Study of Health Literacy in Patients with Dupuytren's Disease.

Health literacy represents the degree to which patients can understand and act on health information. The relevance of health literacy to health care delivery, outcomes, and overall surgical care is unambiguous. This study aimed (1) to determine the prevalence of limited health literacy in patients diagnosed with Dupuytren's contracture and (2) to identify independent predictors of limited health literacy. This cross-sectional study included patients with Dupuytren's disease and with self-reported English fluency. The Newest Vital Sign, a rapid, validated, and reliable screening tool, was selected to measure health literacy. An exploratory multivariable logistic regression model was used to identify possible predictors of limited health literacy. A total of 185 patients met eligibility criteria and were included. From those, 82 (44 percent) were found to have limited health literacy, defined as a score of 3 or less on the Newest Vital Sign. The domain of prose literacy was most highly scored compared to numeracy and document literacy. Lower household income was associated with a 4.7-fold increase in the odds of having limited health literacy. Being an immigrant also increased the odds of having limited health literacy by a factor of 3.6. Sensitivity analyses and subgroup analyses (based on education, maternal language, and immigration status) corroborated these independent predictor findings. Limited health literacy is common among patients with Dupuytren's contracture. System level changes are necessary such as the access and integration to clinical care of universal measures of support to promote productive patient-surgeon interactions.

Insights from the coalface: barriers to accessing medicines and pharmacy services for resettled refugees from Africa.

Resettled refugees in Australia have been shown to exhibit a high prevalence of limited health literacy and are at greater risk of mismanaging their medication and not being able to access the healthcare services they need. The aim of the current study is to explore the barriers to accessing medicines and pharmacy services in Queensland, Australia, among resettled refugees from Africa; this research was conducted from the perspectives of healthcare professionals and people who help the refugees to resettle in their adopted country (resettlement workers). A 'generic qualitative' approach was used in this study. In-depth interviews were conducted among healthcare professionals (two GPs, nine pharmacists and three nurse practitioners) and resettlement workers. Participants were recruited via a purposive snowball sampling method in the cities of Brisbane and Townsville, Queensland, Australia. Twenty-four in-depth interviews were conducted; 14 with healthcare professionals. Three key themes emerged from the data: (1) Communication Barriers; (2) Navigating the Health System; and (3) Belief Systems and Culture. Perceptions of those 'at the coalface' - healthcare professionals and people who are responsible for assisting refugees to resettle in Australia - provide insight into the language and cultural challenges experienced by resettled refugees from Africa regarding access to the Australian health system, including medicines and pharmacy services.

A systematic review of the prevalence of limited health literacy in Southeast Asian countries.

Health literacy is increasingly recognized as a public health concern. Most of the literature on health literacy concentrate in the Western countries. Therefore, this study aimed to systematically review and examine the available studies on health literacy in Southeast Asian countries and estimate its prevalence in this region. Systematic review. A search for relevant articles was carried out using Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE (via EBSCOhost), Scopus, Science Direct, PubMed and Google Scholar with multiple search terms. Inclusion criteria comprised articles published in English language and assessing general health literacy. Risk of bias reduced with the involvement of two independent reviewers in the screening of the literature and the quality assessment process. A total of 11 studies were included, which only consist of studies from five countries out of 11 making up the Southeast Asian region. The overall prevalence of limited health literacy varied considerably, 1.6%-99.5% with a mean of 55.3% (95% confidence interval [CI]: 35.1%-75.6%). A much higher prevalence was noted in studies conducted in healthcare settings, 67.5% (95% CI: 48.6%-86.3%). The most common factors associated with limited health literacy were education attainment, age, income and socio-economic background. Other factors identified were gender and health behaviours. In summary, despite the little evidence available and existences of high heterogeneity among studies, limited health literacy is still prevalent in Southeast Asian countries. Urgent strategies to improve and promote health literacy in the region are highly warranted. Besides, more studies on health literacy with better quality on the methodology aspect are needed.

Health literacy in people undergoing treatment for alcohol abuse – A pilot study

The evidence suggests that limited health literacy (HL) may be associated with health risk behaviour such as smoking, alcohol drinking, or substance use. The aim of this study was to examine the level of HL in people undergoing treatment for alcohol abuse and to determine the most problematic domain of HL. The cross-sectional survey included 113 participants from two facilities in Prague (Department of Addictology and Bohnice Psychiatric Hospital). HL was measured using the HLS-EU-Q questionnaire developed by the European Health Literacy Consortium. The mean general health literacy (GHL) score of the sample was 34.1, indicating a sufficient level of HL. However, almost half of the sample showed a limited level of HL. Health promotion was identified as the most problematic domain of HL, with fifty percent of participants having a limited level. Outpatients achieved overall better scores than inpatients, although the difference was not significant. We found no statistical differences between tested variables. The results suggest that the prevalence of limited HL in people undergoing treatment for alcohol abuse is relatively high. Interventions should be carried out to increase the overall level of HL. An adequate level of HL may improve overall health, as well as the treatment outcomes of people addicted to alcohol.

Limited health literacy and adverse outcomes among kidney transplant candidates.

More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. We evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. Limited health literacy was assessed at KT evaluation by using a standard cutoff score ≤5 on the Brief Health Literacy Screen (score range 0-12, lower scores indicate worse health literacy). We used logistic regression and adjusted Cox proportional hazards models to identify risk factors for limited health literacy and to quantify its association with listing and waitlist mortality. We found that 8.9% of candidates had limited health literacy; risk factors included less than college education (adjusted odds ratio [aOR]=2.87, 95% confidence interval [CI]:1.86-4.43), frailty (aOR=1.85, 95% CI:1.22-2.80), comorbidity (Charlson comorbidity index [1-point increase] aOR=1.12, 95% CI: 1.04-1.20), and cognitive impairment (aOR=3.45, 95% CI: 2.20-5.41) after adjusting for age, sex, race, and income. Candidates with limited health literacy had a 30% (adjusted hazard ratio=0.70, 95% CI: 0.54-0.91) decreased likelihood of listing and a 2.42-fold (95% CI: 1.16- to 5.05-fold) increased risk of waitlist mortality. Limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.