Problematic Health Literacy Research Articles

Education for people with serious chronic respiratory diseases and their informal caregivers: how to address challenges that impact learning.

Shared decision making is crucial in palliative care for people with serious chronic respiratory diseases and their informal caregivers. Patient education is a critical component in this process, as it provides patients and their informal caregivers the necessary knowledge for informed decisions regarding symptom management, coping with breathlessness, and advance care planning. However, education does not automatically lead to acquiring knowledge. This review describes challenges for education for people with serious chronic respiratory diseases and their informal caregivers and describes how learner-centered education can address these. People with serious chronic respiratory diseases and their informal caregivers face diverse information needs and learning challenges, with low health literacy and cognitive problems being common. Healthcare professionals can facilitate learner-centered education by enhancing motivation for knowledge acquisition by meeting information needs and learning preferences of patients and their informal caregivers, and by ensuring that information is understandable and readable for those with low health literacy and cognitive problems. E-health applications may serve as valuable tools in this process. Learner-centered education may enhance knowledge acquisition in people with serious chronic respiratory diseases and their informal caregivers aiming to gain control over symptoms and optimize shared decision making and advance care planning.

Limited critical and communicative health literacy is related to poorer health among older adults

Abstract Background Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults. Methods Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age. Results Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL. Conclusions Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way. Key messages • Limited health literacy among the older population is associated with several negative health-related outcomes. • Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.

Assessment of the level of health literacy in students with specific learning disorders

Abstract Background Specific Learning Disorders (SLDs) include dyslexia, dysorthography, dysgraphia, and dyscalculia and are referred to as specific educational learning disabilities. For students with SLDs, the issue of health literacy (HL) arises because understanding, evaluating and utilising health information are critical to making informed decisions about one’s health. This study aims to determine the level of HL in students with a certified SLD. Methods From November 2023 to April 2024, students with an SLD studying at the University of Udine (Italy) who agreed to participate, were surveyed using an online questionnaire on the EUSurvey platform. This consisted of the HLS-EU-Q47 to measure HL, followed by a socio-demographic section. The HLS-EU-Q47 classified HL into 4 levels: inadequate, problematic, sufficient and excellent; descriptive analysis was performed and the correlation with the sociodemographic data was examined using χ² test. Results 38 students participated (mean age 24 years, 60.5% female), 60% of whom are in an undergraduate degree program. 42% of the sample had a single SLD (26% dyslexia, 13% dysgraphia), while 58% of them have multiple SLDs. Overall, 42% of students were found to have a problematic HL level, 24% inadequate, only 24% sufficient and 11% excellent. No statistically significant association was found between) HL level and gender, number of SLDs, school attended at the time of SLD certification, and use of supports (all p-values>0.05). Conclusions The level of HL in students with SLDs appears to be consistent with data from the Italian population (58% inadequate or problematic) from the 2019-HLS19 Health Literacy Survey. This suggests that the presence of an SLD does not affect the level of HL and that it is likely that the university degree is able compensate for HL difficulties that could be related to the presence of an SLD. A larger sample is needed to see if it is confirmed that there is no association between the investigated variables. Key messages • Despite the presence of SLDs, the HL of academic students follows the same trend compared to the general Italian population. • The structural use of supportive measures by these students probably bridges the gap in access to and correct use of health information.

An exploratory cross-cultural study of community-based health literacy interventions to promote the mental well-being of disadvantaged and disabled young Africans: a multi-method approach.

This study explores the impact of community-based health literacy interventions on the health and mental well-being of disadvantaged young Africans in Zambia, Sierra Leone, Rwanda, and South Africa. The pandemic has exacerbated mental health problems amongst children and young people, underscoring the urgent need for equitable access to mental healthcare resources. Emphasizing the importance of equitable access to mental healthcare resources, the research addresses educational and income disparities in low- and middle-income countries (LMICs), particularly amongst young Africans with disabilities or vulnerabilities. The study comprised 1,624 young Africans, of whom 1,592 were surveyed, while 191 later participated in in-depth interviews and focus groups. Additionally, 32 participants exclusively joined focus groups. Participants were recruited to complete the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), WHO-5 Well-being Index, Pandemic Anxiety Scale (PAS), and Self-rating of Happiness, as well as semi-structured interviews or focus groups. The findings highlight the significance of tailored health literacy interventions in addressing mental health challenges and promoting well-being in marginalized African communities. In the sample, 43.1% (686) reported to have at least a physical disability or serious health condition and 51.4% (818) had special educational needs (SENs). Mental health scores were significantly lower in participants with two or more physical disabilities and pre-existing mental health problems. Factors significantly associated with poor mental health included poor health literacy, physical disabilities, and pre-existing mental health problems. Four main themes were generated from the thematic analysis: early childhood trajectories and mental illness experiences; positionality, open communication, and mental illness experience; mental illness experience, emotional honesty, and social stratification; and spirituality, cultural beliefs, and mental illness experience. The study emphasizes the need for context-specific, culturally appropriate health literacy interventions to support the mental health and well-being of young Africans in LMICs. By focusing on the lived experiences of disadvantaged groups, the research contributes to a better understanding of effective strategies for promoting health literacy and addressing health inequalities in African communities during and after health emergencies.

Factors Associated With the Health Literacy of Caregivers of Patients Undergoing Cranial Neurological Surgery

Caregiver health literacy (HL) in patients' transition from hospital to home care is an important factor for good results. This study aimed to evaluate the HL and associated factors among informal caregivers of cranial neurosurgery patients in a middle-income country. This cross-sectional study included 89 patient-informal caregiver dyads in Brazil. Data were collected using a sociodemographic questionnaire and the European Health Literacy Survey Questionnaire short-short form (HLS-EU-Q6). Data were analysed using descriptive statistics, univariate analyses, and a binary logistic regression model. The caregivers' average age was 48 ± 13.48 years, and 73.0% of them were female. It was found that 6.7% of the caregivers had inadequate HL, 61.8% had problematic HL, and 31.4% had sufficient HL. Being a healthcare professional was significantly associated with sufficient HL (p = 0.016). Furthermore, healthcare workers had more years of schooling than other caregivers (15.3 ± 4.6 vs. 11.2 ± 4.6; p = 0.013). For every 1-year increase in caregiver age, there was a decrease of 0.041 points on the HLS-EU-Q6. Being a healthcare professional increased HL scores by 11.4%. Key findings showed that caregivers with higher HL were typically younger, male, better educated, and more likely to be healthcare professionals. These caregivers managed patients with lower dependence on daily activities, while those with lower HL, mainly females, cared for patients with higher dependence. The study highlights the need for targeted interventions and public policies to enhance HL among caregivers, particularly to improve outcomes for patients with complex needs.

Eating disorders and health literacy in Germany: results from two representative samples of adolescents and adults.

Eating disorders are associated with substantial burden for the affected individuals including negative health outcomes and increased mortality. So far, prevention programs for eating disorders have yielded mixed results concerning their efficacy. Therefore, more targeted prevention programs need to be developed. Health literacy has been identified as a potential influencing factor of eating disorders. This study aimed at exploring the relationship between likely cases of eating disorders and health literacy, alongside additional sociodemographic factors. Two large samples of adults (N = 3,011) and adolescents (N = 1,021) representative of the German-speaking population in Germany were recruited. Likely cases of eating disorders were identified using the SCOFF questionnaire. Health literacy was assessed with the HLS-EU-Q16 questionnaire. Sociodemographic information, including age, gender, social status and level of education, and subjective body image were obtained. χ2-tests of independence were calculated to determine the association between the investigated constructs. Suspected eating disorders were more likely in female than male adolescents but were not related to gender in adults. Rates of suspected eating disorders increased with increasing age in adolescents and decreased with increasing age in adults. While levels of education were unrelated to suspected eating disorders, low social status was associated with higher rates of suspected eating disorders in adults but not adolescents. Inadequate or problematic health literacy and negative body image were associated with higher rates of suspected eating disorders compared to adequate health literacy and more positive body image. Likely cases of eating disorders are related to health literacy and body image as well as sociodemographic factors. These constructs should therefore be addressed in future research to improve prevention programs.

Health literacy and its association with antibiotic use and knowledge of antibiotic among Egyptian population: cross sectional study

BackgroundHigh prevalence of inappropriate antibiotic use in different sectors of the community indicates a possible strong influence of social and cultural context, which may be influenced by social determinants of health and thereby affecting individuals’ health-related behavior, including antibiotic use. And such health-related behavior is largely determined by individuals’ health literacy.ObjectiveThe purpose of this research was to examine the relationship between the Egyptian population's health literacy, antibiotic use, and antibiotic knowledge.MethodIn Egypt, researchers used a cross-sectional study design, between the period of January and March 2024 using validated questionnaires and recruited a convenient sample of adults from seven governorates representing different geographic areas, and socioeconomic and educational backgrounds with the help of the validated questionnaires the HLS-EU-Q16, a shortened version of the European Health Literacy Survey Questionnaire (derived from the World Health Organization's Antibiotic Resistance: Multi-Country Public Awareness Survey) and, familiarity with drugs and understanding of antibiotic resistance via online methods and face-to-face interviews.ResultsThe survey included a participation of 500 persons in total. The participants' age distribution indicated that 28.8% (n = 144) were aged 18–24, while 27.4% (n = 137) were within the 25–34 age group. Moreover, a total of 274 participants, accounting for 54.8% of the sample, described themselves as female. Significantly, 60.7% of the patients indicated acquiring antibiotics without a prescription. The evaluation of health literacy (HL) levels among the participants revealed that 36.2% had problematic HL, while 8.4% showed inadequate HL. A strong positive link was found between the scores of antibiotic knowledge and the scores of HL (R = 0.876; P-value = 0.001).ConclusionOverall, it is imperative to implement awareness-raising curricula and public health education initiatives without delay. Furthermore, it is highly advised to implement public health awareness initiatives about the appropriate use of antibiotics, alongside national policies aimed at regulating the availability and prescription of antibiotics.

Painkiller intake and problematic health literacy in sport and music students - A cross-sectional study

Previous works have suggested a high prevalence of painkiller intake (PI) among sport students but also improved health literacy (HL) for sports-active students than for sports-inactive students. Since health-related content also forms part of the sport science curriculum, the study focuses on these seemingly paradoxical results. Music students who are also physically active through their instrumental practice, who act in an area with increased PI and who have no health-related teaching content in their curriculum composed the comparison group. Therefore, this study investigated the prevalence of PI and HL in cohorts of sport (n = 222; 54.5% female) and music students (n = 89; 67.4% female) using a cross-sectional online survey in Lower Saxony, Germany. The hypothesis tests were validated by calculating frequentist and Bayesian statistics. The results show that 50.9% of sport and 28.1% of music students exhibit PI concerning their study programs, often for prophylactical purposes and in the presence of low HL levels. The weak negative correlation between PI and HL was not statistically confirmed and requires further research with improved test power. Regarding the possible health consequences of an inconsiderate PI, target group-specific prevention is indicated to increase general health awareness and HL.

Health Literacy Level and Quality of Life among Post-Partum Mothers

Pregnancy and childbirth are natural physiological processes that involve tremendous changes in the mother's physiology, anatomy, and psychology. Apart from that, pregnancy and birth can disrupt physical and mental health, so it has a significant impact on the quality of life of postpartum mothers. Poor quality of life in postpartum mothers becomes, which affects the health of the mother and baby. This study aims to analyze the relationship between health literacy and the quality of life of postpartum mothers in the Bandung Health Center, Tegal City. The research method uses quantitative with a cross-sectional approach. The population of this study was all postpartum mothers who gave birth in June – July 2023 in the Bandung Community Health Center area, Tegal City. The total sample was 59 postpartum mothers. Data collection using the HLS-EU-Q16 and Postpartum Quality of Life (PQOL) questionnaires. In the adequate health literacy category, 43 respondents (72.9%), followed by the problematic health literacy category 15 respondents (25.4%) and low literacy level 1 respondent (1.7%). In addition, of the respondents who have a good quality of life, 57 respondents (96.6%) had a good quality of life, and 2 respondents (3.4%) had a low quality of life. Based on the chi-square test, there is a relationship between health literacy and the quality of life of postpartum mothers, which shows a significant relationship with a significance level of p=0.05). This research concludes that good health literacy gives postpartum mothers a good quality of life so they can care for their newborn babies.

The Rising Challenge of Poor Health Literacy of Patients with Systemic Sclerosis: Preliminary Data Identify Important Unmet Needs in an Italian Cohort.

Health literacy (HL) is pivotal for the successful self-management of chronic diseases. Little HL information is currently available in SSc patients; therefore, the present study aims at evaluating the HL levels in an Italian cohort of SSc patients. SSc patients were enrolled with the support of Italian patient associations, from September 2022 to March 2023. Health literacy characteristics were derived from the Health Literacy Scale European Questionnaire-16 (HLS-EU-Q16), consisting of 16 items designed on a four-point Likert scale ranging from "very difficult" to "very easy", and three HL levels were identified: inadequate HL (0-8 score); problematic HL (9-12 score); and sufficient HL (13-16 score). Enrolled patients (n = 57, mean age = 59 years, SD = 13.2) were mostly female (98.2%), partnered (73.7%), and unemployed or retired (67.9%). Almost half of SSc patients were diagnosed more than 10 years ago, with first symptoms appearing on average 19 years ago (SD 10.5). In 63% of the participants, the overall health literacy skills were inadequate, or problematic, especially in the health care and disease prevention domains. Indeed, 49.2% of the patients declared difficulty in finding information on treatments for illnesses and where to get professional help (42.1%), 47.6% found difficulty in retrieving information on how to manage mental health problems, and 40.4% declared difficulties in judging whether the information on health risks in the media was reliable. Our findings show that SSc patients have inadequate or problematic levels of HL, suggesting the need for periodic screenings to uncover poor health literacy skills and to provide tailored and understandable educational material. This study was not registered.

Health literacy of women giving birth in Vilnius Perinatology Centre

Abstract The aim of the study To investigate the health literacy and associated factors of women giving birth at the Vilnius Perinatology Centre. Material and methods The study was conducted between June 2022 and September 2022 at the Vilnius University Hospital in Lithuania. Five hundred and eight women who had delivered healthy newborns were surveyed. The study instrument was the European Health Literacy Questionnaire (HLS-EU-Q47) in addition to other questionnaires to assess socio-demographic factors of the mother. The Health Literacy Questionnaire was used with the permission of the authors. The survey data was processed using IBM SPSS version 23. Results and conclusions The study showed that more than half of women who gave birth at the Vilnius Perinatology Centre had inadequate or problematic health literacy. Across all literacy indices (including health care, disease prevention, and health promotion), they particularly lack expertise in health promotion. The assessment of health information processing indices (to obtain, understand, evaluate, and apply) revealed that the evaluation of recent health information is the most challenging task for those women. The study confirmed the assumption that women with higher levels of education and who had attended maternity skills training have higher levels of health literacy. Higher rates of unplanned births are also linked to lower levels of health literacy among women.

Abstract 18715: A Cardiovascular Health Literacy Intervention Targeting Arab Women

Health Literacy (HL) is defined as an individual's motivation and ability to gain access to, understand and use information in ways which promote and maintain good health. Low health literacy is associated with increased cardiovascular risk factors. Arab women in Israel are at high cardiovascular risk with cardiovascular mortality that exceeds the mortality in Jewish women by 60%, and may have reduced health literacy. Objectives: To assess HL in Arab women in East Jerusalem and to design, implement and evaluate an interactive HL intervention in Arab women that will lead to an Increase in the percentage of women who utilize effective patient-doctor communication skills, increased self efficacy with regards to the patient-doctor interaction, improved comprehension of test results and increased cardiovascular knowledge. Methods: Tailored 3 session workshop. Questionnaires were administered before and 3 months after the intervention. Results: 267 women participated. 12.1% had inadequate health literacy and 24.2% had problematic health literacy. Of these women, there were matched pre/post questionnaires for 195 women. Matched participants reported increased preparatory behaviors before doctor visits including preparing symptom lists, question lists, medication lists, and medical documents (all p<.001.) They reported increased scores on the Perceived Efficacy in Patient-Physician Interactions scale (7.25 to 7.95, p<.001) , in particular in low efficacy participants who increased from 5.6 to 7.7, p<.001. Health literacy as measured on the HLS-EU-16 increased from 12.6 to 14.33 (p<.001), and 84.5% were in the sufficient range. Conclusions: A three session, tailored interactive HL workshop improved patients’ pre-visit preparation skills, self-efficacy and HL in a convenience sample of Arab women from East Jerusalem. HL can be improved with intervention and as such can be considered a modifiable risk factor for cardiovascular disease.

The Turkish Validity and Reliability of the Coronavirus-Related Health Literacy Scale on Health Science Students

Objective: Health literacy is one’s ability to access, comprehend, appraise, and apply health-related information. Health literacy has become an important topic since the COVID-19 pandemic. This methodological study aimed to adapt the Coronavirus-Related Health Literacy Scale (HLS-COVID-Q22) to Turkish. 
 Methods: The sample consisted of 539 students of the faculty of health sciences of a university in Turkey. The study was conducted between December 2020 and May 2021. The content validity ratio was calculated for content validity. The construct and concurrent validity, internal consistency reliability, test-retest reliability, and ceiling and floor effects were also determined. A confirmatory factor analysis was performed for construct validity. 
 Results: The fit indices indicated an adequate fit (2/df: 4.970.70) and Cronbach’s alpha values (>0.90) were above acceptable limits. Most students had “adequate health literacy” (71.8%). A quarter of the students had “problematic health literacy” (24.5%). The remaining students had “inadequate health literacy” (3.7%). Students with lower levels of health literacy were more likely to have confusion about coronavirus-related information (p

Health literacy: association with socioeconomic determinants and the use of health services in Spain.

Health literacy (HL) is the set of social and cognitive skills that determine person's level of motivation and the ability to access, understand and use information to promote and maintain good health. The aim of this study is to assess the level of health literacy, and to analyze its relationship with sociodemographic variables, state of health, and use of health services in the population aged 15 and over in the Valencian Community (Spain). Cross-sectional study based on a sample of 5,485 subjects participating in the Health Survey of the Valencia Community. The HLS-EU-Q16 was used. As outcome variables we considered HL categorized into 2 levels: Inadequate or Problematic HL and Sufficient HL and the standardized literacy index. Prevalence rates and HL means were estimated and OR were calculated to analyze the association between variables. A total of 12.8% of the subjects surveyed presented an inadequate or problematic degree of HL. This percentage was higher in people >85 years (63.1%), with a low level of education (46.5%), in retired people (27.4%) or in other work situations (25.0%), in foreigners (18.1%), in low-income people (16.2%), with a perception of poor health status (26.9%), chronic disease (18.5%) or with activity limitations (56.4% severe, 19.7% not severe). Significant differences were found. With the exception of chronic disease, all the variables analyzed were associated with HL. Low HL was associated with a lower consumption of medicines, a greater use of health services, general medical consultations, poorer knowledge of new health technologies and fewer preventive health visits. The percentage of inadequate or problematic HL was globally not very high, but certain population subgroups notably presented a high degree of inadequate or problematic HL. Raising the HL level of such groups should be regarded as a priority. HL was shown to be associated with the service use and new health technology use. Enhancing the population's HL should lead to the following: a greater probability of adopting preventive practices; improving the use of the health system; and boosting people's abilities to manage and to improve their own health.

Assessing perceived and functional health literacy among parents in Cyprus: A cross-sectional study.

Parents often must take decisions regarding their children's health, which requires certain skills and competences. Parental health literacy (HL) is important in establishing positive health-promoting behaviours and better health outcomes to their children. Limited parental HL has been associated with various negative children's health outcomes. The aim of the study was to explore perceived and functional HL among parents in Cyprus. A cross-sectional study was conducted with a convenience sample of 416 parents of children, aged 6 months to 15 years old, presenting in pediatric outpatient departments across three Cypriot cities. Participants completed the HLS-EU-Q47, a self-reported measure of HL, and the NVS (Newest Vital Sign), a performance-based measure of HL. Associations with socio-demographic characteristics and health behaviors were explored. Based on suggested ranges, among 416 parents, mostly mothers (83.2%), almost half of parents (42.6%) were classified as having inadequate or problematic perceived HL. Consistently, 62.8% showed high likelihood or significant possibility of limited functional HL, based on the NVS with a mean score of 2.73 out of 6 (SD = 2.02). Nevertheless, no correlation was observed between the two measures of HL. Limited parental perceived HL was statistically significantly associated with lower educational attainment, lower number of children in the family, increased self-assessed health status, and limited exercise habits. Limited parental functional HL was statistically significantly associated with female gender, younger age, lower educational attainment, receiving financial aid, lower family income, and lower alcohol consumption. Even though there was lack of agreement in the classification according to the HLS-EU-Q47 and the NVS, moderate-to-low levels of perceived HL appear consistent with a performance-based measure of HL. As a high number of parents may face challenges in assessing and applying health information to improve outcomes for their children, with evidence of social gradient, healthcare services should be oriented towards identifying problematic HL while Public Health interventions are needed to enhance parental HL.

Associations between maternal health literacy, neonatal health and breastfeeding outcomes in the early postpartum period.

Maternal health literacy is a social skill that is relevant to successful postnatal newborn adaptation, neonatal feeding, and neonatal health outcomes, given the importance of maternal health literacy in newborn healthcare. The study aims to identify and assess the associations between maternal health literacy, neonatal health, and breastfeeding outcomes during the early postpartum period. Five hundred women who gave birth to full-term newborns at Vilnius University Hospital were invited to the study from 1 May to 30 September 2022. The 47 questions of the European Health Literacy Questionnaire (HLS-EU-Q47) were used to assess maternal health literacy on days 2 and 3 after birth. Each subject's health literacy indices were divided into four categories: inadequate, problematic, sufficient, and excellent. The neonatal health indicators were birth weight and height, along with the APGAR score and the outcomes of feeding either exclusively with breast milk or with adapted formula in addition to breastfeeding. Most women who participated in the survey had insufficient or problematic health literacy (69%). The study showed that women's higher health literacy is associated with a lower risk of obesity, a healthier diet, regular physical activity, and a higher birth weight and height of their newborns (p<0.05). Mothers with inadequate/problematic health literacy were more likely to feed their newborns with adapted formula in addition to breastfeeding. Women's health literacy is a factor that affects women's healthy lifestyle choices before and during pregnancy and is significant for newborns' health indicators.

The association between health literacy, COVID-19 knowledge and adherence to preventive measures in Turkey.

Despite vaccination and various prevention policies, the coronavirus (COVID-19) pandemic maintains its negative effects globally. Therefore, people must be adequately informed and put this knowledge into practice in order to take the necessary precautions. This can be achieved with adequate health literacy. In this context, this study was conducted to determine the relationship between health literacy, COVID-19 knowledge and adherence to preventive measures. The sample of this descriptive cross-sectional online survey consisted of 1086 people. Data were collected using a demographics questionnaire, the European Health Literacy Scale, the COVID-19 Knowledge Assessment Questionnaire and the COVID-19 Adherence Assessment Questionnaire. Participants' health literacy index had a median score of 30.9, with 67.5% having inadequate or problematic health literacy. Gender, age, education, marital status, region of residence, employment status and economic status were associated with health literacy (p < 0.05). Participants' median knowledge and adherence scores were 40 and 54, respectively. There were significant positive correlations between health literacy index, knowledge and adherence scores (p < 0.001). This study demonstrated that health literacy, COVID-19 knowledge and adherence were associated with each other. As a result, strategies aimed at improving health literacy may be beneficial in terms of having better knowledge and demonstrating high adherence to measures, thus, eradicating the COVID-19 pandemic, reducing COVID-19-related conditions and promoting public 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.

Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program

Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. The Wellness4Teachers email program is expected to improve the participating teachers' mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program's launch. The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program's impact on subscribers' mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. PRR1-10.2196/44370.

Health literacy is associated with less depression symptoms, higher perceived recovery, higher perceived participation, and walking ability one year after stroke – a cross-sectional study

ABSTRACT Introduction Life after stroke may entail several lifestyle changes and new routines. Hence, it is imperative for people with stroke to understand and make use of health information, i.e. to have sufficient health literacy. This study aimed to explore health literacy and its associations with outcomes at 12-months post-discharge regarding depression symptoms, walking ability, perceived stroke recovery, and perceived participation in people with stroke. Methods This was a cross-sectional study of a Swedish cohort. Data were collected at 12 months post-discharge using European Health Literacy Survey Questionnaire, the Hospital Anxiety and Depression Scale, the 10-m walk test, and the Stroke Impact Scale 3.0. Each outcome was then dichotomized into favorable versus unfavorable outcome. Logistic regression was performed to assess the association between health literacy and favorable outcomes. Results The participants, n = 108, were on average 72 years old, 60% had mild disability, 48% had a university/college degree, and 64% were men. At 12 months post-discharge, 9% of the participants had inadequate health literacy, 29% problematic health literacy, and 62% sufficient health literacy. Higher levels of health literacy were significantly associated with favorable outcomes relating to depression symptoms, walking ability, perceived stroke recovery, and perceived participation in models adjusted for age, sex, and education level. Conclusion The association between health literacy and mental, physical, and social functioning 12-months post-discharge suggests that health literacy is an important factor to consider in post-stroke rehabilitation. Longitudinal studies of health literacy in people with stroke are warranted to explore the underlying reasons for these associations.