Problematic Health Literacy Research Articles

Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study

ObjectivesThe aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery.DesignA prospective cross-sectional...

Health Literacy and COVID-19 preventive behaviours in during the Lock-Down Phase in Tuscany (Italy)

Abstract In the first COVID-19 pandemic period, when no vaccines were available, individual behaviours were essential for controlling the spread of the virus. In this context of rapidly changing guidance, emerging new evidence, fake news and misinformation, there have been new challenges for health literacy (HL). This study explored whether guidance-compliant healthy behaviours were associated with HL in individuals who have performed essential activities (public employees and volunteers of the Civil Protection) during the lock-down period in the Province of Prato, Italy. Items on knowledge, attitudes and practices (KAP) towards COVID-19 preventive measures and COVID-19 risk perception, along with the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6), were collected using a self-administered structured questionnaire. In May 2020, 751 responses were collected; respondents were mostly males (59%), younger than 65 years old (83.5%), with sufficient HL (56%), and never smokers (54.2%). Most of the items related to the KAP towards COVID-19 preventive measures were significantly correlated with the HLS-EU-Q6 score in the total sample. In the multiple linear model, HL results to be a predictor of both a better self-reported knowledge of COVID-19 preventive measures (beta 0.32 for sufficient HL, 0.11 for problematic HL, 1.00 for inadequate HL) and a higher score of attitude towards the importance of COVID-19 preventive measures (beta 0.33 for sufficient HL, 0.17 for problematic HL, 1.00 for inadequate HL), while it has no role in predicting a higher risk perception. These findings can be useful to understand the importance of HL in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly. Key messages Lower levels of Health Literacy predict poor COVID-19 related knowledge and a worse attitudes towards the importance of COVID-19 preventive measures. Health Literacy may be an important factor in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Literasi Kesehatan pada Pasien Diabetes Mellitus Tipe 2

Background: Health literacy can play an important role in the quality of the provided care since patients with T2DM need long-term and high level of complex care. Inadequate literacy patients with DM related to less knowledge about diabetes and poorer health outcome.
 Objective: This study aimed to examine health literacy among patients with type 2 diabetes mellitus and its related factors.
 Methods: This study used cross sectional design. The respondents recruited with a convenience sampling in outpatient internal medicine department in a hospital located in Sleman regency from September 2017 to January 2018. The Charlson Comorbidity Index and the European Health Literacy Survey - Questionnaire 47 were employ. Data analysis involved descriptive and bivariate analysis.
 Results: A hundred and fifty two subjects enrolled in this research. The average score of health literacy was 29.5 (SD = 3.4). Factors related with health literacy were total number of complications (r = -.26; p = .001), education (p = .010) and monthly income (p = .000).
 Conclusion: Problematic health literacy has been found to be prevailing in patients with type 2 diabetes mellitus in Yogyakarta, Indonesia. Total number of complications, education, and monthly income were significantly correlated with health literacy in this population.

Sağlık Bilimleri Fakültesi Öğrencilerinin Sağlık Okuryazarlığı Düzeylerini Arttırmaya Yönelik Bir Eğitim Müdahalesi

Purpose: In this study, it is aimed to increase the level of health literacy of the students who are studying at the Faculty of Health Sciences and who will take place in different stages of health service provision in the future with educational intervention.Method: This study is an intervention study. Students of Ankara Gazi University Faculty of Health Sciences were given a 12-week face-to-face training within the sope of 2019-2020 Fall Period Health Literacy course. Pre and post-training health literacy levels were measured with Turkey Health Literacy Scale-32. The data were analyzed with the SPSS 23 program. Pre-test and post-test scores were compared using the Wilcoxon test. The statistical significance level was accepted as p<0,05.Results: A total of 48 people, 35 women (72.9%) and 13 men (27.1) were included in this study. The mean age is 22.2±2.7 and the median age is 22 ( min:19- max: 36). In the pre-test, 62.5% of the participants have inadequate /problematic health literacy level. In the post-test 41.7% of the participants have excellent level and 33.3% of the participants have sufficient level. Only 25% of the participants have insufficient problematic level.Conclusion: A range of skills and competencies such as accessing information, understanding, applying and critical thinking are required to protect and improve helath and to use health services correctly and effectively. The biggest factor that will ensure this is to improve health literacy levels. Good levels of the health literacy contribute to improving healt outcomes. At this point, it is of great importance to improve the health literacy levels of the society. In order to achieve this, it is necessary to improve the health literacy levels of allhealthcare professionals who work in every step of the health service delivery to the community.

Design and preliminary evaluation of a newly designed patient-friendly discharge letter \u2013 a randomized, controlled participant-blind trial

BackgroundLow health literacy has been associated with poor health outcome and impaired use of healthcare services. The hospital discharge letter represents a key source of medical information for patients and can be used to address the problem of low health literacy. The aim of this project was to develop and evaluate a new, patient-directed, version of the discharge letter.MethodsBased upon two conventional discharge letters (CDL; one surgical and one medical letter), two new, patient-friendly discharge letters (PFDL) were designed following 5 key principles: short sentences, few abbreviations, large font size, avoidance of technical terms and no more than 4 pages length. Medical undergraduates were randomized into two blinded groups (CDL, PFDL) and asked to assess the assigned letter for the 3 domains structure, content and patient-friendliness. Subsections were rated on a 6-point Likert scale (1 = completely agree, 6 = completely disagree), the results of the survey were compared using the Mann-Whitney-U-Test with a p < 0.05 being the level of significance.ResultsIn total, 74 undergraduates participated in this study. PFDL (35 participants) were rated significantly better than CDL (39 participants) regarding structure (median 1 vs. 2, p = 0.005), content (1 vs. 3, p < 0.001) and patient-friendliness (2 vs. 6, p < 0.001). Of all 17 subsections, PFDL were rated significantly better in 12 cases, and never worse than CDL.ConclusionsPFDL were rated significantly better than their CDL counterparts. Medical undergraduates were considered the ideal cohort, not being medical lays and yet unbiased regarding everyday clinical practice procedures. Further tests evaluating the impact of the PFDL on patient comprehension and health literacy are necessary.

Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study.

BackgroundSelf-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.ObjectiveThis study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.MethodsThe eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months’ access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.ResultsThree main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants’ experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.ConclusionsFindings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.Trial RegistrationClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016851

Health literacy and cancer screening behaviors among community-dwelling female adults in Taiwan

ABSTRACT This study was designed to explore the association among health literacy and cancer screening behaviors in Taiwanese females. A total of 353 community-dwelling females were recruited in this cross-sectional study from February to October 2015. Demographic, socioeconomic and personal behavior variables including physical activity, community activity, smoking, alcohol consumption, and betel nut chewing were recorded. Health literacy was evaluated using the Mandarin version of the European Health Literacy Survey Questionnaire. Data on screening behaviors for cervical, breast and colorectal cancers were confirmed by the Taiwanese National eHealth Database. Most respondents with inadequate or problematic general health literacy had no or irregular screening behaviors for cervical, breast and colorectal cancers. In multivariable regression analysis, women with inadequate health literacy were at a greater risk (Odds ratio = 5.71; 95% CI: 1.40–23.26) of having no previous Pap smear screening or >3 years screening interval regardless of education level. However, this association was not detected for breast or colorectal cancer. Women with inadequate health literacy were more likely to have irregular cervical cancer screening, however no associations among health literacy and breast or colorectal cancer were detected. The impact of health literacy on cancer screening behavior warrants further attention and research.

The Relationship Between Health Literacy Level and Media Used as a Source of Health-Related Information.

Background:Previous studies have not shown the level of health literacy or associated factors on a national level in Turkey using a scale that has been adapted to the country and its culture.Objective:This study aimed to determine health literacy levels in Turkey and to investigate the association of health literacy with socioeconomic factors as well as with the instruments used as sources of health-related information.Methods:This cross-sectional, nationally representative study was conducted using a computer-assisted personal interview approach and included 6,228 households (response rate, 70.9%). The Turkey Health Literacy Scale was used to measure health literacy. Sources of health-related information, such as newspapers, television, internet, and smartphones, were included in the regression model for health literacy.Key Results:The proportion of participants with inadequate and problematic health literacy was 30.9% and 38%, respectively, showing that approximately 7 of 10 participants had limited health literacy. The frequencies of inadequate and problematic health literacy were higher in the disease prevention and promotion domains (37.4% and 34.2%, respectively) compared with those in the health care domain (27.1% and 31.3%, respectively). The most frequently used medium as a source of health-related information was the internet (48.6%), followed by television (33%). In controlled models, higher health literacy scores were associated with higher education and income levels. The effects of television (β = 1,917), internet (β = 2,803), newspapers (β = 1,489), and smartphones (β = 1,974) as sources of health-related information were statistically significant in the general health literacy index model.Conclusions:Health literacy in Turkey reflects social inequalities. The model accounting for socioeconomic variables demonstrated the relevance of sources of health information to level of health literacy. These findings emphasize the importance of improving sources of health information to improve health literacy. [HLRP: Health Literacy Research and Practice. 2021;5(2):e109–e117.]Plain Language Summary:This is a cross-sectional study that is representative of the population of Turkey. We reported that health literacy scores were higher for people in higher levels of socioeconomic status. We showed that using the television, internet, newspapers, and smartphones as a source of health-related information is associated with health literacy even when accounting for socioeconomic variables.

The Impact of Health literacy on Health Outcomes in Cancer Patients Attending Inpatient Rehabilitation

Health literacy (HL) entails people's knowledge, motivation, and competences to access, understand, appraise, and apply health information. Lower HL is associated with poorer psychosocial health. However, there are no studies so far evaluating the impact of HL within oncological rehabilitation in Germany. Therefore, we explored HL in cancer patients in inpatient rehabilitation and its association with rehabilitation outcome. We conducted a secondary data analysis of a questionnaire survey with 449 cancer patients (breast, prostate, and colon cancer) at 3 measurement occasions (end of rehabilitation, 3- and 9 months follow-up). We assessed HL with the European Health Literacy Survey (HLS-EU-Q6). We evaluated rehabilitation outcomes by measuring fear of progression (FoP-Q-SF), need for psychosocial support, physical functioning and global quality of life (EORTC-QLQ-C30), and the work ability index (WAI). To explore the impact of HL on rehabilitation outcome, we used multiple regression analyses controlling for other factors. At the end of rehabilitation, up to 56% of the patients reported difficulties in HL dimensions. Better HL was significantly associated with lower fear of progression (β=- 0,33) and need for psychosocial support (OR=0,28), higher physical functioning (β=0,22), higher global health status (β=0,23), and higher work ability (β=0,21). Longitudinal analyses showed that improvement in HL was significantly accompanied by improvements in all rehabilitation outcomes (0,18 ≤ β ≤ 0,24). HL is a relevant factor within cancer rehabilitation. More than half of the patients showed problematic HL at discharge. Furthermore, HL is a predictor of psychosocial, somatic, and work-related rehabilitation outcomes up to 9 months. Effective strategies to support patients in dealing with health information are essential and should be promoted within rehabilitation.

A survey of health information source use in rural communities identifies complex health literacy barriers

Access to health information is critical for good health. However, residents of rural communities may face more difficulties in accessing health information than residents in rural areas. Problems may be structural, socio-economic and cultural. The study assessed sources and challenges concerning health information access and use among residents of five rural communities in Ibadan, Nigeria. Descriptive survey design was adopted, and data were elicited from forty respondents through focus group discussions (FGD). Elicited data were thematically analysed. Several informal and primary information sources were often used. Residents used the radio to access health information, and they also visited hospitals/health centres, asked doctors, participated in health sensitisation programmes and consulted traditional herbalists. However, the barriers included financial problems, infrastructure problems (bad road network, unreliable electricity supplies), living far from health centres and finding suitable health information in their own language. These are individual and systemic/structural challenges. The focus group participants were aware of the importance of reliable health information sources, but often had to use a mixture of sources. Traditional herbalists were valued sources (more available and affordable). Health literacy problems concern education and language. Service provision could be improved to make health information more efficient and effective for rural communities, by building on what works (e.g. health sensitisation programmes, radio programmes providing health education) and providing more multi-lingual services. The study also confirmed the importance of evaluating traditional herbal medicine.

Health literacy problems of kidney patients.

Health literacy problems of kidney patients.

How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies.

BackgroundLimited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. MethodsWe performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009–19. We assessed the quality of the studies and conducted a best-evidence synthesis.ResultsWe identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient–provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak.ConclusionsStudy heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.

Running for Health? Polish Long-Distance Leisure Runnersand the Problem of Health Literacy

Running for Health? Polish Long-Distance Leisure Runnersand the Problem of Health Literacy

The Use of Fitness Influencers' Websites by Young Adult Women: A Cross-Sectional Study.

The growth of the fitness industry observed in the last decade has been accompanied by the emergence of an occupation as a social media fitness influencer. The most popular are able to accumulate millions of followers. The marketing potential of fitness influencers is a subject of interest, not only for the fitness industry but also for other sectors offering products related to health, wellness, or healthy nutrition. However, the activities of fitness influencers related to the promotion of physical activity and healthy lifestyle converge with the aims of those promoting public health. The main objective of this study was to make an assessment of the determinants of regular access to fitness influencers’ sites (FIS) and their relationship with the health behaviors of young adult women. It was based on the data originating from an online survey on a representative sample of Polish women aged 18–35 years. Chi2 test, univariate, and multiply logistic regression models were used to determine the relationships between FIS and the variables related to the respondents’ characteristics of and their health behaviors. FIS were accessed by 29.3% of respondents (n = 1030) at least once a week. It was found that those living in cities with a population ranging from 20,000 to 100,000 were more likely to access FIS than those living in rural areas. Similarly, greater access was made by those in a high-income household rather than those with the lowest income, by those with inadequate rather than those with problematic health literacy and by those with high rather than low e-health literacy. The use of FIS was significantly associated with the consumptions of fruit and vegetables (OR, 95%CI: 2.77, 2.01–3.82), physical activity (1.74, 1.27–2.38), breast self-examination (1.54, 1.11–2.13), and also with the greater use of e-cigarettes (1.63, 1.09–2.43) and increased consumption of alcohol (1.37, 1.01–1.88). In conclusion, as access to Internet resources run by fitness influencers was a prevailing predictor of young adult Polish women’s health behaviors, FIS may play a potentially important role in promoting a healthy lifestyle in this population. However, it should be remembered that there are complex patterns of associations with specific behaviors, e.g., the use of e-cigarettes or alcohol consumption.

Adaptation of HLS-EU-Q47 for the Russian population

Abstract Background Health literacy (HL) is recognized as one of the major determinants of health. International population HL surveys in Europe and Asia using a unified measurement of European Health Literacy Survey Questionnaire (HLS-EU-Q) demonstrated similar results of approximately 50% of population having poor or problematic health literacy level. In the present study the HLS-EU Q47 was adapted for the Russian population for the first time. Russian language is spoken widely beyond the Russian Federation (RF). Among international migrants, more than 25 million are from the RF or former Soviet Union, typically speak Russian and have a common historical and cultural background. Methods Adaptation of the questionnaire was based on the HLS-EU methodology and included 5 stages: translation from English into Russian, back translation by two independent translators, focus group (n = 12), online expert opinion (n = 12), field-testing (n = 90). For the focus group, the purposeful sampling was used, stratified by gender, age, education level and place of living (urban/rural). The field-testing was conducted by personal interviews in households, using a random stratified sampling based on gender and age. Results The translations analysis identified discrepancies on the use of plain language, and allowed to simplify the wording in 10 questions (13%). The focus group and expert opinion qualitative analysis allowed identifying and adapting cultural and linguistic peculiarities, so 24 questions (31%) were adapted. The field-testing showed 86% feasibility of the questionnaire in real settings. Conclusions Despite that the instrument was translated into Russian and used in some countries for the Russian-speaking population, a substantial adaptation of the questionnaire is necessary, taking into account the cultural and linguistic characteristics and background of the studied population. The instrument can contribute for measurement of HL in Russian population living in different countries. Key messages The HLS-EU-Q 47 was adapted for the Russian population. The adapted instrument can contribute to further health literacy measurements of the Russian population worldwide.

Development of School Reproductive Health Education Index Model (Indeks Pendidikan Kesehatan Reproduksi Sekolah / IPKPRS)

One of the important health issues to be on the agenda of health promotion in schools is reproductive health. The results of the Basic Health Research (Riskesdas) in 2018 showed that nationally as many as 65.2% of the population had less knowledge about HIV/AIDS. This indicates that Indonesia is faced with the problem of low reproductive health literacy of school residents. The R&amp;D design is used to develop the School Reproductive Health Education Index (IPKRS) instrument. R&amp;D is carried out in 3 stages, namely: 1) determination of IPKRS dimensions and parameters by the focus group discussion (FGD) method; 2) Preparation, consultation and revision of the IPKRS model through experts judgment by the Delphy method; 3) Testing the validity of IPKRS by experts. The results shows that there are 4 dimensions of IPKRS, namely 1) the knowledge of school residents; 2) curriculum; 3) infrastructure; 4) institutional. The four dimensions are described in 13 IPKRS parameters. The validity test results shows all IPKRS parameters proved to be valid (Aiken’s coefficient V value for each item ≥ 0.92). The findings of the IPKRS model need to be followed up by implementing in schools within the framework of mapping the quality of school reproductive health education.

Health Literacy and Its Related Factors in Non-Medical College Students

Abstract Introduction: Health literacy plays a vital role in health education and health promotion and has received increasing attention as a means to improve health outcomes and reduce health inequality. The students’ awareness of health literacy and their weaknesses in this area are essential for educational planning. Objective: This study aimed to investigate the health literacy of non-medical college students and it’s affecting factors. Materials and Methods: This is a correlational study conducted on 250 non-medical students at the Islamic Azad University of Rasht branch, Rasht City, Iran in the academic year 2018-2019. They were selected using a random sampling method. The data collection tool was the Health Literacy For Iranian Adults (HELIA) questionnaire. The collected data were analyzed using the descriptive and analytical statistics (t-test, the Pearson correlation test, and the Chi-square test). Results: The Mean±SD of the HELIA score was 68.44±12.72 (out of 100). About 6.8% of students had inadequate health literacy, 29.6% problematic health literacy, 54.4% adequate health literacy, and 9.2% excellent health literacy. Students had the highest score in the dimensions of understanding Mean±SD (77.11±15.82) and access Mean±SD (72.35±16.73), while in decision-making and applying health information Mean±SD (55.62±15.01) they had the lowest score. There was no statistically significant correlation between students’ age and health literacy scores, but a statistically significant relationship was reported between their gender and health literacy levels (P=0.049). The Internet (54.8%) and physicians and health workers (27.2%) were the most important sources of information about health for students. Conclusion: Many students lacked sufficient health literacy. Since most of them received information about health issues through the Internet, educational health programs and contents can be provided to them through the Internet and social networks.

The Association Between Health Literacy and Quality of Life and Its Associated Factors Among Adults with Type 2 Diabetes Mellitus in Public Primary Care Clinic

Introduction: Low health literacy (HL) is one of the contributing factors that leads to negative diabetic outcome. Quality of life (QOL) is a state of complete physical, mental and social wellbeing. There is limited evidence on association of HL and QOL among type 2 diabetes mellitus (T2DM), therefore the objectives of this study were to identify the HL and QOL status, to determine the association between HL and QOL and factors associated with QOL among T2DM patients. Methods: This was a cross sectional study involving patients with T2DM from two public primary care clinics. HL and QOL were measured using translated and validatedHLS – Asia Q16 and DQoL-BCI questionnaires respectively among T2DM patients. Results: The mean HL score was 12.39 (3.34), 17.7 % had “inadequate HL”, 25.7% had “problematic HL” and 56.6% had “sufficient HL”. The mean DQoL-BCI score was 32.09 (6.51). Lower QOL level was negatively associated with age (b -0.140; CI: -0.190, - 0.090; p&lt;0.001), not obese (b -1.476; CI: -2.605, - 0.347; p&lt;0.011), and HL level (b -0.425; CI: -0.59, - 0.259; p&lt;0.001). Lower QOL level was positively associated with uncontrolled glycaemic status (HbA1c &gt;6.5%)(b 1.308; CI: -0.042, 2.659; p&lt;0.058), treatment with insulin (b 4.163; CI:1.538, 6.788; p&lt;0.002) and combination treatment of insulin and oral hypoglycaemic agents (OHA) (b 2.450; CI:1.145, 3.756; p&lt;0.001). Conclusions: This study demonstrated that age, body mass index, HL, glycaemic control, treatment with OHA and insulin were significantly associated with QOL. This suggest the importance of identifying high risk patients with poor QOL for targeted intervention.

The association between health literacy and colorectal cancer screening uptake in a publicly funded screening program in Denmark: Cross-sectional study.

There are multiple reasons for not participating in colorectal cancer screening, but the role of health literacy in screening uptake is not well understood. The aims of this study were to determine the association between health literacy and colorectal cancer screening uptake and to explore whether socioeconomic and -demographic characteristics and worry and attitude variables modify this association. In a cross-sectional study, 10,030 53-74-year-old randomly selected citizens resident in Central Denmark Region received a questionnaire assessing health literacy using the European Health Literacy Survey Short Scale 16-item. Data on colorectal cancer screening uptake were obtained from the Danish Colorectal Cancer Screening database, and socioeconomic and -demographic data were linked from Statistics Denmark. The response rate was 71% (n=7142). Odds ratio (OR) for uptake was 1.06 (95% confidence interval (CI): 0.96, 1.19) for problematic health literacy and 1.00 (95% CI: 0.87, 1.16) for inadequate health literacy, when using adequate health literacy as the reference value. The association was not modified by socioeconomic or -demographic characteristics, worry or attitude. No association was found between health literacy and colorectal cancer screening uptake. Future research needs to clarify which dimensions of health literacy may predict screening uptake and how it is best measured.

Assessing health science students' health literacy and its association with health behaviours.

Health science students will play an important role in helping their patients to assess health information and thus to examine their health literacy level is crucial. We aimed to assess the health literacy (HL) status and its potential association with health behaviours. A cross-sectional study was conducted in 381 students (mean age of 20.68±3.89years). The HL questionnaire (HLS-EU-Q47) and the Health-Promoting Lifestyle Behaviors (HPLP-II) were used. The overall mean HL score was 36.52±7.73. About 30.2% of students have inadequate or problematic HL. The HPLP-II total score (β=0.188, 95% CI=0.024, 0.352), physical activity (β=0.062, 95% CI=0.009, 0.116) and health responsibility domains (β=0.042, 95% CI=-0.001, 0.086) were significantly associated with HL. Most health science students, as future healthcare providers, need to improve health literacy skills. Health literacy was linked to health behaviours, supporting the importance of including focus on health literacy in higher education curriculum.