Short Test Of Functional Health Literacy In Adults Research Articles

Health literacy of patients eligible for cochlear implants

Background Hearing loss is known to be an independent risk factor for inadequate health literacy. The objective of this study was to assess the level of health literacy among patients undergoing cochlear implantation to determine areas for improvement in delivery of patient information. Methods A cross-sectional survey was conducted at the otology-neurotology clinic at Sunnybrook Health Sciences Centre. Patients eligible for cochlear implantation completed two health literacy screening tools: The Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Brief Health Literacy Screen (BHLS). Results Thirty seven patients were included (41% female, 59% male, mean age: 55 years). Most patients had adequate health literacy through BHLS (76%) and S-TOFHLA (98%) scoring. Over 80% of patients were not able to correctly recount all the operative risks associated with cochlear implant surgery and one third of patients did not correctly recount any risks associated with a cochlear implant surgery. Female sex was associated with higher scores (p=0.03) and low income (<$35,000) was associated with lower scores (p=0.05). Conclusion Patients eligible for cochlear implants have adequate health literacy, but most are not able to recount operative risks. Educational tools are required to improve patient retention, understand, and perioperative health information delivery.

The Relationship Between Signature Time and Functional Health Literacy: Results from a Prospective Study of an Urban Low-Income Population Receiving Long-Term Anticoagulation.

Low health literacy (HL) is consistently associated with worse health outcomes. Routine clinical screening with available instruments is impractical because of added time and effort. Prior findings suggested that signature time may be a reliable alternative measure of HL among general medicine patients. Our aim was to assess the screening performance of signature time and explore optimal thresholds for identifying patients with limited HL in a chronically anticoagulated population. English-speaking patients receiving long-term anticoagulation therapy were recruited. HL was assessed using the Short Test of Functional Health Literacy in Adults (STOFHLA). Signature time was measured using a stopwatch. Logistic regression models and receiver-operating characteristic (ROC) curves were used to evaluate the association and accuracy of signature time compared to HL, respectively. Of 139 enrolled patients, mean age was 60.1 years, 70.5% were African-American, 48.9% reported < $25,000 income, and 27.3% had marginal or inadequate HL. Overall, median time to sign was 6.1 s. Signature time was longest with inadequate HL (median 9.5 s) compared to adequate HL (5.7 s; p < 0.01). Longer signature time was significantly associated with lower HL after adjusting for age and education (aOR 0.77, 95% CI: 0.68-0.88, p < 0.01). Signature time demonstrated high accuracy (area under the curve [AUC] > 0.8) in identifying HL levels. Thresholds of 5.1 s and 9.0 s showed appropriate screening performance in distinguishing patients with adequate vs. marginal and marginal vs. inadequate HL, respectively. Signature time demonstrated strong screening performance and may offer a quick and practical approach to assessing HL among patients receiving long-term anticoagulation management.

Insight into global research on health literacy and heart diseases: A bibliometric analysis.

Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.

Validation of the Short-Test of Functional Health Literacy in Adults for the Samoan Population.

Background:Health literacy encompasses various levels of communication for an individual, provider, and an organization. Validated and reliable tools have been developed to assess health literacy; however, there is a paucity of tools available to assess health literacy in native languages for indigenous and racial/ethnic minority populations.Objective:This article shares the process taken to translate and evaluate validation and reliability of the Short Test of Functional Health Literacy in Adults for use with the Samoan population.Methods:Respondent-driven sampling was used to collect data from 1,543 adults age 45 years and older in American Samoa. A confirmatory factor analysis using a two-factor model for validation was conducted.Key Results:The validation results indicated a “good fit” in multiple indices and Cronbach's alpha indicated high internal consistency in both the English and Samoan languages.Conclusions:Developing culturally validated and reliable health literacy assessment tools is important to help health care professionals decrease health disparities and address inadequate health literacy in all cultures. [HLRP: Health Literacy Research and Practice. 2022;6(4):e247–e256.]Plain Language Summary:The INSPIRE project studied the Short Test of Functional Health Literacy in Adults (STOFHLA) tested on the American Samoan population age 50 years and older. The results would show if the STOFHLA is a valid tool to measure functional health literacy in American Samoa adults.

Psychometric Evaluation of Three Translated Measures of Functional Health Literacy among Jordanians.

Assessment of functional health literacy (FHL) is not integrated into clinical settings in Jordan possibly because relevant psychometric studies are lacking. The aim of this secondary analysis of data on family caregivers (N = 115) was to evaluate the internal consistency reliability and construct validity of three measures of FHL among Jordanians: the Short Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), and the Single Item Literacy Screener (SILS). Cronbach's alpha was excellent for the S-TOFHLA (.92), but suboptimal for the REALM-R (.67). In bivariate analysis, FHL measured by the S-TOFHLA and the REALM-R, but not the SILS, was positively associated with educational attainment (p < .05) and negatively related to self-reported anxiety (p < .05). Among Jordanians, psychometric rigor was fully demonstrated for the S-TOFHLA and partially for the REALM-R, but not for the SILS.

Understanding the hidden epidemic of metabolic syndrome in people accessing community rehabilitation: a cross-sectional study of physical activity, dietary intake, and health literacy

Purpose To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome. Materials and methods A cross-sectional, multi-centre, observational study of adults (n = 193) presenting to rehabilitation with various health complaints. Metabolic syndrome was determined according to the International Diabetes Federation joint consensus worldwide definition. Health literacy was assessed using the Rapid Estimate of Adult literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Physical activity was assessed using accelerometers and dietary intake was assessed using a food frequency questionnaire. Results One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD −2.10, 95% confidence interval (CI) −3.98 to −0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake. Conclusions Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitation Almost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome. Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome. A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.

The Montreal cognitive assessment as a cognitive screening tool in sickle cell disease: Associations with clinically significant cognitive domains.

SummaryAdults with sickle cell disease (SCD) are at risk for cognitive impairment, which causes significant morbidity. Guidelines support routine cognitive screening, but no screening test is validated in this population. We explored the Montreal Cognitive Assessment (MoCA) as a possible screening test in SCD. We administered the MoCA; a literacy test, the Wide Range Achievement Test, fourth edition (WRAT‐4); and a health literacy test, the Shortened Test of Functional Health Literacy in Adults (S‐TOFHLA) to adults with SCD and gathered clinical variables through chart review. Spearman's rho, Mann–Whitney, and Kruskal–Wallis tests and quantile regression models were used. Among our sample of 49 adults with SCD, the median MoCA score was 25.0 [interquartile range (IQR) 22.0–28.0]. Higher educational attainment was associated with MoCA scores (p = 0.001). In multivariable models, MoCA scores were associated with S‐TOFHLA (p = 0.001) and WRAT‐4 Reading (p = 0.002) scores, and overt stroke (p = 0.03) at the median. This pilot study adds to the limited literature of cognitive screening tests in adults with SCD and demonstrates a relationship between MoCA scores and measures of literacy and health literacy. The MoCA is a promising option for briefly screening for cognitive impairment in adults with SCD, though further study is needed to confirm its validity.

Role of Health Literacy on Health Behaviour Change among the College Girl Students

Health literacy refers to a person's knowledge and abilities to make sound health decisions in everyday life. The overall goal of this study was to discover the influence of health literacy on the health behaviour of college girls, using proportionate stratified sampling, 178 (55.27% females studying health and physical education (HPE) at Surkhet Campus, and HA/Staff Nurse at SEDA Campus, Surkhet were chosen. Researchers used a cross-sectional design for this study. The Short Test of Functional Health Literacy in Adults (S-TOFHLA) was used to assess health literacy, while the Self-Administered Questionnaire was used to assess health behaviour. As per the survey findings, 53.93% of respondents had appropriate health literacy. Health literacy plays a key role in physical activity and its duration. Furthermore, study revealed that health literacy has no role on campus girls' smoking, using alcohol, and health check-up behaviour. Finally, the research suggested that health literacy is required to include in higher education programmes.

Association of health literacy and other risk factors with glycemic control among patients with type 2 diabetes in Kuwait: A cross-sectional study

BackgroundPoor health literacy (HL) has received much attention recently as a risk factor for poor health outcomes especially among patients with chronic diseases. The degree to which HL affects health outcomes is unknown among patients with type 2 diabetes mellitus (T2DM) in Kuwait. This study aimed to investigate the association between HL and glycated hemoglobin (HbA1c) among patients with T2DM. Methods356 patients with T2DM were selected from 27 primary care clinics covering the state of Kuwait. HL was measured by the Short Test of Functional Health Literacy in Adults (STOFHLA). Prevalence of uncontrolled HbA1c was estimated and its association with HL was modeled and tested using Poisson regression with log-link function and robust variance-covariance matrix, while adjusting for several confounders. ResultsThe prevalence of uncontrolled HbA1c was 77.8%. Among those with inadequate or marginal HL, about 50.7% have uncontrolled HbA1c. The prevalence of uncontrolled HbA1c among those on diet alone was 36.3% lower compared to those on mixed treatment regimen (APR = 0.637, 95% CI: 0.455–0.891, PV = 0.008). The prevalence of uncontrolled HbA1c among patients on oral hypoglycemic (OH) drugs alone was 22.3% lower compared to those on mixed treatment (OH plus Insulin) regimen (APR = 0.777, 95% CI: 0.697–0.865, PV < 0.001). For every one-year increase in age, there is 1.4% reduction in the prevalence of uncontrolled HbA1c (APR = 0.986, 95% CI: 0.978–0.994, PV < 0.001). For one STOFHLA score increase, there is 0.3% reduction in the prevalence of uncontrolled HbA1c (APR = 0.997, 95% CI: 0.994–1.00, PV = 0.055). Finally, for every year increase since T2DM onset, there is 1.1% increase in the prevalence of uncontrolled HbA1c (APR = 1.011, 95% CI: 1.003–1.019, PV = 0.008). ConclusionsThe prevalence of uncontrolled HbA1c among patients with T2DM in Kuwait is high. Half of T2DM with inadequate or marginal HL have uncontrolled HbA1c. Patients on diet alone or OH alone have lower prevalence of uncontrolled HbA1c compared to those on mixed treatment regimen. Older T2DM patients or those with higher STOFHLA score have lower prevalence of uncontrolled HbA1c, while those with longer T2DM onset have higher prevalence of uncontrolled HbA1c. Future interventions should focus on younger patients, improve HL, and establish better communications between physicians and patients with T2DM for better glycemic control.

Considerations on Health Literacy and Hearing Aid Use

Considerations on Health Literacy and Hearing Aid Use

Reading Comprehension Abilities in the Anglophone Aging Population with Post-Secondary Education

Literacy skills such as reading comprehension are essential in order to understand written information and complete daily tasks. Low literacy skills are common in the aging population thus affecting quality of life, independence and social integration. Reading comprehension is a complex activity that requires processing at many different levels. According to Kintsch’s construction-integration model, three levels of representations of a text must be achieved in order to fully comprehend a text. Previous studies often considered the aging population as a single group and compared this group to young adults. However, few studies examined the variability in reading comprehension abilities within the aging population. Studies examining the variability in the construction of a situation model in older adults are even more scarce. The main objective of this study is to examine the effect of age on reading comprehension abilities at the surface model, text-based model and situation model in the aging population with high education level.&#x0D; Participants were recruited in northern Ontario and were grouped into three age intervals (60-69 years; 70-79 years; ≥ 80 years). Participants’ cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) and health literacy was assessed using the Short Test of Functional Health Literacy in Adults (STOFHLA). Reading comprehension abilities were evaluated using the Woodcock Reading Mastery Tests - third edition (WRMT-III) as well as the Gray Oral Reading Test – fifth edition (GORT5).&#x0D; Results indicated no significant differences in performance of reading comprehension abilities among the three age groups at the surface level, text-based level, and situation model level of reading comprehension. These findings suggest no age-related effect on reading comprehension abilities in adults with high levels of education. The lack of differences observed may be explained by the absence of differences in cognitive functions between the three age groups as well as the high level of education which may have acted as a protective factor. Future studies should examine reading comprehension in Anglophone adults with lower levels of education to better understand whether education is a protective factor against a decline in reading comprehension abilities in the aging population.

Aging and Functional Health Literacy: A Population-based Study

To investigate functional health literacy and its associated factors among older adults drawn from a disadvantaged area.Cross-sectional epidemiologic study.Population-based cohort randomly selected from the voter registration lists.Individuals aged 65+ (N=1066).The Short Test of Functional Health Literacy in Adults (S-TOFHLA); demographics; self-rated health; number of prescription drugs; modified Center for Epidemiologic Studies- Depression scale; Mini-Mental State Examination; Wechsler Test of Adult Reading; Clinical Dementia Rating; cognitive domain composite scores; independence in Instrumental Activities of Daily Living and medication management; health services utilization (emergency/urgent care visits and hospitalizations).Low (inadequate or marginal) S-TOFHLA scores were obtained by 7.04% of the sample. In unadjusted analyses, participants with low S-TOFHLA scores were significantly more likely than those with higher scores to be older, male, non-White, with lesser education and lower household income, to have lower scores on the Wechsler Test of Adult Reading, the Mini-Mental State Examination, and all cognitive domains; to be more dependent in Instrumental Activities of Daily Living and be taking more prescription drugs. In a multiple regression model including all covariates, only older age, male sex, and lower reading level were independently associated with inadequate or marginal S-TOFHLA scores.In a population-based sample of older adults, low functional health literacy was associated with age, sex, education, and reading ability. Basic functional health literacy is essential for understanding health information and instructions. Clinicians should formally or informally assess health literacy in their older patients to ensure effective communication and enhance health outcomes.

Factors influencing chemotherapy knowledge in women with breast cancer

BackgroundChemotherapy knowledge is linked to managing side effects, reducing exposure to potential infection, and adjusting lifestyle behaviors while going through treatment. However, no research exists regarding the influence of patients’ personal attributes on chemotherapy knowledge.AimThe aim of this study was to describe the relationships of health literacy and demographics on chemotherapy knowledge among women with breast cancer undergoing treatment. MethodWe used a descriptive, exploratory design with convenience sampling of women with breast cancer receiving intravenous chemotherapy who completed one mandatory education session. Participants completed a demographic questionnaire and three instruments: 1) Rapid Estimate of Adult Literacy – Short Form (REALM-SF); 2) Shortened Test of Functional Health Literacy in Adults (S-TOFHLA); and 3) Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC). We used univariate linear regression and ANOVA to identify how health literacy and demographics influenced chemotherapy knowledge. ResultsThe REALM-SF (p = .022) and S-TOFHLA (p = .023) scores were significantly associated with chemotherapy knowledge. Chemotherapy knowledge scores were affected by marital status (p = .018) and income (p < .001) where married women had significantly higher chemotherapy knowledge scores (M = 92.6, SD = 6.6) than women who were divorced (M = 83.3, SD = 16.7) with a knowledge score difference of −9.3 between the groups (p = .02). Comparisons showed significant differences of chemotherapy knowledge between women with differing income levels. ConclusionsThis study highlights the relevance of considering patients' health literacy and personal attributes such as marital status and income when teaching about chemotherapy.

Health literacy and related health behaviour: a community-based cross-sectional study from a developing country

Abstract Objectives The concept of health literacy (HL) is globally evolving, and understanding its nature and impact is essential for disease prevention and treatment. Therefore, we aimed in this study to assess level of HL and predictors of inadequate HL in Jordanian population as an example case of a developing country. Method This cross-sectional study was conducted in a public tertiary hospital and community pharmacies in Jordan. All respondents answered a questionnaire, which included demographic data, Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Short Test of Functional HL in Adults (S-TOFHLA), and All Aspects of HL Scale (AAHLS). Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for HL. Key findings Among 310 participants, REALM-R showed that around 27.1% had limited HL. Similar findings with S-TOFHLA and AAHLS were shown with a mean score 25.6 out of 35 (SD = 3.54, Range = 16–33) for AAHLS. Functional and critical HL were comparably low. Education level, age, living area and chronic conditions were significant predictors of HL (P &amp;lt; 0.05). Conclusions Health literacy was inadequate among Jordanians. Further research is required to assess the effect of inadequate HL on healthcare access and health outcomes. Health education programmes are required to improve HL particularly for patients with chronic diseases.

Health Literacy and Medication Adherence in COPD Patients: When Caregiver Presence Is Not Sufficient

Limited health literacy (HL) is associated with a lower medication adherence in patients with chronic obstructive pulmonary disease (COPD). In this study, we examined the potential mitigating role of caregiver support on the relationship between HL and adherence to COPD medications. We conducted a prospective observational study of adults with COPD and their caregivers. HL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and COPD medication adherence was evaluated with the Medication Adherence Rating Scale (MARS). We also collected caregiver HL data for a subset of participants. We tested whether having a caregiver impacted the relationship between HL and medication adherence using cross-sectional data collected between 2011 and 2015. Our sample included 388 COPD patients and 97 caregivers. COPD patients with low HL had a lower medication adherence (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.24–0.81) after adjusting for sociodemographic factors. Caregiver presence was not associated with increased patient medication adherence (OR: 1.28, 95% CI: 0.79–2.08). Among the subset of patients with caregivers, low patient HL remained associated with a lower medication adherence (OR: 0.28, 95% CI: 0.09–0.82) when adjusted for caregiver HL and sociodemographic factors. Low HL is associated with lower COPD medication adherence, and this effect is not mitigated by the presence of a caregiver. These findings suggest a need for effective strategies to manage high-risk COPD patients with low HL, even among those with adequate support from caregivers, and to design interventions for both patients and caregivers with low HL.

Role of Health Literacy on Menstrual Hygiene Practice among the Girl Students

The main aim of this study was to find out the role of health literacy on menstruation hygiene practice of campus girls. The population of this study were girls studying health and physical education in Surkhet Campus and HA/Staff Nurse in SEDA Campus. Surkhet was selected by proportional stratified sampling. This study followed descriptive and cross-sectional design. The study used two tools Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Self Administrated Questionnaire for collecting data. It was found that health literacy among girls of study area is not satisfactory. The findings indicate that 53.93 percent respondents have adequate health literacy. Adequate health literacy level of girls of HA/Staff nurse, aged 16-18 years and 19-21 years and Chhetri and Janajati had adequate health literary. The findings support that higher proportions of the adequate health literate respondents have good menstruation hygiene practice than inadequate health literate respondents. Finally, the results indicated that health literacy among the girls is inadequate, that calls more concern to the matter of health literacy in educational programs.

2285-PUB: Risk of Developing T2DM in Lebanon: The Role of Health Literacy, Quality of Life, and Dietary Habits

Background: International T2DM Federation (IDF) estimates T2DM prevalence in Lebanese adults around 14%. Identifying people at risk of developing type 2 T2DM mellitus (T2DM) as to prevent rising prevalence and development of T2DM related complications is crucial. Aim: to identify people at high risk for developing T2DM. Methods: A convenience sample (N=198) of healthy Lebanese adults, 40 years of age and above, were recruited through snowballing from all over Lebanon. Food Frequency Questionnaire (FFQ), Short Test of Functional Health Literacy in Adults (STOFHLA), World Health Organization Quality of Life-BREF (WHOQoL-BREF), and ARABRISK were administered. Results: Majority of the participants were 40 to 54 years (74.25%), females (57.58%), married (51.02%), employed (59.90%) and reported having “enough to make ends meet” (64.29%). Significant association resulted between ARABRISK scale score and WHOQoL-BREF scale (β= -1.642, p= 0.001) as well as two of its subscales, physical (β= -2.21, p &amp;lt; 0.001) and psychological (β= -1.17, p= 0.003). Significant association was noted between ARABRISK scale score and demographic characteristics; mainly marital status, particularly being “married” (β= 15.47, p &amp;lt; 0.001) and “widowed/divorced” (β= 25.72, p &amp;lt; 0.001), and employment statuses particularly “not enough to make ends meet” (β= 8.64, p= .021).Significant association resulted between ARABRISK scale score and at whole grain consumption (β= -4.97, p = 0.035) and red meat (β= 13.02, p = 0.003). Marital status, red meat consumption, whole grains consumption, and physical health subscale were significantly associated with ARABRISK in the fully adjusted multiple linear regression model. The combination of the latter variables accounted for 36.83% of the variance of ARABRISK score. Conclusion: Findings will help health care practitioners to understand the determinants of T2DM risk, which will set the stage for effective preventive measures in reducing the risk and incidence of T2DM. Disclosure O.A. Sukkarieh-Haraty: None. J. Abi Kharma: None. N. Farran: None. M. Bassil: None. Funding Lebanese American University

PCV86 THE RELATIONSHIP BETWEEN SIGNATURE TIME AND FUNCTIONAL HEALTH LITERACY IN AN UNDERSERVED URBAN POPULATION

Low health literacy (HL) is consistently associated with worse health outcomes. Clinical screening for HL with available instruments is impractical due to added time and effort. Signature time may be a reliable, alternative option. Our aim is to explore the association between time to sign and HL in an underserved urban population. English-speaking patients receiving long-term warfarin therapy at UI Health were recruited. HL was assessed using the Short Test of Functional Health Literacy in Adults (STOFHLA). Time to sign was the average of two signature times recorded by stopwatch. Partial proportional odds logistic models, using odds ratios (OR) and 95% confidence intervals (CI), were fitted to evaluate the association between signature time and 3-level HL. Of 139 recruited patients, mean (SD) age was 59.7 (13.7) years, 98 (70.5%) were African-American, and 68 (48.9%) reported <$25,000 income. As for education level, 56 (40.3%) reported some college or above, 62 (44.6%) reported high school diploma or equivalent, and 20 (14.4%) reported less than high school diploma. HL was adequate in 101 patients (72.7%), marginal in 11 (7.9%) and inadequate in 27 (19.4%). For the total population, median (IQR) time to sign was 6.1 s (4.7-8.7). Time to sign was longest with inadequate HL, median (IQR) of 9.5 s (7.1-14.0), compared to marginal HL 7.4 s (5.4-9.6) and adequate HL 5.7 s (4.5-7.1) (p<0.001). Longer time to sign was significantly associated with lower HL in crude model (OR 0.76, 95% CI: 0.67-0.86, p<0.001), and model adjusted for age and education (aOR 0.79, 95% CI: 0.69-0.90, p<0.001). Longer time to sign was associated with lower HL levels in this underserved population. Evaluation of the relationship between signature time as a proxy for HL and anticoagulation clinical outcomes is warranted in the future.

Health Literacy: Current Status and Challenges in the Work of Family Doctors in Bosnia and Herzegovina.

Health literacy (HL) has become an important area of research. The aim of this study was to evaluate the HL of primary healthcare patients in the Republic of Srpska (RS), Bosnia and Herzegovina (B&H) and to identify socioeconomic and health factors associated with HL. This cross-sectional study among 768 patients was conducted in two healthcare centres between March and May 2017, using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Analysis was done using descriptive and inferential statistics (a chi-squared test and logistic regression). Inadequate and marginal HL was found in 34,6% of respondents. Socioeconomic and self-reported health factors were significantly related to HL. An age of 55 years and over (OR 1.02), living in a rural environment (OR 2.25), being divorced (OR 3.32), being insufficiently physically active (OR 1.29), having poor income (OR 1.96), having more than three chronic diseases (OR 1.94), and poor health (OR 1.59) were significantly corelated with inadequate and marginal HL. The results of our study indicate that a low level of HL is related to the elderly, having a divorce, having a rural residence, poor income, having more than three chronic diseases, poor health, and insufficient physical activity. Further evaluation, monitoring, and activities to improve HL are of great importance for patients’ health outcomes.

Assessment of health literacy in the adult population registered to family medicine physicians in the Republic of Srpska, Bosnia and Herzegovina

Background: Health literacy is an important determinant of health. This concept is under-researched in the Republic of Srpska, Bosnia and Herzegovina.Objectives: To assess health literacy and its association with sociodemographic variables, self-perception of health and the presence of chronic conditions in primary healthcare setting.Methods: In May 2016, a cross-sectional study was executed in two primary healthcare centres. Out of approximately 1500 patients who visited both health centres during four consecutive days, about 800 were eligible. Of these, 110 patients agreed to complete the translated Short Test of Functional Health Literacy in Adults (S-TOFHLA). The influence of demographic, social, economic, and health characteristics (independent variables) on the S-TOFHLA score (dependent variable) was assessed by multiple logistic regression analysis.Results: One questionnaire was incomplete and therefore 109 questionnaires were analysed. Inadequate, marginal, and adequate health literacy were present in 19 (17.4%), 16 (14.7%) and 74 (67.9%) respondents. Adequate health literacy was found predominantly among respondents younger than 55 years and those with a high level of education. Regression analyses showed that low level of education (OR: 5.3), age 55 years and over (OR: 3.9), living in a rural area (OR: 3.7) and having three or more chronic diseases (OR: 2) were independently associated with inadequate or marginal health literacy.Conclusion: In this study performed in two primary healthcare centres in the Republic of Srpska, Bosnia and Herzegovina, low health literacy was associated with low level of education, older age, living in a rural area, and having more chronic diseases.