Strengthen Health Literacy Research Articles

Non-health outcomes affecting self-care behaviors and medical decision-making preference in patients with type 2 diabetes: a cross-sectional study

BackgroundThe effects of patient sustained self-care behaviors on glycemic control are even greater than the effects of medical treatment, indicating the value of identifying the factors that influence self-care behaviors. To date, these factors have not been placed in a single model to clarify the critical path affecting self-care behaviors. The aims of this study were to explore the relationships of these factors and the differences in patient preference for medical decision-making.MethodsA cross-sectional study was conducted among outpatients with type 2 diabetes at a regional teaching hospital. Purposive sampling was adopted to recruit 316 eligible patients via self-administered questionnaires. Partial least squares structural equation modeling was used for analysis.ResultsSignificant direct pathways were identified from health literacy to self-efficacy, patient empowerment, and self-care behaviors; from self-efficacy to self-care behaviors; and from patient empowerment to self-care behaviors. Indirect pathways were from health literacy to self-care behaviors via self-efficacy or patient empowerment. The pathway from health literacy to self-efficacy was significantly stronger in those preferring shared decision-making than in those who preferred physician decision-making.ConclusionsHealth literacy is a critical factor in improving self-care behaviors in patients with type 2 diabetes, and the effect of health literacy on self-efficacy was more significant in the shared decision-making than in the physician decision-making. Therefore, developing an effective health strategy to strengthen health literacy awareness and designing friendly, diverse health literacy materials, and application tools is the most important factor to facilitate self-care behaviors in this population.

Using survey data on population health literacy for developing a National Action Plan in Germany

Abstract Promoted by the results of the European Health Literacy survey, the first representative German Health Literacy Survey (HLS-GER) was conducted in 2014. The results showed that every second individual in Germany (54.3 %) has limited health literacy. Thus, a majority of the German population is confronted with difficulties in finding, understanding, appraising, and applying health information. Particularly, vulnerable groups as people with migration background, low education attainment, and in older age as well as chronically ill have even more problems in processing health information and thus are confronted with challenges to maintain health, prevent diseases and use the healthcare system. Based on the initial research findings of the HLS-GER and the increasing attention and discussions arising with its results, the National Action Plan Health Literacy was developed by a group of experts to systematically improve and strengthen health literacy in Germany. After agreements with representatives of politics and society, health professions and patient and citizen organizations it was published in 2018. It includes 15 specific recommendations in four areas of action and focusses on fostering health literacy in daily life, creating a user-friendly and health literate healthcare system, HL and chronic illness and expanding health literacy research. Five underlying key principles are mentioned to consider in implementing the National Action Plan. The HLS-GER survey data were further used to discuss some recommendations within specialized workshops leading to more detailed strategy papers. The current political and practical developments and discussions initiated by National Action Plan, will be picked up in the second German Health Literacy Survey (HLS-GER2), which is part of HLS19. By repeatedly assessing population HL in Germany the implementation of the National Action Plan can be monitored and further specified, thus survey data help to create policy.

Potentials of school nursing for strengthening health literacy: a 2017/18 German longitudinal survey

Abstract Background Health literacy (HL) plays a key role in explaining health disparities. School nurses provide health related expert knowledge and skills within the school setting. A positive effect on the HL of children but also their teachers and parents is assumed and supported by some research but gaps persist in the available data. Methods As part of a pilot school nursing project, which placed school nurses in 28 public schools in two German states, all teachers, parents and students (11+ years) attending the schools were invited to participate in a 2017 baseline (T0) and 2018 follow-up (T1) survey. Adult HL was measured using the HLS-EU-Q16 and child HL with the HLSAC. Bi- and multivariate analyses were carried out. Results Comparing T0 and T1, HL scores improved in all populations. In East Germany (Brandenburg), the percentage of teachers with problematic or inadequate HL decreased from 56.6 (N = 173) to 51.5 (N = 173) and among parents from 45.7 (N = 1719) to 43.2 (N = 1080). In West Germany (Hessen), the percentage of teachers with problematic or inadequate HL also decreased, from 43.7 (N = 201) to 42.2 (N = 263), and among parents from 42.2 (N = 2013) to 34.9 (N = 1251). The percentage of children that scored in the moderate or high HL brackets increased from 77.9 (N = 898) to 82.2 (N = 736) in Brandenburg and from 84.9 (N = 1379) to 86.5 (N = 1487) in Hessen. There were strong statistical relationships between child/parental HL and child health behaviors in all datasets. The T0 and T1 comparison showed some improvements over time. The presence of school nurses in public schools seemed to increase health awareness, thus contributing to a “healthy school.” After a short period (18 months) and despite a rather nonspecific spectrum of interventions, the HL of all relevant target groups improved. Further research is needed to quantify the relative contribution of the school nurses to improvements in HL, for example, by implementing a HL curriculum in a controlled setting. Key messages The presence of a school nurse seemed to increase health awareness contributing to a “healthy school.” After 18 months of intervention, the health literacy of children, parents and teachers improved.

P203 Breaking the Vicious Cycle of Health Literacy and Related Health Outcomes: A Systematic Review

Background The goal to address health literacy issues and in turn improve health related outcomes has increased; however, evidence-based studies divulging the aspects that strengthen health literacy interventions in underserved populations is limited. Objective The purpose of this systematic review is to determine the factors that contribute to efficacy of health literacy interventions based on studies that were published between 2012 and 2018. Study Design, Settings, Participants Following the PRISMA guidelines, relevant studies were obtained through Medline, PubMed, Science Direct, and Scopus databases. Five authors screened and determined the quality of the studies using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and extracted the data from the articles. Measurable Outcome/Analysis A total of ten studies were reviewed. Results Factors identified as important contributors to efficacy of health literacy interventions included: comprehensive baseline assessment, tailoring messages based on the assessment, distinguishing health knowledge versus health literacy, applying recommended strategies for health literacy and affording adequate duration and dosage for the intervention. Conclusions Based on this review, studies that were successful in achieving their health literacy goals conducted comprehensive baseline interventions, utilized the results of the assessment to inform the intervention, and employed best practices for health literacy beyond the use of plain language. Most importantly, they allocated adequate dosage and duration as a commitment to change the desired behaviour. Funding None.

The effect of strengthening health literacy in nursing homes on employee pain and consequences of pain ‒ a stepped-wedge intervention trial.

Objective This study examined the effectiveness of a workplace health literacy intervention on pain intensity, bothersomeness of pain, and sickness absence. Methods The quasi-experimental stepped-wedge cluster trial evaluated an intervention with two elements: (i) courses for employees and management to organize a joint foundation of knowledge about pain prevention and management with communication tools, and (ii) structured dialogs between employee and supervisor, to develop action plans to prevent and reduce pain. Monthly measurements were taken of pain intensity (0-10 scale), bothersomeness (days/month), and pain-related absence (days/month). Results Six workplaces were recruited, and 88% of employees (509) participated in evaluations. At baseline, mean pain level was 4.0, mean bothersomeness was 3.8 days/month, and mean pain-related absence was 0.6 days/month. From linear mixed models, pain intensity was reduced by -0.28 [95% confidence interval (CI) -0.52- -0.04] corresponding to a 7% reduction. For employees with pain >3 at baseline, the reduction was -0.74 (95% CI -1.11- -0.38) or 12%. There was no significant mean change in bothersomeness or sickness absence among all employees. Conclusion This intervention was both feasible and effective in shifting the overall mean pain level downwards for the entire population by 7%, with an accentuated effect among employees with pain levels >3. Organizing health literacy in nursing homes might be a feasible and effective way to build work environment efforts targeting the needs of employees. Future studies should investigate whether organizing health literacy is effective in other workplace settings and for employees with other health challenges.

3.4-O7Informed choice in mammography screening program among migrant and non-migrant women: a survey among first-time invitees in Germany, 2013-2015

Background: In Germany, women aged 50 to 69 are invited biennially to the population-based mammography screening programme (MSP). There is still a broad discussion whether the benefits of the programme outweigh its harms. Hence, the concept of informed choice is of particular importance for MSP. The aim of this survey was to assess the proportion of informed choices among migrant and non-migrant women invited to the German MSP for the first time. Methods: A random sample of 17,349 women aged 50 from a sub-region of North Rhine Westphalia was invited to participate in a postal cross-sectional survey conducted in German and Turkish. Turkish and other migrants were identified by country of birth and German resettlers additionally by self-reported resettler-status. Turkish migrant women were oversampled, due to expected lower response-rates. The effect of migration status on informed choice and on its three components (knowledge, attitude and intention) were assessed by chi-square tests and logistic regression modelling. Results:5,847 (33.7%) women responded to the postal questionnaire. 4,113 complete cases were included in the analyses. The proportion of women making informed choices was low (27.1%). Turkish migrant women had the highest odds for making an uninformed choice (OR 5.30, 95%CI 1.92-14.66) independent of educational level. Other migrant groups only had slightly higher odds for making an uninformed choice (German resettlers: OR 1.50, 95%CI 1.00-2.25; other migrants: OR 1.57, 95%CI 0.96-2.57) compared to non-migrant women. Fewer Turkish and other immigrant women intended to participate in the MSP. Immigrant women had a more positive attitude and a lower proportion of sufficient knowledge compared to non-migrant women. Conclusions: The overall proportion of informed choice in the German MSP is low and knowledge is poor. Measures are needed to improve information materials, strengthen health literacy and create a user-friendly environment facilitating informed choices especially for migrant women.

Primary care intervention to address cardiovascular disease medication health literacy among Indigenous peoples: Canadian results of a pre-post-design study

ContextCardiovascular diseases (CVD) are a leading cause of illness and death for Indigenous people in Canada and globally. Appropriate medication can significantly improve health outcomes for persons diagnosed with CVD or for those at high risk of CVD. Poor health literacy has been identified as a major barrier that interferes with client understanding and taking of CVD medication. Strengthening health literacy within health services is particularly relevant in Indigenous contexts, where there are systemic barriers to accessing literacy skills.ObjectiveThe aim of this study is to test the effect of a customized, structured health literacy educational program addressing CVD medications.MethodsPre-post-design involves health providers and Indigenous clients at the De dwa da dehs nye>s Aboriginal Health Centre (DAHC) in Ontario, Canada. Forty-seven Indigenous clients with or at high risk of CVD received three educational sessions delivered by a trained Indigenous nurse over a 4- to 7-week period. A tablet application, pill card and booklet supported the sessions. Primary outcomes were knowledge of CVD medications and health literacy practices, which were assessed before and after the programe.ResultsFollowing the program compared to before, mean medication knowledge scores were 3.3 to 6.1 times higher for the four included CVD medications. Participants were also more likely to refer to the customized pill card and booklet for information and answer questions from others regarding CVD.ConclusionsThis customized education program was highly effective in increasing medication knowledge and health literacy practice among Indigenous people with CVD or at risk of CVD attending the program at an urban Indigenous health centre.

Health literacy: a critical concept for public health

Health literacy: a critical concept for public health

Evidence-Based Information on Mammography Screening in Austria - Reality or More Pie in the Sky?

Health literacy is gaining increasing importance in prevention and health care. This is the case for patients and for health-care professionals. Information and risk communication should comply with defined criteria and strengthen health literacy as they are a prerequisite for informed decision making. In this study, we analyse the content of the printed information material (brochures and pamphlets) on mammography screening for consumers that were distributed in Austria in 2011. The evaluation of the 11 brochures shows that the content does not comply with the prerequisites for informed decision making. Since the last study - published in 2004 - the situation has only slightly improved. The authors reemphasise the need for a targeted multimodal information campaign. This is particularly important as a systematic national mammography screening program in compliance with the guidelines of the European Commission will be introduced in Austria in 2013.

Interventional study to strengthen the health promoting behaviours of pregnant women to prevent anaemia in southern India

Objectivesto determine the effectiveness of a health information package in terms of empowering the pregnant women to modify their health-care behaviour and take appropriate action to combat anaemia in pregnancy. Designthe study was conceptualized based on Rosenstock and Becker's health belief model. A quasi-experimental pretest–posttest control group design was used. The sample consists of 225 anaemic pregnant women randomly allocated in experimental (n=75), control group A (n=75) and control group B (n=75). The health seeking behaviour outcome measure included knowledge regarding anaemia, food selection ability, increase in haemoglobin level and compliance to iron supplementation. Intervention was a validated planned educational programme with visual aids and iron supplementation. Findingsthe results show the mean gain of knowledge scores of experimental group was comparatively higher and control groups A and B showed that F ratio was (F(2,190)=11.910, p<0.01) indicating that the pregnant women learned more about anaemia prevention than others. With regard to food selection ability scores of experimental, control groups A and B the F ratio was also significant (F(2,190)=20.92, p<0.01). Nearly 61.2% of the subjects in experimental group became non-anaemic after the intervention when compared to control group A. This indicated that inspite of iron supplementation received by the three groups health education contributed significantly in modifying their health seeking behaviour and their perception about significance of anaemia has a problem. Conclusiondeveloping countries still face the critical problem of anaemia in pregnancy. These are the socio-cultural priority problems that demand immediate attention by the policy makers and health professionals. The national anaemia control programme focuses on iron supplementation, but nutritional education and supervision of iron supplementation has failed in different regions. The study implies that economic empowerment; strengthening health literacy through planned educational programs will definitely improve the health behaviour of individual and community at large.

The Development of a Health Literacy Assessment Tool for Health Plans

Despite growing information on the magnitude and consequences of low health literacy, there is little information about the role health plans are playing and the activities they undertake to address this problem. Our goal was to develop a health literacy organizational assessment tool for health plans that could be used as a benchmark and encourage further work. The existing tool consists of six evaluation areas: (1) information for members/navigation; (2) member services/communication; (3) web navigation; (4) forms; (5) nurse call line; and (6) nurse case/disease management. During May and June, 2009, a pilot was conducted with eight diverse health plans, including national, regional, and local plans serving commercial, Medicare, and/or Medicaid members. After incorporating feedback from the pilot, the full assessment was launched in June 2009. Feedback from the participating plans has been very positive about using this tool as a benchmark and using the results to help strengthen health literacy efforts within their health plans. The variety of health plans that have utilized this assessment tool suggests that widespread use is possible. Evaluation of health literacy efforts using this comprehensive tool can help bring attention to areas in need of improvement and help plans better engage consumers in their own health.

Nutrition and Schools Knowledge Summary

This review examined 117 research articles using a policy framework generated in previous research. Findings include: students are experiencing both food insecurity and an “epidemic of obesity”; policymakers remain focused on achievement; provinces address nutrition in isolation; poverty is a significant contributor; restriction of food is not an effective treatment; nurses and training may strengthen health literacy; costs offer barriers to implementation and sustainability; teacher training, funding, nutritious foods, and health professionals are important; the impact of “one-off” programs is small; and there is limited implementation and evaluation of comprehensive approaches to school health.

Track C10: Workshop: Strengthening health literacy—a strategic approach

Track C10: Workshop: Strengthening health literacy—a strategic approach