Sufficient Health Literacy Research Articles

Health Literacy and Active Transport in Austria: Results from a Rural Setting.

Health literacy (HL) has been determined for the general population and for subgroups, though the relationship between HL and active transport in rural areas was not explored. The aim of our study is to investigate HL among citizens in an Austrian rural region and to explore the associations between HL and active transport. This cross-sectional telephone survey included 288 adults (171 women) with a mean age of 57.8 (SD 0.9). HL was assessed using the HLS-EU-Q16 questionnaire. Active transport was measured as the minutes per week spent on walking or cycling from A to B. After descriptive analysis, the association between HL and active transport was assessed using linear regression models. The mean HL score for all participants was 37.1 (SD 7.7). Among all subjects, 6.9% showed inadequate HL, 25.7% problematic HL, 38.9% sufficient HL, and 28.5% excellent HL. HL was significantly higher among citizens with high education (p = 0.04) and training/employment in healthcare (p = 0.001). Active transport was not associated with HL (p = 0.281). Active transport in rural areas might be influenced by other predictors like distance to work, street connectivity, and accessible facilities for walking and biking. This needs to be explored further for rural areas.

‘Don’t know’ responding and estimates of perceived risk: failing to provide a ‘don’t know’ response systematically biases laypeople’s perceived risk estimates

Individuals sometimes report that they don’t know their risk for a health problem, but many studies of illness risk perception do not provide a ‘don’t know’ (DK) response option. We examined how providing versus not providing a DK option affected responding – either the number of DK responses when the option was provided or the number of skips when a DK option was not provided. We also examined whether it systematically affected perceived risk estimates. Participants (N = 960) reported perceived absolute and comparative risk for four health issues. They were randomly assigned to receive risk questions with or without a DK response option. In the DK Option condition, ‘don’t know’ answers ranged from 3.5% to 12.7% of responses. For all absolute risk questions, perceived risk was significantly higher in the DK Option condition; all Fs (1, 932) < 3.79, all ps < .05. DK responding was issue-specific; more than 25% of the sample answered DK to at least once, but only 2.7% answered DK to more than half of the items. Substantial use of the DK response option and higher perceived absolute risk estimates were seen when a DK response was provided. These findings have implications for assessing the validity of measured risk estimates, of relations between constructs, and for survey design best practices. In addition, they suggest that DK responses are primarily knowledge-based – that individuals answer DK largely because of lacking sufficient knowledge or health literacy to form a risk perception rather than due to satisficing.

Coronavirus-Related Health Literacy in Germany: A Cross-Sectional Study in Adults During the COVID-19 Infodemic

Background: The COVID-19 pandemic is surrounded by an infodemic – an overabundance of valid and invalid health information. Health literacy is the ability to access, understand, appraise and apply health information, making it crucial for navigating coronavirus and COVID-19 information environments. The aim of this cross-sectional study is to investigate health literacy in relation to coronavirus and the associated infodemic. Methods: A cross sectional representative study of participants ≥16 years in Germany was conducted using an online survey. A coronavirus-related health literacy measure was developed (HLS-COVID-Q22). Reliability and validity were evaluated by applying internal consistency and confirmatory factor analyses. Health literacy data was analysed using descriptive statistics and bivariate correlations. Findings: Internal consistency for the HLS-COVID-Q22 was very high (α = ·940; ρ = ·891). 50·1% of our sample had “problematic” (15·2%) or “inadequate” (34·9%) health literacy and 49·9% had sufficient health literacy. The participants felt well informed about coronavirus but 47·8% reported having difficulties judging whether they could trust media information on COVID-19. Confusion about coronavirus information was significantly higher among those who had lower health literacy. Interpretation: HLS-COVID-Q22 is a feasible tool for assessing coronavirus-related health literacy in population surveys. While the overall level of health literacy is high, a vast number of participants report difficulties dealing with coronavirus information. This calls for targeted public information campaigns and promotion of population-based health literacy for better navigation of the infodemic, identification of disinformation, and decision-making based on reliable and trustworthy information. Funding: German Federal Ministry of Education and Research (BMBF), Orkan Okan and Torsten Michael Bollweg received funding (01EL1824A; grant holder Ullrich Bauer) from the Federal Ministry of Education and Research: Health Literacy in Childhood and Adolescence (HLCA) for this work. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was approved by the Bielefeld University Ethics Board (Reference No 2020-060_S). All personal data obtained was anonymized by Allensbach, and Bielefeld University study group received a fully anonymized. Data protection procedures were covered in adherence with the European Union General Data Protection Regulation (EU) (GDPR).

Hemşirelik Öğrencilerinde COVID-19 Pandemisi Farkındalıklarının ve Sağlık Davranışlarının Sağlık Okuryazarlığı ile İlişkisinin Değerlendirilmesi

INTRODUCTION: This study aimed to evaluate the relationship between nursing students’ awareness of the COVID-19 pandemic and health behaviors with health literacy. METHODS: This descriptive and cross-sectional study comprised 408 students enrolled in an undergraduate nursing program at a public university in Turkey. The data were collected online using the Individual Information Form, Healthy Lifestyle Behavior Scale II, and Turkish Health Literacy Scale-32. The percentiles, significance test of the difference between two means, and Pearson correlation analysis were used to analyze the data. RESULTS: The mean age of students was 20.89±1.95 and three of them had been diagnosed with COVID-19. It was determined that the students had sufficient health literacy (𝒙̅ =35.97±8.73), and healthy lifestyle behaviors during the COVID-19 pandemic were at a moderate level (𝒙̅ =55.76±12.05). The results showed that as awareness of nursing students regarding COVID-19 and precautions against it increased, their mean score of health literacy increased, too (p&lt;.05). Furthermore, there was a positive correlation between students’ mean score of healthy lifestyle behaviors in nutrition, physical activity, and stress management and their mean score of health literacy (p&lt;.05). DISCUSSION AND CONCLUSION: As the results have shown a relationship between nursing students’ awareness of COVID-19 and healthy lifestyle behaviors and health literacy, it is suggested to adapt the health literacy to students’ daily life during the pandemic period.

Measuring health literacy: performance-based versus perception-based measures

Abstract Background Many performance-based or perception-based measurement tools of health literacy (HL) have been developed. The aim of this study is to compare the results of performance-based versus perception-based measures of HL in a population-based sample in Florence (Italy). Methods 223 subjects were interviewed. To measure HL, HLS-EU-Q16 (perception-based measure of general HL) and NVS (performance-based measure of functional HL) were used. Sociodemographic characteristics were collected. Results The majority of the subjects had high school (36%) or university (44%) degree and gets to the end of the month quite or very easily with financial resources available (69%). Considering age classes, 22% was 18-45, 26% 46-55, 34% 56-65, 18% 66-70 year-old. According to HLS-EU-Q16, 11.8% had inadequate, 55.5% problematic and 33% sufficient HL; considering NVS, 11.7% had high likelihood of limited HL, 28.7% possibility of limited HL, 59.6% adequate HL. The percentage of people with low HL was higher for HLS-EU-Q16 than for NVS in each category of age class, educational level, and financial resources. For both measures, the percentage of people with low HL increased with age, becoming more similar for older people: for HLS-EU-Q16, from 59.2% for 18-45 to 78.4% for &amp;gt;65 years old; for NVS, from 20% for 18-45 to 67.5% for &amp;gt;65 years old. Similar results were observed for educational level and financial resources: for both tests, the percentage of people with low HL increased with the decreasing of educational level or financial resources; for the worst situations (less than high school diploma or having not enough financial resources), the percentage of people with low HL become similar comparing the two tests. Conclusions Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects, but in the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result. Key messages Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects. In the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result.

The Role of Academic Partnership in Disaster Risk Management: A Systematic Review.

The aim of this systematic review is to investigate the community-based academic partnership roles in disaster risk management. The assessment of the documents was conducted by reviewing abstracts and full papers of the available studies, which provided considerable background and promoted knowledge in academic interventional roles in disaster risk management. The articles were searched with a wide range of key words related to the research topic. The studies included the research available between 2000 and September 2017 in the English language. The selection of articles was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Of 997 articles, we selected 12 full-text articles that met the criteria for the final review based on the study objective. The results show that, although universities can play multidirectional roles in disaster risk management phases, the development of the academic partnership potential and collaboration for disaster risk management and disaster risk reduction for stakeholders is necessary. The universities' potential in providing sufficient disaster health literacy is not currently considered important enough in communities.Therefore, the proper context-bound models of development based on a community's skills and universities' potential should receive more attention.

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

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

Health Literacy in Adolescent and Young Adult Cancer Patients and Its Association with Health Outcomes.

This cross-sectional German study examined the frequency of health literacy (HL) in adolescents and young adult (AYA) cancer patients and the factors associated with HL. A sample of 206 AYA-aged patients (80.1% female; age 15-39 years) completed measures of HL, health-related quality of life (HRQoL), depression, and sociodemographic characteristics; 28% had a sufficient HL score. Males and patients with higher education levels reported higher HL scores. Regression revealed positive associations between HL and HRQoL and depressive symptoms. Results suggest the need to further examine HL and its predictors in AYAs with cancer to develop interventions for improving HL.

Development and Validation of an Environmental Health Literacy Assessment Screening Tool for Domestic Well Owners: The Water Environmental Literacy Level Scale (WELLS).

In the U.S., privately owned wells are not subject to any regulatory testing requirements. Well owners must have sufficient environmental health literacy (EHL) to understand and interpret information that contain complex terms and labels to manage their water quality. The objective of this paper is to assess the performance and validity of a new EHL screening tool. The Water Environmental Literacy Level Scale (WELLS) is based on the Newest Vital Sign (NVS) and contains six questions on comprehension, calculations and application of information. Content validity was assessed from expert review. Criterion-related and construct validity were evaluated using an online, convenience sample of adults (n = 869). Percent of correct responses for items ranged from 53% to 96% for NVS and from 41% to 97% for WELLS. Completion time, mean scores, distributions, and internal consistency were equivalent between both scales. Higher scores suggest higher EHL. The scales were moderately correlated (ρ = 0.47, p < 0.001). Kappa agreement was 74%. Bland-Altman plots depicted little mean difference between the scales. Education and income level were positively associated with EHL. WELLS showed criterion-validity with NVS and construct validity with education and income. In practice or research, WELLS could quickly screen individuals for low EHL.

Healthcare utilisation and health literacy among young adults seeking care in Sweden: findings from a cross-sectional and retrospective study with questionnaire and registry-based data.

The objective of this study was to examine young adults' healthcare utilisation and its possible association with health literacy. Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20-29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor. This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischer's exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation. Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002). Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults' reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.

Are anxiety levels associated with the decision to participate in a Swedish colorectal cancer screening programme? A nationwide cross-sectional study

ObjectivesColorectal cancer (CRC) screening programmes are commonly challenged by low uptake, limiting their potential to reduce CRC burden. We aimed to investigate anxiety levels related to the decision to participate...

Health Literacy and Knowledge of Chronic Diseases in Nepal.

Background:Understanding of risk factors and developing healthy lifestyles is a way of tackling the surging burden of chronic diseases in low-to-middle income countries such as Nepal. Health literacy (HL) has a pivotal role in prevention, adherence to treatment, self-care, and better use of health care; therefore, factors associated with HL need to be studied in the context of Nepal.Objective:This study was conducted to assess the level of HL and explore disease-specific knowledge among patients with chronic diseases.Methods:A cross-sectional study was conducted among 426 respondents with hypertension, diabetes mellitus, or chronic obstructive pulmonary disease from a tertiary care hospital and primary care clinics using face-to-face interviews. HL was measured using a translated and pretested HL questionnaire (the Europe-Asia Health Literacy Survey Questionnaire). Disease-related knowledge was assessed using a validated questionnaire.Key Results:The study found that 27% of the respondents had sufficient HL, 19% had marginal HL, and 54% had inadequate HL. Factors associated with inadequate HL included being older and female, and having lower or no education, unemployment or retired status, poverty, and having a history of smoking or a history of consuming alcohol. HL was a strong predictor of knowledge regarding hypertension (β = 0.32; p < .05), diabetes mellitus (β = 0.41; p < .05), and chronic obstructive pulmonary disease (β = 0.37; p < .05) in multiple regression analyses after adjusting for age, gender, education, marriage, family history of disease, attendance at follow-up clinics at recommended intervals, information received regarding disease at clinics, smoking, and alcohol intake.Conclusions:A sufficient level of HL was uncommon among participants in our study. People with sufficient HL knew significantly more about their diseases or conditions than those with inadequate HL. [HLRP: Health Literacy Research and Practice. 2018;2(4):e221–e230.]Plain Language Summary:Very little is known about health literacy in Nepal. We conducted a study to learn how much people in Nepal with hypertension, diabetes, or chronic obstructive pulmonary disease knew about their condition and sought to check its association with health literacy. We found that more than one-half of the participants did not have adequate health literacy levels. Participants who were older, female, uneducated, retired from work, or poor had lower levels of health literacy. We also found that those with high levels of health literacy had better knowledge of their disease. Therefore, we recommend that in Nepal health literacy should be measured for each patient and support regarding management of his or her condition should be provided if necessary.

The Relationship between Health Literacy and General Health Level of Hemodialysis Patients: A Case Study in Iran

Background: Health literacy includes the social cognitive skills that determine the motivation and ability of individuals in achieving, understanding, and utilizing information to maintain and enhance health. People with inadequate health literacy have a weaker health condition. The present study aimed at investigating the relationship between health literacy and the general health level of hemodialysis patients. Methods: This descriptive - analytical study was performed on 130 hemodialysis patients of Baharlu Hospital in Tehran. Data were collected using Health Literacy and General Health Assessment Tool. The collected data were analyzed using SPSS 21.0 software and Spearman correlation test. Results: The results revealed that the health literacy mean score was 46.81 ± 22.87 and that the studied individuals did not have sufficient health literacy. The general health mean score was 14.20 ± 6.50, and there was a statistically significant relationship between health literacy and general health (P < 0.05). Conclusions: In this study, it was found that those with higher health literacy score had better general health. Dialysis causes many clinical and psychological problems, limiting physical and mental activities of the patients. The decrease in health literacy is associated with a decrease in health including physical and psychological problems. In general, dialysis patients still need to learn more about health literacy and general health.

Health literacy of students. Results of an online survey at the Bochum health university (Germany) / Gesundheitskompetenz Studierender – Ergebnisse einer Online-Befragung an der Hochschule für Gesundheit Bochum

Abstract Background Health literacy is of growing importance in public health research in Germany. People with good health literacy are likely to make better health decisions. A large proportion of the German population, not just vulnerable groups, has a problematic or insufficient health literacy. Aims The study describes the health literacy of students at a German health university. It investigates the influence of sociodemographic and course-related factors on health literacy. The results are compared with those of the general population from Germany. Methodology Study participants were recruited by email. 203 students took part in the online survey (response rate 20.2%). From the European Health Literacy Questionaire 16 (HLS-EU-Q16) 127 datasets of students were completely available and were analyzed in this study. In addition to health literacy, sociodemographic and course-related factors were ascertained. Results 39 (30.7%) of the students have a sufficient or excellent health literacy. On average, health literacy is lower in the group of students of health-related courses (M=30.6) than in the normal German population (M=34.5). The levels are particularly low in the dimensions of appraising and applying of health information. Conclusion The results must be interpreted with care. They can be used as a base for long-term monitoring of students’ health literacy and provide starting points for health promotion within the academic setting. Students of health-related degree should be encouraged to reflect on their own and others health literacy, as this is important for their future work with patients or clients.

Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas.

ObjectivesKnowledge concerning antibiotic use in the general population is insufficient. The way health literacy is related to antibiotic use aside from knowledge needs further investigation. Our aim was to compare the levels of knowledge of antibiotics and health literacy in individuals who had taken antibiotics in recent years compared with those who not had taken antibiotics.MethodsA population-based cross-sectional survey of 2,000 individuals aged 35 and older from Berlin, Germany and its surrounding rural and suburban areas (response rate 59%) with strata urban/rural, sex, age, and education. Computer-assisted personal interviews were conducted by external, trained interviewers during home visits. Knowledge, health literacy, and antibiotic use were assessed using standardized questionnaires.ResultsIn all, 33.3% (666/2,000) of the participants indicated having had an antimicrobial therapy during the previous 12 months. Adjusting for sex, age, educational level and health literacy, individuals with four correct answers regarding antibiotics were 1.70 times and those with three correct answers 1.94 more likely to have had a history of recent antibiotic use than those who did not have any correct answers. Individuals with sufficient health literacy were 0.57 times less likely to have had a recent history of antibiotic use than individuals with insufficient health literacy.ConclusionPatients who have used antibiotics might have more knowledge as a result of their recent involvement with the topic of antibiotic use; health literacy may be a preventive mechanism to use antibiotics more critically. Besides improving the health knowledge of the general population and of vulnerable groups such as patients with low levels of health literacy, intervention strategies should focus on providers as well.

Young adult health literacy on health promotion as social determinant of health: Challenges for health education practice in Lithuania

A synthesis of theory, research, and practice shows that education is linked to better health through individuals’ increased health knowledge and healthy behaviour. Health literacy is put forward as the central mediator between education and health. Scientific studies have shown a strong association between the levels of health literacy and health outcomes. The aim of the study is to identify the levels of health literacy on health promotion among Lithuania’s young adults. The anonymous self-reported questionnaire survey was carried out in the period of 2014-2015. The research sample involved 842 young adults aged 18-29. Health literacy was measured using an HLS-EU-Q-47 questionnaire. The research studies suggest that less than half of Lithuanian young adults have sufficient or excellent health literacy on health promotion, which is essential in maintaining good health and the quality of life. These findings are important evidence that health education should become a priority area at all levels of educational process at every stage of the life: from childhood through adulthood.

The role of the nurse in improving health literacy among older adults

Abstract Introduction. The level of health literacy tells us how an individual functions within the healthcare system, how well he or she understands the instructions connected to health care, and how he or she looks after own health. However, at the same time, it can be an indicator of how healthy an individual is going to be in the future. In our research we wanted to establish the role of a nurse in improving health literacy among older adults. Method. The research was based on a quantitative research approach, using descriptive method. Data were collected with the interviewing technique. As a measuring instrument, a questionnaire formed on the basis of the review of domestic and foreign, professional and scientific literature, was used. We used a non-random purposive pattern, in which we included 148 older adults aged 65 years and above, who live in different residential environments and do not suffer from dementia. There were 140 correctly completed questionnaires, which represent a 94% realization of the sample. The data were analyzed by statistical program SPSS 22.0. Results. Older adults who took part in the research have achieved limited health literacy in the fields of general health literacy (AV=27.0), healthcare (AV=26.2), disease prevention (AV=28.8) and health promotion (AV=26.6). In the field of nurse counseling they achieved sufficient health literacy (AV=34.6). Discussion and conclusion. Health literacy is one of the factors that significantly affect the quality of life of older adults. We established that older adults who took part in the research have limited health literacy. The nurses can significantly contribute to improving the health literacy of older adults through health-educational work and health promotion. In the future, the role of the nurse in health promotion will have to become more prominent, particularly through their work in reference clinics and reference centers for health promotion.

Health literacy in Catalonia: Situation Analysis

Introduction: The World Health Organisation describes health literacy as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Health literate individuals have skills to keep healthier by themselves and to maintain their quality of life for longer. In ageing societies, where chronic conditions are expected to keep growing while resources will remain stable, health literacy is one of the keys challenges facing community health at the beginning of the XXI century.The Health Plan for Catalonia (HPC) is the indicative instrument and framework for all public programs in the field of the Health Ministry of the Government of Catalonia. The main 2020 goal of the HPC is to increase healthy life expectancy, that is, the proportion of years with a good self-perceived health status. This objective aligns with the purpose of promoting more health literate societies.Methods: During 2014 the health survey for Catalonia (HSC) included the short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). HSC is an official survey that provides information on the health status, life styles and the use of health services of Catalonia’s population. 3.642 people aged 15 and over answered the questionnaire. HLS-EU-Q16 is a shortened version of the questionnaire HLS-EU-Q47, developed by the European Health Literacy Project 2009-2012, which was administered in eight different countries. As the longer version, HLS-EU-Q16 assumes a multidimensional concept of health literacy, which helps to identify health literacy profiles of individuals, but also of populations. A descriptive analysis of sociodemographic characteristics, health status and healht service use (% and CI95%) is performed according to the health literacy level of people.Results: Results show that the proportion of people with insufficient health literacy (either problematic or inadequate health literacy levels) is higher among people aged 65 and over, among people who attained primary education or below, and among people who belong to lower social classes. On the other hand, people without sufficient health literacy show worse perception of their health status, declare chronic conditions and have disabilities in a higher proportion than those who have sufficient health literacy levels. Regarding the use of health services, people with problematic or inadequate health literacy levels attend to the GP, consume medicines and go to the emergency department more frequently than people with sufficient health literacy.Discussion: The WHO global strategy on person-centred and integrated health care services establishes empowering and engaging individuals and communities as its first strategic goal. Promotion of health literacy is about providing resources and abilities to empower individuals and comunities but also about adapting health care systems to the needs of people. Results show that some people would face more difficulties than expected if they had to perfom health related activities. On the other hand, health literate people enjoy more autonomy when dealing with activities related to health information. In order to advance towards much more integrated and person-centred health care services, health literacy levels should be taken into account and promotion of health literacy at population, individual and health care serveices is desirable.Conclusion: Several difference arise in health status and health care service use arise according the health literacy level of people. These results are the starting point for designing the strategy on health literacy for Catalonia, which will help to design interventions aimed at strengthening and promoting health literacy, but also person-centred health care services.

The impact of health literacy, patient-centered communication and shared decision-making on patients' satisfaction with care received in German primary care practices.

BackgroundFindings on the association between health literacy skills and patient-reported outcomes such as satisfaction with health care delivery are scarce. We explored the extent to which subjective health literacy skills and the perception of the application of patient-centered communication and shared decision-making are associated with patient’s satisfaction with care received by their general practitioner (GP).MethodsA nationwide cross sectional survey was administered in a random sample of 1125 German adults. A binary logistic regression model controlling for demographics and health status was used to examine the independent contributions of predictor variables (i.e. subjective health literacy, shared decision-making, patient-centered communication) on satisfaction with care received by the GP.ResultsRespondents with sufficient health literacy skills were 2.06 times as likely (95 % [CI]: 1.002–4.264) and those who were involved in shared decision-making by their GP were 4.02 times as likely (95 % [CI]: 1.849–8.744) to be satisfied with care received by their GP. Respondents who experienced that their GP explained things in an easy to understand way (OR: 4.44; 95 % [CI]: 1.817–10.869), knew important things about their medical history (OR: 3.46; 95 % [CI]: 1.502–7.994) and spent enough time with them, also reported to be more satisfied (OR: 3.12; 95 % [CI]: 1.410–6.905).ConclusionGerman adults having sufficient subjective health literacy skills and experiencing a more patient-centered relationship with their GP are more likely to be satisfied with care. These findings are important for health care organizations aiming to respond to health literacy needs of patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1693-y) contains supplementary material, which is available to authorized users.

The Association of Health Literacy with Health Behavior, Socioeconomic Indicators, and Self-Assessed Health From a National Adult Survey in Israel

There is a growing need to understand how health literacy influences health outcomes in diverse populations. The aim of this study was to examine the relationship between health literacy, health behavior, sociodemographic indicators, and self-assessed health in the adult population in Israel while identifying populations at risk for low health literacy. A cross-sectional national survey was conducted among 600 adults randomly selected from a national database. The Health Literacy Survey-Europe-Q16 (HLS-EU-Q16) research instrument, adapted for use in Israel, was the basis for home interviews in Hebrew, Russian, and Arabic. Three levels of health literacy were distinguished: More than 31% of the sample had inadequate or problematic health literacy, and 69% showed likely sufficient health literacy. Logistic regression analyses showed that after we controlled for other determinants, years of education (β = 1.8) and income (β = 2.2) were significantly associated with health literacy. Multinomial logistic regression analysis showed that health literacy, along with age, was the strongest independent variable associated with self-assessed health. Thus, health literacy, strongly influenced by income and years of education, may play a key role in determining self-assessed health, a proxy health outcome, beyond sociodemographic variables. The study results contribute to understanding the role of health literacy in health disparities and identifying action areas for health promotion.