Test Of Functional Health Literacy In Adults Research Articles

Examining health literacy and self-efficacy levels and their association with preventive behaviors of urinary tract infection in Iranian pregnant women: across sectional study

ObjectiveUrinary tract infection (UTI) is assumed to be associated with the risk of fetal and maternal mortality and morbidity during pregnancy. The potential effect of health literacy and self-efficacy on UTI preventive behaviors among pregnant women has not yet been fully studied. Our objectives were to determine the level of health literacy, self-efficacy, and UTI prevention behaviors in pregnant women, and whether health literacy and self-efficacy are associated with UTI prevention behaviors in pregnant women.DesignA cross-sectional study was conducted, from November 2020 to December 2020, through a multi-stage sampling design on 235 pregnant women aged between 18 and 42 years in Mashhad, Iran. Data were collected through valid and reliable questionnaires including the Test of Functional Health Literacy in Adults (TOFHLA), General Self-Efficacy Questionnaire (GSE), and research made-preventive behaviors recommendations for UTI disease.ResultsThe level of UTI prevention behaviors scores is moderate (71.39 ± 8.58) among women during their pregnancy. Insufficient health literacy and self-efficacy were observed in 53.6% and 59.3% of participants, respectively. The regression model highlighted that 21.20% of the total variance of UTI preventive behaviors was predicted by sociodemographic characteristics, while 40.81% of the variance of UTI preventive behaviors was predicted by health literacy and self-efficacy.ConclusionIt has been observed that health literacy and self-efficacy are main determinants to improve UTI preventive behaviors. Focusing on an intervention based on health literacy skills may be a practical strategy to promote a healthy lifestyle in this population.

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.

Tools to Measure Health Literacy among Adult Hispanic Populations with Type 2 Diabetes Mellitus: A Review of the Literature.

Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts.

Effect of Peer Support on Health Literacy in Diabetic Patients With Limited Access to Support Resources in Iran: A Randomized Clinical Trial

Background: Health literacy (HL) is one of the factors influencing the use of health-related information by patients with diabetes. As a social support resource, peers can help improve diabetes knowledge in these patients. The aim of this study was to determine the effect of peer support on HL in patients with type 2 diabetes (T2D) with low support resources. Methods: This randomized controlled trial was conducted on 80 patients with T2D referring to a diabetes clinic in Aligoudarz. Patients meeting the inclusion criteria were selected by the random sampling method and randomly assigned to two groups of intervention and control each containing 40 cases. The data were collected using the Test of Functional Health literacy in Adults (TOFHLA) at the beginning of the study and after 3 months of educational peer support intervention. Eventually, data were analyzed by the statistical tests of chi-square, Fisher’s exact test, t test, and paired t test. Results: The results showed that there was no significant difference in the mean (±SD) HL between the two groups before the intervention (53.12±13.86 vs. 56.62±10.34, P=0.204). However, the mean HL in the intervention group represented a significant improvement after 3 months of peer intervention compared to the control group (70.27±9.78 vs. 56.87±10.07, P<0.001). Conclusion: Overall, peer support was found to be effective in improving the HL of diabetic patients with limited access to support resources. Therefore, it is recommended to use the capacity of peers as a social support resource in diabetes care programs.

Health Literacy, Numeracy, and Dietary Approaches to Stop Hypertension Accordance Among Hypertensive Adults.

Health literacy (HL) and health numeracy (HN), the ability to interpret and act on quantitative health information, are important for hypertension self-management such as limiting sodium intake. We examined associations of HL, HN, and Dietary Approaches to Stop Hypertension (DASH) diet accordance. Among 1,073 hypertensive adults enrolled in a Baltimore, Maryland-based cohort study, we performed a cross-sectional analysis. Rapid Estimate of Adult Literacy in Medicine (REALM) measured HL and Test of Functional Health Literacy in Adults (TOFHLA) numeracy score measured HN. DASH accordance was based on nine key nutrients. Linear regression models estimated associations of HL and HN with DASH total and sodium score, inclusive of dietary supplement data. In our sample, 39% of participants were male, 66% were Black, 40.2% lived in poverty, and 29.5% reported food insecurity. Fully, 32.5% had limited HL and 14.5% had limited HN. Mean DASH score overall was 2 (range = 0-7.5); only 6.9% were DASH accordant (score ≥4.5). In age and sex adjusted models, higher REALM was associated with a higher DASH score in the overall sample; the relationship of HN with DASH was statistically significant among White but not Black participants. Educational attainment appeared to explain both findings. There were no significant associations between HL or HN and DASH sodium scores. Differences in educational attainment explained the relation of higher HL and greater accordance to the DASH diet in a population of hypertensive adults. Understanding these factors is vital to reducing disparities in hypertension and its sequelae.

Correlation Between Health Literacy and Quality of Life Among the Elderly: The Community Versa Nursing Home

Background: Enhancing health literacy may improve health-related quality of life. Given the more educational programs in nursing homes, this study aimed to determine the relationship between health literacy and the quality of life among the elderly living in nursing homes and those living with their families in Ahvaz, Iran.
 Methods: This descriptive-analytical cross-sectional study was conducted in 2017. The research population was the elderly in Ahvaz city, Iran. This population consisted of two groups, those living in nursing homes and those who do not. There were 62 samples. Random cluster sampling was used to select the participants. The data collection tools included a demographic questionnaire as well as Test of Functional Health Literacy in Adults (TOFHLA) and LEIPAD questionnaires. The data were analyzed by independent t-test, Mann-Whitney test, Spearman correlation, and Chi-square test using SPSS 19.
 Results: The mean health literacy of the elderly living in nursing homes estimated to be relatively desirable (3.60 ± 0.77) and the mean health literacy of the elderly not living in nursing homes was estimated to be relatively undesirable (2.30 ± 0.83). The quality of life was estimated to be moderate for both groups, the mean score for nursing homes was 2.65 ± 0.37 and for the community was 2.98 ± 0.52. Simple regression indicated that appraisal and decision, among the subscales of health literacy, are predicting factors for quality of life in the elderly.
 Conclusion: Using self-help groups and the participation of the elderly in decision making as well as designing educational programs for identifying the accuracy of health information of the media and encouraging them to share health knowledge with others can ultimately improve quality of life in the elderly.

Health Literacy and Health-Promoting Behaviors in Southern Iran

Background and Objective: Health-promoting behaviors are fundamental and important activities for the development and maintenance of health in individuals. However, people with inadequate health literacy are in a worse health position. Today, health literacy is considered a main factor involved in healthcare outcomes and costs. The present research aimed to determine the level of health literacy among the 18–64-year-old residents of Hormozgan Province in association with health promotion behaviors. Materials and Methods: This cross-sectional study on 840 subjects aged from 18 to 64 years, who referred to the urban and rural health centers in Hormozgan, Iran. They were selected through a multi-stratified sampling method in 2017. The data collection instrument was a questionnaire comprised of a demographic section, the test of functional health literacy in adults (TOFHLA), and Walkers’ health promoting lifestyle profile (HPLP-II). The data were analyzed by SPSS version 23 based on the descriptive and analytical statistics tests. Results: The mean and standard deviation of the subjects’ age was 30.6±8.2 years. Most of the participants (586, 72.2%) had an adequate level of health literacy and 226 subjects (27.8%) had inadequate health literacy. The mean and standard deviation of the overall health promotion behavior was found to be 142.95±20.11, interpreted as an acceptable level. The highest average value was observed in the subclass of self-actualization (27.7±4.9) and the lowest mean related to the subclass of physical activity (17.4±5.4). Internet (43.1%) and appealing to the healthcare team (36.9%) were 43.1% and 36.9%, respectively. Conclusion: Our findings showed that educational plans are essential based on different domains of health promotion behaviors with a focus on physical activity. It is also necessary to plan for educating different dimensions of health literacy in the virtual world and social health networks.

Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults.

Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual's ability to manage one's health. We sought to examine health literacy over time among older adults using three widely used measures. A prospective cohort study. Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = - 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = - 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI - 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.

Health Literacy and Adherence to Dietary Regimen among Women with Gestational Diabetes under Nutrition Therapy

Background: Treatment adherence in diabetics is an important challenge in controlling diabetes. Health literacy is a great determinant of health. Future studies need to address determinants of adherence, as this may be crucial. Aim: Determining the association between health literacy and treatment adherence to the treatment regimen in women with gestational diabetes. Method: The present cross-sectional study was conducted on 260 women with gestational diabetes receive nutrition therapy from September to January 2019. The subjects were selected by multistage sampling methods from ten health centers and Imam Reza, Ghaem, and Ommolbanin Hospitals of Mashhad. Data were collected by the brief Test of Functional Health Literacy in Adults (TOFHLA), and a researcher-made questionnaire of adherence to the treatment regimen (diet, exercise, and blood sugar monitoring) with verified validity and reliability. Data were analyzed using SPSS 16. Results: Spearman's rank correlation coefficient indicated significant direct relationships between health literacy and the score of dietary adherence (p <0.001, r=0.314), blood sugar monitoring (p <0.001, r=0.241), exercise adherence (P=0.009, r=0.162) with total adherence to the treatment regimen (p <0.001, r=0.356). Implications for Practice: Promoting health literacy through educational interventions in mothers with gestational diabetes is essential according to its relation to raise dietary adherence (diet, exercise, blood sugar monitoring).

Health literacy rates among pediatric tracheostomy caregivers

IntroductionAs health outcomes and disparities become more important in national healthcare, physicians must be aware of every patient's health literacy in order to deliver effective care. Our goal was to measure the health literacy rates in the caregivers of our pediatric tracheostomy population. These caregivers specifically have an immense responsibility that requires a certain capacity for understanding and learning complex skills. Thus far there have been no studies or surveys investigating the rates of health literacy in this population or tracheostomy patients in general. Caregivers' literacy rates were measured by administering a Test of Functional Health Literacy in Adults (TOFHLA). This test uses actual materials that patients might encounter in a typical clinic and consists of a reading comprehension and numeracy section. To assess impact of the complex care on caregiver quality of life, we simultaneously administered the Pediatric Tracheostomy Health Status Instrument (PTHSI), a validated caregiver quality of life measurement. MethodsCaregivers of children with tracheostomies were recruited and surveyed during the Pediatric Tracheostomy Clinic between July 2019–October 2019. Twenty - six caregivers completed the TOFHLA; 24 completed all three parts - the TOFHLA, the demographic survey, and the PTHSI. ResultsHealth literacy rates among patient families in the out-patient setting with experience with tracheostomy were deemed “adequate” in 85% of caregivers; the remaining 15% of caregivers scored “inadequate”. Overall adult literacy rates in the general population in this state are 26% “inadequate.” Approximately 80% of our caregivers rely solely on Medicaid for healthcare insurance and nearly half of participants reported an annual household income less than $5000. Ages of caregivers ranged from 20 to 61 years, with no significant correlation to health literacy. The average PTHSI score was 36 (SD 8.6), denoting a moderate level of caregiver burden but no correlation to the caregiver health literacy score was found. When comparing caregiver health literacy scores in relation to education level, caregivers with college and post-graduate education had higher literacy scores than those with a high school education, p = .0086. In addition, when comparing African American to white caregivers, white caregivers were found to have higher health literacy scores, p = .036. Notably, caregiver burden as measured by the PTHSI score did not differ significantly between caregivers in lower income and higher income levels, p = .91. ConclusionHealth literacy measurements for caregivers of children with complex medical conditions exceed the health literacy rates of the general population in our state, potentially biased by the intensive training provided to families during their prolonged hospitalization. Healthcare disparities may impact the medically complex child differently from the healthy child. Assumptions about health, wealth and caregiver burden may be inaccurate and warrant further evaluation. Assessing health literacy before institutionalization has occurred may enable us to more accurately design caregiver training programs to further augment literacy and health literacy.

Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology.

Background:Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer.Objective:The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy.Methods:A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy.Key Results:Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy.Conclusions:This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200–e207.]Plain Language Summary:This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.

The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV

Abstract Objective Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH). Participants and Method This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales. Results A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p &amp;lt; 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps &amp;lt; .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = &amp;lt;.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = &amp;lt;.01). Conclusions Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.

Associating of mother’s health literacy with sunlight protective behaviors of teenage children: application of social cognitive theory

ABSTRACTThe relative contributions of health literacy to promote health-related behaviors and characteristics of social cognition are still equivocal, and relevant information is limited. We aimed to examine the effect of the mother’s health literacy level on their teenage children’s sun protective behaviors based on social cognitive theory. This was a cross-sectional study of 202 women who had children between 12 and 18 year-old and they live in Sabzevar, Iran. The Test of Functional Health Literacy in adults (TOFHLA) questionnaire and sun protective behavior questionnaire based on structures of the social cognitive theory were used to collect data. Multiple statistical tests (correlation and the regression analysis) were analyses to examine whether the health literacy level of mothers associated with sun protective behaviors of their children. The results showed health literacy level of mother was positively significantly (p < 0.01) correlated with all constructs of social cognitive theory and teens’ performance to avoid sunlight (r = 0.242, P < 0.01). Likewise, the self-efficacy showed the strongest correlation with a health literacy level of the mother (r = 0.360, p < 0.01), and with the performance of the teenagers (r = 0.282, p < 0.01). Linear regression showed that all constructs of social cognitive theory and health literacy level of mothers predicted 34.9% of teenage children’s sunlight protective behaviors. Health literacy level of mother and constructs from social cognitive theory are significantly supported determinants of sun protective behaviors and could be considered in developing and designing educational interventions program to facilitate a healthy active lifestyle.

Adult Functional Health Literacy and its Related Factors: A Cross-Sectional Study

Background and aims: Health literacy (HL) can affect individual health, health communication and error in taking medicine. The aim of this study was to determine the level of HL and associated factors among Iranian adults. Methods: In this cross-sectional study, 240 participants over 18 years of age referring to health centers in Hamadan, west of Iran in 2015 were selected by multistage random sampling. HL was assessed by the Test of Functional Health Literacy in Adults (TOFHLA). The questionnaire was completed by a trained interviewer. The independent variables were structural and intermediate social factors based on the Commission on Social Determinants of Health (CSDH). Data were analyzed by using IBM SPSS version 22. Results: Average age of the participants was 30.88 ±7.38 years and 75.4% of the them were female. The total score of HL was 64.58 ±16.71 (range: 23.82-98.98). Overall, 31.7% (n=76) of the participants had adequate HL level, 32.5% (n=78) had borderline HL level and 35.8% (n=86) had inadequate HL level. Additionally, participants with higher educational levels had higher HL scores than those with lower educational levels (P&lt;0.001). HL score was significantly higher in males than in females (P=0.017). Conclusion: HL level seems to be inadequate among Iranian adults in the west of Iran. Moreover, enhancing social determinants such as educational level seems to increase HL. The results highlighted the necessity for change and improvement in adults’ HL.

Instruments used to evaluate functional health literacy in elderly persons with chronic kidney disease: Integrative review

Abstract Objective: To identify the instruments used to evaluate the functional health literacy of elderly persons with chronic kidney disease, and to assess whether they are suitable for this population. Method: An integrative review of the Lilacs, PubMed, Ibecs, Scopus and Cochrane databases was carried out in July and August 2018, seeking original articles dealing with functional health literacy and chronic kidney disease in the elderly. Results: A total of 15 articles were evaluated and seven different instruments used in the research were identified, with the Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults (TOFHLA) the most prevalent. Conclusion: The instruments identified are applicable for the elderly, but are not specific for this population. The construction and/or adaptation of new instruments is suggested considering the specific characteristics of this age group.

Test of health Literacy for Portuguese-speaking Adults.

Health literacy has been evaluated in several countries by tools developed for local language and culture. This study aimed to adapt and to validate the Health Literacy Test (TLS) for the Brazilian Portuguese language based on the Test of functional health literacy in adults (TOFHLA). The TLS, translated and adapted to the Brazilian scenario based on the Test of functional health literacy in adults, was administered to 302 users of a clinic of a University in Santa Catarina from September to October 2013. Cronbach's Alpha coefficient, Spearman's correlation and Analysis of Variance were used to assess the internal consistency, the correlation between the parts of the test and association between sociodemographic variables and the score of the Test, respectively. The average score of the test was 72,2, and 54.6% of participants had adequate health literacy, 19.2% had marginal health literacy and 26.2% had inadequate health literacy. The average score of the test was inversely related to the age of the participants and directly related to the level of education. There was no significant difference in the other sociodemographic characteristics. The internal consistency (Cronbach's alpha) was 0.953. The coefficients for the numerical and reading passages were 0.808 and 0.951, respectively. All the sections correlated positively and significantly with the Test, and also with each other. The validation of this test provides a new instrument to determine the literacy level in Brazilian adults.

Health Literacy and Health-promoting Lifestyle among Health Volunteers in Neyshabour

Introduction: Health literacy is a measure of individuals ability to read, comprehend, and act on medical instructions. Health literacy and lifestyle are determinants of health. We aimed to assess the relationship between health literacy and health promoting behaviors. Materials and Methods: This cross-sectional, descriptive, and analytical study was conducted on 250 health volunteers who were selected randomly. Data were collected using questionnaires of Health-Promoting Lifestyle Profile II (HPLP-II) and Test of Functional Health Literacy in Adults (TOFHLA). Data were analyzed using descriptive statistics, and to study the variables relationships Chi-square and Spearman correlation coefficient were applied. Findings: The mean age of the participants was 32.9±9.7 years, and 61.5% had elementary and junior high school education. Health literacy was insufficient in 44.6% of the health volunteers, at a border level in 32.2%, and adequate in 23.1%. The mean score of health-promoting lifestyle was 130±23.8. In this study, there was a significant relationship between educational level, age and health literacy status. Inadequate health literacy was more common among individuals with advanced age and lower education. Health literacy level was significantly correlated with nutrition, spirituality, health responsibility, physical activity, interpersonal support, and stress management (P less-than 0.001). Conclusion: This study showed that the health literacy level was inadequate in health volunteers. This result showed that health literacy and striving to improve it are important. Creating a simple, understandable and accessible media and training materials, as well as implementing theory-based educational interventions are some the ways to improve health literacy.

A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum.

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.

The Effect of Educational Intervention based on the Self Efficacy and Health Literacy Theory on Health Promoting Lifestyles among Female Health Volunteers of Neyshabur, Iran

Background: The importance of health promoting behaviors are due to their potential role in preventing chronic diseases, reducing morbidity, improving quality of life and reducing health care burdens in the community. Health literacy and lifestyle are social determinants of health. This study was designed to determine the effect of educational intervention based on the Self Efficacy and health literacy Theory on the health promoting behavior of female health volunteers in Neyshabur, Iran. Methods: This randomized clinical trial was conducted on 80 female health volunteers in Neyshabur. Participants were randomly divided into the two control and experimental groups. Data gathering tools were the Healthy Lifestyle questionnaire (HPLPII), Sherer General Self-Efficacy Scale and Test of Functional Health Literacy in Adults (TOFHLA). Educational intervention was conducted based on the self-efficacy theory and health literacy. The subjects in the intervention group received 4 sessions of 1 hour education on a weekly basis. Data analysis was done through SPSS16 and using Chi- square, Repeated Measures and Friedman Test. Results: Before the intervention, there was no significant difference in mean score of lifestyle (P=0.89) and self-efficacy (P=0.146) between the two groups. But, after the intervention, the two groups showed significant difference in all variables (P. 0.001). Conclusion: Educational intervention based on the self- efficacy and health literacy theory can promote healthy lifestyle among health volunteers.

The long-term effects of using telehomecare technology on functional health literacy: results from a randomized trial

ObjectivesThe association between the use of telehomecare technology and functional health literacy is rather unexplored in the current literature. This relationship could prove important in the future management of chronic diseases, as technology has become a more integrated part of modern healthcare systems. Therefore, the purpose of this study was to explore how the use of telehomecare technology affects the level of functional health literacy over a period of 10 months. Study designRandomized controlled trial. MethodsOur sample comprised 116 patients diagnosed with chronic obstructive pulmonary disease. A face-to-face interview and an objective test of functional health literacy were conducted with each patient at baseline and again at follow-up after 10 months. Twenty-six patients were lost to follow-up and thus, providing a total of 47 chronic obstructive pulmonary disease patients in the intervention group and 43 in the control group for this follow-up study. The level of functional health literacy was assessed with the Danish Test of Functional Health Literacy in Adults. The difference from baseline to follow-up, in both the functional health literacy score and the mean response time to the entire Danish Test of Functional Health Literacy in Adults (TOFHLA), was tested for statistical significance between the intervention group and the control group. ResultsA significant increase in functional health literacy is observed in both the groups from baseline to follow-up, but there is no statistical difference between groups (P-value = 0.62). ConclusionsA significant increase in the functional health literacy score was observed in both groups, but the findings of this present study provide no information on what causes the increase, so further research is needed to explore the increase in functional health literacy score more thoroughly and establish if the use of telehomecare technology is a part of the explanation.