Test Of Functional Health Literacy Research Articles

Health literacy of patients eligible for cochlear implants

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

Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population.

Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to validate a novel three-item question set for predicting health literacy. This cross-sectional study utilized an in-person questionnaire alongside the S-TOFHLA. The sample included 2027 English- and Spanish-speaking adults (≥18years) recruited from primary care practices serving a low-income eastern Pennsylvania community. Most patients (57.7%) identified as Hispanic. Diagnostic accuracy of each question and aggregated scores were assessed against the validated survey by calculating the area under the receiver operating characteristic (AUROC) curve. Questions in the 'Problems Learning' and 'Help Reading' domains (AUROC 0.66 for each) performed better than the 'Confident Forms' question (AUROC 0.64). Summing all three scores resulted in an even higher AUROC curve (0.71). Cronbach's alpha of the combined items was 0.696. Study results suggest that any of the three questions are viable options for screening health literacy levels of diverse patients in primary care clinical settings. However, they perform better as a summed score than when used individually.

Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review.

Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.

Fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana

Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.

Factors that influence health literacy in patients with coronary artery disease.

to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.

Any Questions? Understanding the Functional Health Literacy in Patients Who Underwent Ureteroscopy

To correlate health literacy of patients undergoing ureteroscopy and identify gaps within current patient education practices in order to better tailor the preoperative experience. Eighteen patients were retrospectively recruited to complete an in-depth semistructured interview and the Test of Functional Health Literacy for Adults (TOFHLA). All interviews were recorded, transcribed, and then coded and analyzed using the grounded theory of analysis. The average participant age was 56.2±12.8years, and 10 (55.6%) identified as female. Education level ranged from some high school to a professional degree. The average TOFHLA score was 88.1±11.7. Irrespective of score, all participants felt they understood the purpose and basic elements of a ureteroscopy. The use of nontechnical language, repetition, and previous healthcare experiences were identified as positive aspects of the education experience. However, 72.2% (n=13) identified the primary gap in understanding revolved around the use, purpose, and pain associated with stents. Functional health literacy is an essential element, but not the only factor informing patient education and comprehension. Current practices are effective in explaining the basics of a ureteroscopy, but even when identified health literacy is higher than expected, a gap remains in stent education. Efforts should be made to better understand how stents can be effectively explained to patients in addition to continuing to refine education practices to elicit true comprehension.

Limited health literacy in Hispanic caregivers of children with cancer and childhood cancer survivors.

190 Background: Health literacy (HL) is the individual’s ability to find and use information and services to make health decisions. Limited HL is associated with poorer outcomes. HL is vastly understudied in childhood cancer. Thus, we investigated HL and associations with Social Determinants of Health in caregivers of children with newly diagnosed cancer and of childhood cancer survivors. Methods: We conducted a prospective cross-sectional study in caregivers of children with newly diagnosed cancer and caregivers of childhood cancer survivors at Rady Children’s Hospital (2016-2019). Caregivers completed questionnaires in-person to assess sociodemographics, acculturation and HL with the Test of Functional Health Literacy (S- TOFHLA) and the Newest Vital Sign (NVS). Results: 459 caregivers were enrolled (199 caregivers of children with newly diagnosed cancer and 260 caregivers of childhood cancer survivors). 56% (n=256) were Hispanic and of those, 38% were Spanish-speaking, and 53% had low acculturation. Hispanics, compared to non-Hispanic Whites, had lower S-TOFHLA and NVS scores (p&lt;0.001). Moreover, Hispanics had lower income (p&lt;0.001) and lower education attainment (p&lt;0.001), and were more likely to have public insurance (p&lt;0.001), and unmarried marital status (p&lt;0.001). Adjusted multivariable regression showed a higher odds ratio (OR) of limited HL in caregivers with education level of high school or less (OR=3.040, 95%CI:1.308,7.087), unmarried marital status (OR=2.573, 95%CI:1.065, 6.424), and Spanish as preferred language (OR=5.072, 95%CI:1.960,14.018). Conclusions: We found that Hispanic and Spanish-speaking caregivers of children with newly diagnosed cancer and caregivers of childhood cancer survivors were at higher risk for limited HL. Hispanics were also more likely to have public insurance, unmarried marital status, and lower education level. In underserved groups such as these, HL is an especially critical component of navigating cancer care and making informed health decisions. It is, therefore, essential to direct future research efforts towards developing interventions to improve HL in underserved populations to improve cancer clinical outcomes.

55 Health literacy mediates racial differences in cognitive functioning among people with and without HIV

Objective:Health disparities among African Americans (AAs) in the United States are evident, especially among older adults and people living with HIV (PLWH). These health disparities include worse cognitive functioning among AAs than White counterparts. Though disparities in health literacy among AAs impact health outcomes across clinical populations, less is known on the mechanistic role health literacy may play in explaining racial differences in cognitive functioning among older PLWH. The current study investigated the association between health literacy and global cognitive functioning among middle-aged and older AA and White adults with and without HIV in the Deep South.Participants and Methods:Two hundred and seventy-three people (170 PLWH: 146 AA, 24 White; 103 HIV-negative: 67 AA, 36 White) were enrolled in an observational study and completed measures of sociodemographic characteristics, as well as the reading subtest of the Wide Range Achievement Test-3rd Edition to assess verbal IQ. A composite score of socioeconomic status (SES) was created using total years of education and annual household income. Neurocognitive functioning was assessed using a comprehensive cognitive battery (i.e., verbal, attention/working memory, executive function, learning, recall, speed of processing, and motor), from which a sample-based global Z-score composite was created. Health literacy was measured using a sample-based composite Z-score derived from the Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults Reading Comprehension, Newest Vital Sign, and Expanded Numeracy Scale. First, multivariable linear regression analyses were performed within both PLWH and HIV-negative samples examining the association between race, SES, verbal IQ, and health literacy with cognitive functioning. These results informed two bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and global cognitive functioning.Results:In both PLWH and HIV-negative individuals, linear regressions showed that Whites had better global cognitive functioning, health literacy, and verbal IQ than AAs. Linear regressions showed that health literacy had an independent association with cognitive function when accounting for verbal IQ and SES. Mediations showed that health literacy significantly mediated the association between race and global cognitive functioning in both samples, independent of verbal IQ (PLWH: b = .07, 95% CI [0.0096, 0.2149]; HIV-negative: b = .15, 95% CI [0.0518, 0.2877]), indicating that Whites were expected to obtain higher global cognitive Z-scores than AAs in both PLWH and HIV-negative samples, through the mediating effect of better health literacy.Conclusions:Health literacy significantly mediated the association between race and global cognitive functioning among middle-aged and older adults with and without HIV, underscoring the importance of health literacy in explaining racial disparities in cognitive outcomes among AAs in the Deep South. Findings have implications for guiding clinicians and healthcare providers in developing interventions that promote health literacy in these underserved populations, which may have downstream impacts on cognitive functioning. Future work is needed to examine mechanisms whereby health literacy impacts neurocognition among AA PLWH.

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

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

#3311 INDEPENDENT PREDICTORS FOR COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY: A PROSPECTIVE COHORT STUDY

Abstract Background and Aims Acute Kidney Injury (AKI) is a syndrome characterized by an abrupt drop in glomerular filtration and/or a decrease in urinary output. The awakening to a different kind of AKI that also occurs outside the hospital named community-acquired AKI (CA-AKI) occurred in 1991, however, few data have been published about its epidemiology, risk factors and outcome, especially in low-income countries. The recognition of risk factors for CA-AKI and development of symptom-based risk tool that aims to predict the risk of AKI might be able to avoid delays in its recognizing, improve the timely diagnosis and patient outcomes in this frequent syndrome. We aimed to assess CA-AKI incidence, characteristics and independent risk factors associated with CA-AKI; to evaluate the discriminatory capacity of a clinical score tool to AKI prediction to predict CA-AKI in our sample. Method We conducted a prospective observational study of general medical admissions to a tertiary hospital in Campinas (São Paulo) between 10th January 2019 and 16th September 2021; we included patients ≥ 14 years, medical suspicion of infection (or confirmed) and /or presence of at least one of the signs or symptoms on admission: fever, dyspnea, decrease in urine output, edema, hypotension, hemodynamic shock, jaundice, petechiae, ecchymosis or decreased level of consciousness. We excluded patients with stage 5 chronic kidney disease at baseline and pre-existing renal replacement therapy (undergoing dialysis and renal transplantation), and also patients with COVID diagnosis. All patients included were assessed utilizing a symptom-based risk score to predict the development of severe AKI, the need for dialysis and mortality. Patients were subjected to complete history taking, socioeconomic and education data were collected. Healthy literacy was assessed using the test of functional health literacy in adults – short version (S- TOFHLA). Predictors of CA-AKI risk were assessed using multivariate logistic regression analysis. Patients were followed up until discharged hospital. The study outcomes were development of CA-AKI, hospital mortality, dialytic need. Results We enrolled 261 patients. CA-AKI was diagnosed in 65 (25%) patients. The CA-AKI patients were older [59 (51-66) vs. 54 (38-65) years, p = 0,02], had higher basal serum creatinine [0,7 (0,5–0,9) vs. 0,6 (0,5-0,8) mg/dL; p = 0,01], lower baseline estimated glomerular filtration rate (eGFR) [103 (88–113) vs. 109 (97–121) mL/min/1,73 m2; p = 0,01] and lower eGFR on admission [64 (44 – 81) vs. 104 (82 – 116) mL/min/1,73 m2; p = 0,0001]. Liver and heart disease were most common comorbidities in the group CA-AKI [10 (16%) vs. 14 (7%) patients, p = 0.04 and 21 (33%) vs. 39 (20%), p = 0,03, respectively]. The risk score did not show significant accuracy to predicting CA-AKI, however, logistic regression showed that scores ≥7 points (OR 95% CI 1.282, 6.133 p = 0.010) followed by age (OR 95% CI 1.007, 1.044 p = 0.008] and liver disease (95% CI 1.063, 6.379 p = 0,036) were independent factors associated with increased risk for CA-AKI in our population. A higher percentage of patients in our sample declared household income &amp;lt; $ 719.73 (month) and the CA-AKI group maintained the same distribution. Only 41 (16%) patients were able to perform the S-TOFHLA and 18 (44%) were considered inadequate or insufficient health literacy. For hospitalized patients, the mean hospital stay in CA-AKI group was longer [8 (4-18) vs. 4 (2-11) days p = 0,001] than without CA-AKI. Overall mortality rate during the follow up was 5% (13 patients), need dialysis 1% (2 patients) and were not statistically significant between the groups. Conclusion Healthy literacy, education, and social class did not show association with CA-AKI; dialysis needed and mortality were not different between the groups CA-AKI or without CA-AKI. Covariates and factors associated with risk for CA-AKI were age, liver disease and scores ≥7 points. The main limitation of our study was not feasible to screen all the patients due to the high numbers seen daily.

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.

Validation of the Arabic Version of the Health Literacy (HLS-Q12) Questionnaire in chronically ill patients.

Health literacy (HL) is an essential component of public health. Few tools are used to measure HL in Arabic-speaking countries, essentially the Short Test of Functional Health Literacy in Adults and the Single Item Literacy Screener. The new 12-item version of the European Health Literacy Survey Questionnaire (HLS-Q12), has not been validated in the Arabic language. This study aimed to translate the English version of HLS-Q12 into Arabic, test its structure and explain any variance in HLS-Q12 scores, allowing its use in Arabic-speaking healthcare contexts. A forward-backward translation was adopted. Reliability was assessed using Cronbach's α. Confirmatory factor analysis (CFA) and Rasch Model evaluated the model fit of the Arabic version of HLS-12. The effects of different patient-related variables on HLS-Q12 scores were tested using linear regression. A total of 389 patients visiting the site hospital outpatient clinics participated in the study. HLS-Q12 mean ± SD score was 35.8 ± 5.0, 50.9% of the participants showed an intermediate HL score. Good reliability (α = 0.832) was observed. CFA confirmed the scale unidimensionality. Rasch analysis indicated HLS-Q12 items to be within the fit acceptable thresholds except for Item 12. The only item that displayed unordered response categories was Item 4. Most of the items were considered relatively easy by respondents. Linear regression revealed age, education, healthcare-related education and income to have effects significantly different from zero on HLS-Q12 score. Interventions targeting the most health-disparate groups of individuals with characteristics contributing to lower HL, are needed.

Abstract P642: Assessment of Health Literacy in Colombia: A First Step for a Cardiovascular Education Program for the Community

Introduction: Adequate health literacy enables patients and caregivers to make appropriate decisions and achieve better health outcomes. However, much information about health literacy comes from developed and English-speaking countries. There is very little information about health literacy levels in countries such as Colombia and these data, therefore, cannot be used as an input in the development of cardiovascular education programs for the community. Our objective was to optimize and adapt the Spanish validation of the short version of the Test of Functional Health Literacy in adults (s-TOFHLA) to the context of the Colombian health system. This test was chosen because its multiple questions and sections can guide the skills that should be emphasized in a health education course for patients and caregivers (i.e. navigation in the health care system, interpretation of medical instructions, understanding of doses and forms of drug dispensing). This test consists of two parts: numerical and reading comprehension (Readings A and B). The TOFHLA is graded using a score between 1 and 100 points, which classifies the participant into categories of adequate, marginal or inadequate health literacy. Methods: The validation process was carried out in the following steps 1) cultural and language adaptation, 2) expert consensus (n=7), 3) a cognitive survey (n=10), 4) piloting (n=40), and 5) application in the community (n=148). The study was conducted in 6 cities, from 5 departments (equivalent to an state) in Colombia. Results: In the piloting (n=40) Cronbach's α was 0.76 for numerical comprehension, 0.58 for reading A, and 0.95 for reading B. In the broader sample (n=148) the Cronbach's α for numerical comprehension, reading A and reading B was 0.84, 0.89, and 0.95, respectively. Most of the sample had an adequate level of literacy (77.1%), however, the percentages in the marginal (6%) and inadequate (16.7%) categories can still be considered high. Health literacy levels are lower in people with the lowest level of schooling and socioeconomic strata. In addition, there seem to be differences between urban and rural populations. No differences have been observed according to the sex of the participants. Conclusions: It is critical to assess health literacy with instruments that have been adequately validated and adapted to the conditions of each health system. This process requires the participation of health and language experts. The piloting and cognitive surveys provide a good idea of how communities interpret psychometric tests. Our results confirm differences in health literacy among populations with different levels of income and schooling. Health literacy assessment can guide the instructional design of community-directed health education programs.

Oral Health Literacy and Health Seeking Behavior of Older Adults in Rural Community

Objectives: This community-based cross-sectional study aimed to examine health information seeking behavior regarding oral health and oral health literacy and their relationship in older adults. Methods: The research was conducted with 432 participants from the rural area of, Noen Maprang District, Phitsanulok province, Northern Thailand. To measure oral health literacy, modified Short Test of Functional Health Literacy in Dentistry for Older Adults was used. The adapted questionnaire was used to collect health information seeking behavior in the past 3 months. Results: Only 12.3% demonstrated adequate oral health literacy. Some 27.1% presented active health information seeking behavior, 57.3% presented passive health information seeking behavior and 15.6% had never obtained or sought any oral health information. The association between health information seeking behavior and oral health literacy could not be observed. Television, health personnel, family members/relatives and village health volunteers were the most popular information sources. Conclusions: By adding oral health information and improving skills of oral health information for village health volunteers, it is possible to develop oral health literacy in older adults in rural areas.

Health Literacy predicts incident foot ulcers after 4 years – the SHELLED cohort study

Aims/hypothesisTo determine whether health literacy is associated with an index diabetes-related foot ulcer (DFU).MethodsThe SHELLED Study is a 4-year prospective study of people with diabetes aged over 40 with no history of DFU. The primary outcome was development of a first foot ulcer. Health Literacy was measured using the short form Test of Functional Health Literacy in Adults (s-TOFHLA) and nine domains of the Health Literacy Questionnaire (HLQ).ResultsOf 222 participants, 191 (86.0%) completed the study, of whom 13 (5.9%) developed an incident ulcer. In multivariable models, every unit increase in S-TOFHLA was associated with a reduced odds of foot ulcer development by 6% (OR 0.94, 95% CI 0.88 to 0.99). Better scores on two HLQ domains reduced the odds of foot ulcer (actively managing my health (OR 0.23, 95% CI 0.08 to 0.65) and understanding health information well enough to know what to do (OR 0.39, 95% CI 0.19 to 0.78). This was independent of baseline risk for foot disease.Conclusions/interpretationThese data provide novel evidence that health literacy is an important clinical risk factor for index foot ulceration. This is an area of potential focus for research and development of educational programs or policy aimed at reducing development of incident foot ulceration.

Health literacy and health behaviors of Guinean university students residing in Brazil.

To evaluate the health literacy and health behaviors of Guinean university students residing in Brazil. A cross-sectional, analytical study conducted with 51 Guinean university students residing in Brazil. A health behavior questionnaire and the Test of Functional Health Literacy in Adults - Short version were applied. Spearman correlation coefficient, U of Mann-Whitney and Kruskal-Wallis were calculated. Health literacy was adequate (median=79; IQR=24). Reading comprehension (median=70; IQR=16) of health information was better than numerical comprehension (median=14; IQR=14). Better health literacy performance was found in those with daily screen time of 3 to 5 hours (p=0.004) and who consumed fatty meat (p=0.002). Adequate health literacy of Guinean university students was associated with mostly healthy behaviors, except for screen time and consumption of fatty meat.

Evaluation of Health Literacy Levels and Associated Factors Among Patients with Acute Coronary Syndrome and Heart Failure in Qatar.

To determine the prevalence of inadequate health literacy and its associated risk factors among patients with acute coronary syndrome (ACS) and/or heart failure (HF) in Qatar. This cross-sectional observational study was conducted among patients with ACS and/or HF attending the national Heart Hospital in Qatar. Health literacy was assessed using the abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Three-item Brief Health Literacy Screen (3-item BHLS). Three hundred patients with ACS and/or HF, majority male (88%) and non-Qatari (94%), participated in the study. The median (IQR) age of the participants was 55 (11) years. The prevalence of inadequate to marginal health literacy ranged between 36% and 54%. There were statistically significant differences in health literacy level between patients based on their marital status (p=0.010), education (p≤0.001), ability to speak any of Arabic, English, Hindi, Urdu, Malayalam, or other languages (p-values ≤0.001 to 0.035), country of origin (p≤0.001), occupation (p≤0.001), and receiving information from a pharmacist (p=0.008), a physiotherapist (p≤0.001), or a nurse (p=0.004). Inadequate health literacy is common among patients with ACS and/or HF. This study suggests a need for developing strategies to assist healthcare professionals in improving health literacy skills among patients with ACS and HF. A combination of interventions may be needed to improve patients' understanding of their disease and medications, and ultimately overall health outcomes.

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.

Environmental Health Literacy: an index to study its relations with pro-environmental behaviors

Abstract The citizen’ awareness about environmental health risks has been identified as an important determinant of citizens’ choices for the adoption of pro-environmental behaviors, but for its study simple measures to be applied in population studies are still lacking. The Environmental Health Literacy (EHL), is a recent sub-cathegory of health literacy, including functional, critical and interactive dimensions, that can be applied in surveys on environmental health risk perception and behaviors. The aim of our study was to elaborate and validate an EHL Index (ELHI) using data from a large multicenter survey carried out among 4778 students of different disciplines in 15 Italian Universities, with a self-administered anonymous questionnaire investigating risk perceptions, attitudes and behaviors towards environmental health risks and including a simple Functional Health Literacy test (FHL). From the original questionnaire of 56 items three sets of questions were selected to represent the three dimensions of health literacy (Functional, Critical or Interactive) and their outcomes were compared with the answers about FHL test and pro-environmental behaviors. The Principal Component Analysis was used to select the most representative questions that were then grouped in the EHLI. The index was significantly associated with both FHL test and behaviors questions. The ROC curve indicated a satisfying accuracy and was used to identify the best cut-off for ELHI. In conclusion the constructed ELHI can be considered reliable and useful for further population surveys in similar target people to plan communication interventions about environmental health risks and their prevention through individual choices. Key messages

Cognitive impairment and low health literacy are associated with poor health outcomes in patients with heart failure

Abstract Background Cognitive impairment and low health literacy are prevalent in patients with heart failure (HF). Low health literacy is associated with poor health outcomes, such as frequent re-hospitalizations and increased mortality. Little is known about the relationships among cognitive impairment, health literacy, and health outcomes (HF rehospitalization and cardiac death). Objective To explore the associations among cognitive impairment, health literacy, and cardiac event-free survival in patients with HF. Methods This was a longitudinal study of 614 rural patients with HF (male 59%, age 66±13 NYHA class III/IV: 35%). Cognitive function was measured using the Mini-Cog test. Health literacy was measured by the Short Test of Functional Health Literacy in Adults. HF hospitalizations and cardiac mortality were followed at least 2 years and obtained by patient interview, medical record review, and death certificate review. Chi-squares, t-tests, ANOVA, Kaplan-Meier with log rank tests, logistic and Cox regressions were used for data analysis. Results Two hundred and seven patients (34%) had cognitive impairment. Compared to those without cognitive impairment, patients with cognitive impairment were 2.77 times more likely to have low health literacy (P&amp;lt;0.001). Patients were divided into 4 groups based on cognitive impairment or not and adequate/low health literacy: (1) No cognitive impairment with adequate health literacy; (2) cognitive impairment with adequate health literacy; (3) no cognitive impairment with low health literacy; and (4) cognitive impairment with low health literacy. Both cognitive impairment and health literacy independently predicted cardiac event-free survival. Cardiac event-free survival was worst in those with both cognitive impairment and low health literacy compared to patients in any of the other three groups. Patients with cognitive impairment and low health literacy had 3.5 times higher risk of a cardiac event compared to those without cognitive impairment or low health literacy (P&amp;lt;0.001, Figure). Age, income, angiotensin converting enzyme inhibitor use, beta-blocker use, New York Heart Association functional class, left ventricular ejection fraction, BNP level were significantly different among the four cognitive and literacy groups. Conclusion Patients with cognitive impairment with low health literacy were at high risk of experiencing a cardiac event. Interventions need to be developed to target high risk patients with cognitive impairment and low health literacy, such as older, low-income patients, to alleviate poor outcomes in patients with HF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH/NHLBI