Health literacy research and practice最新文献

Background: Digital mental health (dMH) treatments have garnered much attention for increasing access to treatment, yet real-world engagement with these treatments remains a challenge. In upscaling these treatments, we need to ensure that they are equitable and do not exclude groups who already experience inequities in health care, such as people with lower health literacy.

Objective: To co-develop recommendations for the design and delivery of dMH treatments for people with a variety of health literacy levels.

Methods: Drafted recommendations were based on a thematic analysis of 357 free-text comments (likes, dislikes/other suggestions) from 213 people (n = 80 lower, and n = 133 higher health literacy) who had completed unguided internet-delivered cognitive behaviour therapy (iCBT) for depression and anxiety, as part of a trial. The initial set of drafted recommendations were iteratively modified and refined based on a review by a multidisciplinary project team with professional and lived-experience expertise (n = 9) and focus group consultations with people with relevant lived experience (n = 8).

Key results: The co-development process resulted in seven final recommendations: (1) Focus on informative and practical content; (2) Prioritize accessibility and ease of use; (3) Structure content in a progressive, layered way; (4) Enhance interactivity and engagement; (5) Employ strategies to enhance motivation and accountability; (6) Consider participants' emotional wellbeing; (7) Incorporate diverse modes of delivering content. Most recommendations were based on comments from people with lower and higher health literacy.

Conclusions: These recommendations advance both research and practice by outlining a flexible and practical framework for dMH treatment developers and service providers to meet the preferences and needs of people with diverse health literacy strengths and needs. Further research is needed to determine the feasibility and impact of implementing these recommendations across different dMH treatment delivery formats, settings, and populations.

Background: Despite the significance of health literacy, studies show the inadequacy of health literacy in the health system of Iran. Inadequate health literacy is considered a warning for service providers. It needs to be integrated into educational programs that are administered within health and medical centers.

Objective: Therefore, the present study was conducted to explore the barriers to health literacy in Iran's health system.

Methods: The present qualitative study was conducted in 2023 using a conventional content analysis. To this aim, 18 participants were selected among urban health center staff, 21 from rural health centers, 10 health volunteers, and 8 trainees (people participating in training classes) for interviews and group discussions. After the first interview, continuous data analysis began and continued to saturation level. The data were collected through semi-structured interviews and focus group discussions and were simultaneously analysed using a conventional qualitative analysis.

Key results: Two main categories of internal and external barriers were detected. The data analysis led to the extraction of four main subcategories: (1) personal barriers (trainee's inadequate competence, lack of physical or mental health, low motivation and commitment of health staff, beliefs, contextual barriers); (2) interpersonal barriers (health care providers' misunderstanding of correct training, malcommunication or miscommunication in training sessions, the trainer's limited skill, underestimated role of education in behavior change); (3) organizational barriers (high workload of health care staff, inadequate human resources, poor management and distrust in the health system, low organizational motivation); and (4) social barriers (uninterest in learning about health issues, issues related to the internet and cyberspace, lack of interpectoral cooperation).

Conclusion: Considering the multidimensional nature of barriers to health literacy, it is recommended to make and implement a comprehensive plan to integrate efforts by health authorities and institutions, mass media, experts, decision-makers, policymakers, and service providers to remove barriers.

Background: Despite recommendations that medical schools incorporate health literacy (HL) into curricula and identification of consensus areas of HL competence, high-quality data are needed for curricular characteristics and structured evaluation that foster sustained HL competency adoption.

Objective: This study aimed to develop and evaluate a comprehensive longitudinal medical school HL curriculum using qualitative and quantitative assessments. We sought to ground this in existing theory and provide evidence for generalizable use and further theory refinement.

Methods: Across three medical student cohorts, HL was integrated into a 14-month pre-clinical professional development course. The longitudinal curriculum was informed by consensus-derived HL competencies and Bloom's Taxonomy. Student self-assessment and reflection data were linked across three timepoints and analyzed using mixed methods: an inductive approach identified key qualitative themes; exploratory factor analysis (EFA) identified prevalent factors within self-assessments; and analysis of variance identified differences across timepoints.

Key results: Three qualitative themes emerged from student reflections: emotions associated with a backward reading exercise; shifts in awareness of HL as a patient challenge; and plans to continue using HL practices. Among 336 students with quantitative data across all timepoints, EFA identified three factors: foundations, shame-free environment, conveying information. Over the curriculum, students demonstrated significant (p < .05) improvements in each factor.

Conclusions: Our longitudinal HL curriculum, grounded in existing competencies and conceptual framework, elicited positive changes related to medical student HL competencies. Qualitative data demonstrating motivation and intention to continue applying HL practices were augmented by quantitative data showing increased adoption of self-reported behaviors over curricular timepoints. This study fulfills multiple features of a conceptual framework for HL curricula in health professions education, including sequenced, interactive sessions, multiple instruction modes, reflection, integration of knowledge and skill education, and varied assessment methods. Our findings can be used by investigators, institutions, and professional accreditation organizations to broadly enhance HL education.

Background: Community engagement is key to developing culturally responsive public health interventions that resonate with diverse populations and promote health equity.

Brief description of activity: We applied an adapted version of Boot Camp Translation (BCT), a community-based participatory approach, to develop culturally and locally relevant messaging and materials for diverse populations. This adapted BCT approach focuses on three core themes: (1) Listen, (2) Empower, and (3) Co-Create, or LEC. The LEC method helps community leaders and champions learn from community members about barriers and gaps in health care (listen), share health information in a collaborative way (empower), and develop messages and materials that resonate with and motivate community members to take control of their own health (co-create).

Implementation: LEC follows a 3 to 4 month process: an in-person session with expert presentations and group discussions, followed by two virtual meetings to share and refine co-created messages and materials.

Results: The LEC approach was successfully conducted in diverse communities, engaging participants in preferred venues like churches, clinics, and tribal centers over 3 to 4 months. Tailored messages resonated with cultural values, while common themes included family and faith. Preferred materials were fact sheets, pamphlets, posters, videos, and visual stories. Participant evaluations showed high satisfaction, comfort sharing opinions, and improved understanding of how to take care of one's health.

Lessons learned: The LEC method fosters collective responsibility between community members and researchers to collaboratively address health needs. To support implementation, we offer best practices for LEC application, and customizable materials and guidance tailored to community preferences. This flexible, adaptable approach may enhance effectiveness, relevance, and sustainability of public health efforts across diverse settings.

Advancing Health Literacy Franklin County was initiated in June 2021 with a goal of building a sustainable health literate community in Franklin County, Ohio, USA. The project was a collaboration among public health departments, health care organizations, an academic institution, and community organizations and included capacity-building over a 2-year period. Project evaluation included social network analysis mapping of organizational relationships over two project time periods to document change in this area. This brief report describes the social network analysis mapping as a project outcome, a valuable approach to advancing organizational health literacy and health equity, and a practical tool for other health literacy projects as sustainable relationships and networks are important in health literacy research and practice. [HLRP: Health Literacy Research and Practice. 2025;9(3):e78-e82.].

Hispanic and Latino/a/e individuals are more likely to have lower levels of health literacy compared to other ethnic and racial groups. Additionally, 32% of this population also has limited English proficiency. There is a need to develop culturally valid instruments in Spanish to assess health literacy in this population. The Health Literacy Skills Instrument Short Form (HLSI-SF) was developed and validated in English by RTI International, but not in Spanish. Our aim was to culturally adapt the HLSI-SF to be used for Hispanic and Latino/a/e individuals living in the United States. We followed the Patient-Reported Outcome Consortium guidelines for cross-cultural adaptation of measures for content and linguistic validity. This included two forward-translations, reconciliation, two back-translations, revision and harmonization, cognitive interviews (total of six), revision, external expert review, and final version. We involved an expert panel of health professionals and community representatives throughout the process. The panel (n = 4) all self-identified as Hispanic or Latino/a/e and were fluent in English and Spanish. To evaluate the adapted HLSI-SF measure, we conducted cognitive interviews through six online focus groups involving 22 Hispanic and Latino/a/e community members, followed by a psychometric assessment using a sample of 726 Hispanic and Latino/a/e individuals with Spanish as their primary language. Focus group-based cognitive interviews revealed that while most items on the adapted HLSI-SF measure performed well, some participants had difficulties with a few items, which may suggest limited health knowledge. Psychometric analyses revealed that all but the Nutrition Label and Calories items performed well. Further validation of the HLSI-SF is needed to produce a valid and reliable instrument to measure health literacy in Hispanic and Latino/a/e populations in the U.S. [HLRP: Health Literacy Research and Practice. 2025;9(3):e83-e92.].

Background: In recent years, parents have had more opportunities to use applications (apps) to access health care information.

Objective: In this study, we aimed to evaluate whether the use of an app that provides health care information on children improves parents' health literacy.

Methods: This open-label, nonrandomized, parallel-controlled trial was conducted at two health centers in Japan. We recruited parents of 1.5-year-old children and introduced the Oshiete! Doctor app to the intervention group. The primary outcome was a change in the parents' health literacy scores (HLSs).

Key results: A total of 200 parents were included in this study. The mean HLSs slightly improved in both groups, with greater improvement observed in the intervention group than in the control group. However, the difference was not statistically significant. In the intervention group, participants with higher app ratings showed greater improvement in their HLSs after the intervention.

Conclusions: The introduction of an app that provides health care information on children did not show a statistically significant improvement in parents' health literacy. In the intervention group, participants with higher app ratings showed greater improvement in their HLSs after the intervention. Future research on apps and parental health literacy should also consider the frequency of app use. Larger, longer-term studies are needed. [HLRP: Health Literacy Research and Practice. 2025;9(2):e64-e71.].

This study aimed to explore the barriers to cardiac rehabilitation (CR) participation across individuals with different levels of health literacy. A cross-sectional study was conducted among individuals referred to a CR program. Participants completed online surveys assessing CR barriers using the Cardiac Rehabilitation Barriers Scale and health literacy using the Brief Health Literacy Screening Tool. Descriptive statistics and comparisons were performed. Among 881 individuals invited, 400 responded, with varying levels of health literacy: 22(6%) limited, 305(76%) marginal, and 72(18%) adequate. The greatest barriers included family responsibilities, lack of energy, and a preference for managing health alone. However, distinct patterns emerged based on health literacy levels, with individuals citing different barriers. Although no significant differences were observed in CR barriers based on health literacy, understanding individual-specific challenges is crucial for intervention development. Addressing common barriers such as family responsibilities and logistical challenges could enhance CR engagement and adherence. [HLRP: Health Literacy Research and Practice. 2025;9(2):e72-e77.].