Health literacy research and practice最新文献

Objective: Using health literacy informed communication strategies can mitigate health inequities. Despite the high prevalence of limited health literacy among parents and children, pediatricians infrequently use clear communication techniques and further education is imperative. There is minimal literature exploring health literacy curricula in pediatric residencies. We sought to evaluate health literacy education across pediatric residency programs.

Methods: The Academic Pediatric Association's Health Literacy Special Interest Group performed a national, cross-sectional survey of pediatric associate program directors from July 2022 to September 2022. We asked about the presence of health literacy curricula, teaching strategies used, content highlighted, outcomes assessed, and barriers encountered.

Results: Among 55 associate program directors from programs diverse in setting, size, and geographic region who participated, most (84%) reported their residents would benefit from more health literacy training. Only 44% reported the presence of health literacy education, with minimal teaching of evidence-based principles, such as the universal precautions approach to clear communication.

Conclusion: Health literacy is infrequently taught in pediatric residency programs and there is appreciable variability among existing curricula. There is need for greater dissemination of existing resources, as well as standardization of curricula and assessment tools to ensure pediatricians are well-versed in use of health literacy-informed communication techniques. [HLRP: Health Literacy Research and Practice. 2025;9(1):e3-e7.].

Background: Formerly incarcerated individuals (FIIs) encounter difficulties with covering the cost of dental and medical care, adhering to medication regimens, and receiving fair treatment from health care providers. Yet, no published research has examined modifiable pathways to increase FIIs' health literacy (HL), which is essential for addressing the health needs of this vulnerable population.

Objective: The aim of this article is to examine neighborhood characteristics (neighborhood deprivation, racial and economic polarization, and residential segregation) and public assistance program enrollment as structural determinants of limited health literacy (LHL) among FIIs.

Methods: Using a socioecological framework, we analyzed a subsample of 578 FIIs from the 2023 Survey of Racism and Public Health, an online cross-sectional survey spanning U.S. Department of Health & Human Services Regions 1, 2, and 3. HL was assessed using the Brief Health Literacy Screen. Logistic regression models estimated unadjusted and adjusted associations of LHL with neighborhood characteristics and public assistance program enrollment. Adjusted models controlled for age, race and ethnicity, gender identity, educational attainment, marital and employment status, number of children, chronic health conditions, and incarceration length.

Key results: The 578 FIIs had an average age of 46, with 42% having LHL. We observed a statistically significant association between public assistance program enrollment and LHL (unadjusted odds ratio [OR] = 2.72, 95% confidence interval [CI]: 1.87, 4.01; adjusted OR = 2.50, 95% CI: 1.62, 3.88). We found no statistically significant associations of LHL with neighborhood deprivation, racial and economic polarization, and residential segregation.

Conclusions: Our findings suggest that there may be an opportunity to develop tailored interventions for increasing HL among FIIs through public assistance programs. Dissemination of HL resources among this marginalized group can improve their self-management of chronic diseases. This is of paramount importance because FIIs must simultaneously navigate other challenges after incarceration (e.g., unstable housing). [HLRP: Health Literacy Research and Practice. 2025;9(1):e8-e18.].

Background: While adolescents and young adults are increasingly expected to take more responsibility for their health and wellbeing, continuing digital transformation and increased implementation of digital health services (DHS) demand skills to utilize digital solutions offered to successfully undertake self-care and self-management. However, research is lacking regarding measurement of adolescents' and young adults' "ability to utilize DHS" (or "DHC").

Objective: This study aims to measure young people's DHC by (1) validating the Digital HealthCare Scale (DHC scale) in adolescents and in young adults and (2) exploring the extent to which DHC and digital health literacy (DHL) are associated with the number of general practitioner, emergency, or specialist visits.

Methods: A cross-sectional survey was conducted among 890 Norwegian adolescents and young adults age 16 to 25 years. Data were collected from April 2020 to October 2020 using computer-assisted telephone interviewing. Rasch modeling, independent samples t-test, chi-square test, and negative binomial regression models were used to analyze the data.

Key results: The DHC scale is considered valid for measuring DHC in adolescents and young adults, showing sufficient unidimensionality, good overall data-model fit, and no disordered response categories nor differential item functioning. Results showed that female participants and adolescents age 16 to 20 years self-reported significantly lower DHL and DHC than male participants and young adults age 21 to 25 years. Regression analyses displayed a statistically significant association between adolescents' and young adults' DHL (n = 371) and DHC (n = 389) and their utilization of specialist health services. For every unit (logit) increase in DHL and DHC, the number of specialist visits decreased by 25% and 28%, respectively.

Conclusions: Aligned with previous research calling for new up-to-date instruments to measure the new aspects of DHL, our study has introduced a new measurement scale (DHC scale) for use among adolescents and young adults. This scale may be useful for health authorities, public health workers, and health providers in evaluating and adapting DHC. [HLRP: Health Literacy Research and Practice. 2025;9(1):e19-e28.].

Background: The COVID-19 pandemic exacerbated long-standing disparities that many people in the United States experience due to their race and ethnicity and socioeconomic status.

Brief description of activity: An outcry from several relevant stakeholders ignited a federal response from the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS), who, among other entities, decided to address low health literacy (HL) in underserved communities. Evidence suggests that HL impacts under-resourced communities' understanding of health issues and whether they adhere to health guidelines.

Implementation: This article aims to provide an ecological analysis of HL best practices, highlighting their role in community health during public health crises.

Results: Although a vast amount of literature applies Ecological Systems Theory (EST) to understanding and addressing a range of issues impacting the health of communities, scarce literature applies EST to understanding HL interventions.

Lessons learned: We discuss implications for public health efforts, concluding that Bronfenbrenner's Ecological Systems Theory is effective for grounding the development and implementation of best practices for promoting HL interventions. [HLRP: Health Literacy Research and Practice. 2025;9(1):e29-e36.].

Background: Health literacy (HL) plays a crucial role in navigating the coronavirus disease 2019 (COVID-19) pandemic, especially with the abundance of conflicting information from unauthorized sources.

Objective: This study aims to measure COVID-19 vaccine acceptability, COVID-19 HL, and COVID-19 infodemic and their predictors in Iranians.

Methods: A cross-sectional study was conducted on the general population in Iran between August 20, 2021 to October 29, 2021. Data were collected using a valid questionnaire with four parts. Univariable and multivariable logistic regression models, generalized linear models, and ordinal regression with the Polytomous Universal Model were performed using SPSS version 26.

Key results: The study revealed that 68.6% of the participants were willing to accept the COVID-19 vaccine, 45% had sufficient knowledge about COVID-19, and 52.2% were confused by false information during the pandemic. The results showed that having sufficient COVID-19 HL was significantly associated with higher acceptance of the vaccine (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.02, 2.12). Additionally, higher COVID-19 HL scores were associated with a higher adjusted odds of confusion by false information with an odds ratio of 1.12 (95% CI: 1 .11, 1 .13).

Conclusion: This study exhibits low levels of COVID-19 HL in Iran, and the fact that higher COVID-19 HL is associated with higher vaccine acceptance. Because vaccination is an essential preventive measure to stop the COVID-19 pandemic, factors associated with low vaccine acceptance need to be addressed by public health strategies. [HLRP: Health Literacy Research and Practice. 2024;8(4):e184-e193.].

Background: Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL).

Objective: This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables.

Methods: A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy.

Key results: Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (β = 0.176, p = .003), less than minimum wage (β = -0.197, p = .001) and insulin therapy (β = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities.

Conclusion: In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

Background: Young adults face a number of health concerns and are typically beginning to manage their health on their own. At the same time, this age group is more connected to digital technology than ever before, and studies show that young adults can struggle with digital health literacy skills.

Objective: The online Get Health'e' Program consists of six modules addressing digital health literacy skills, including topics such as internet searches and social media. This study evaluates the program based on a usability and pilot study.

Methods: Recruited participants ranged in age from 18 to 24 years and were predominantly White women. After an eligibility screening, half of the participants were randomly assigned to the program group. All 131 participants were administered two surveys, 2 weeks apart; the program group had access to the program for that week. Survey questions included demographics, the eHealth Literacy Scale (eHEALS), and six sets of five multiple-choice questions assessing digital health knowledge.

Key results: Both groups showed an improvement of 1.0 points on the eHEALS scale, but a repeated measures analysis comparing scores for the program and control groups indicated no significant difference in score improvement between the two groups, F(1, 129) = 0.003, p = .96. The program group had an average improvement in quiz scores (from pre to post) from 1.6 to 2.3 which was better than score improvement in the control group across the six modules. The majority of participants in the program group found the program to be useful (67.2%) and informative (59.4%), and 93.8% said they would recommend it to someone they know.

Conclusions: The Get Health'e' program was well received by participants and led to an increase in digital health knowledge. Programs like this have the potential to raise awareness among youth about how to access and evaluate health information online. [HLRP: Health Literacy Research and Practice. 2024;8(4):e224-e235.].

Background: The relative contributions of common patient-reported social determinants of health on 30- and 90-day post-discharge outcomes among patients with acute coronary syndromes (ACS) is unclear.

Objective: The aim of this article is to examine the independent associations of social determinants with readmission or death, accounting for medical history.

Methods: Participants included adults who were hospitalized with ACS at an academic medical center. Domains measured were social support, health literacy/numeracy, and socioeconomic status (SES) (including education and difficulty paying bills). We employed multivariable Cox proportional hazard models to study associations with time to all-cause readmission or death, up to 30 or 90 days after discharge, and adjusted for demographics and medical history (prior admissions and Elixhauser comorbidity index).

Key results: Among 1,168 patients with ACS and no history of heart failure, more prior admissions, and higher comorbidity index (the medical history domain) were associated with higher rates of 30- and 90-day readmission or death (domain p values <.01 and <.0001, respectively). The social support domain was not associated with outcomes. Higher health literacy and numeracy were associated with lower rates of 30- and 90-day readmission or death (domain p values .016 and .002, respectively). Higher education and less difficulty paying bills (the SES domain) was marginally associated with lower rates of 90-day readmission or death (domain, p = .052).

Conclusions: In addition to medical history, the domain of health literacy and numeracy was independently associated with readmission or death of patients with ACS during the 90 days after hospital discharge. [HLRP: Health Literacy Research and Practice. 2024;8(4):e212-e223.].

Background: The lack of therapeutic treatment options for depressive disorders increases the relevance of digital interventions for patients and general practitioners (GPs), particularly to bridge waiting times. However, patients may require adequate (digital) health literacy (HL) to partake in such interventions.

Objective: This study contrasts expected benefits and risks of digital mental health interventions, specifically digital therapeutics on prescription (DTx), among GPs and patients with depression according to HL dimensions (access, understanding, appraisal, and application) and patients' personal determinants.

Methods: We conducted semi-structured interviews with purposively sampled GPs (n = 17) and patients with mild or moderate depression (n = 17) in Germany. The interviews were audio-recorded, transcribed verbatim, and coded. Data were analyzed using qualitative content analysis.

Key results: DTx include benefits to access health information and promote HL as DTx can improve understanding of health content and foster self-management skills. But DTx also implies risks for routine care distribution and creates new media barriers. During waiting times patients appraise DTx for themselves as more positive than GPs expect. However, digital- and disease-specific challenges such as non-commitment, listlessness or lethargy appear to hinder the use of DTx in practical situations. While GPs were not convinced about the digital skills of their patients, patients raised concerns that depressive symptoms may inhibit them from actual use.

Conclusion: In the context of DTx for depressive disorders, patients' mental health needs are seldom noticed and rarely promoted. To foster (digital) HL, DTx should be comprehensively embedded in supply situations. [HLRP: Health Literacy Research and Practice. 2024;8(4):e236-e245.].