Health literacy research and practice最新文献

Background: Research indicates that the effectiveness of coronavirus disease 2019 (COVID-19) physical distancing mandates is influenced by several individual factors, including health literacy; internal health locus of control (IHLOC), the belief that physical distancing can reduce COVID-19 risk; social norms; self-efficacy; and perceptions of the benefits and barriers associated with distancing. However, further investigation is needed to understand the links between these factors and compliance intentions.

Objective: This study investigates the mechanism linking these factors with the intentions to comply with physical distancing mandates.

Methods: A total of 759 participants (Mean age = 29.13, standard deviation [SD] = 8.33; 68.5% women) were surveyed online from September 2020 to October 2020. Data were analyzed using ANOVA (analysis of variance) and structural equation modeling.

Key results: Health literacy was associated with more perceived benefits (β = .175, p = .001), greater self-efficacy (β = .193, p < .001), and less perceived barriers (β = -.391, p < .001). IHLOC was significantly associated with greater perceived benefits (β = .156, p = .007) and self-efficacy (β = .294, p < .001). Family descriptive norms were significantly associated with fewer perceived barriers (β = -.276, p < .001), while injunctive norms were associated with more perceived benefits (β = .202, p = .001) and higher self-efficacy (β = .299, p < .001). Intentions to adhere to physical distancing mandates were significantly associated with past compliance (β = .427, p < .001) and perceived barriers (β = -.205, p < .001) and benefits (β = .295, p < .001). Post-hoc mediation analyses revealed several small yet significant indirect effects, highlighting the complex pathways shaping adherence intentions.

Conclusions: This study identifies how health literacy, IHLOC, social norms, perceived benefits and barriers, and self-efficacy intricately shape intentions to comply with physical distancing mandates. These findings offer valuable implications for public health policy and interventions. [HLRP: Health Literacy Research and Practice. 2024;8(2):e69-e78.].

Background: The first 3 years of life offer an opportunity to prevent allergic diseases. Pediatricians are an important source of health information for parents. However, a certain degree of health literacy is necessary to understand, appraise, and apply preventive behavior, which can be supported by health literacy (HL) sensitive consultations and a HL friendly environment.

Objective: In this study, we want to shed light on how pediatricians in outpatient care in Germany advise on early childhood allergy prevention (ECAP) and how they consider parental HL.

Methods: We conducted 19 semi-standardized telephone interviews with pediatricians from North-Rhine-Westphalia and Bavaria. The interviews were audio-recorded, transcribed, pseudonymized, and subjected to content analysis.

Key results: Current ECAP recommendations were well known among our sample. Despite the shift of evidence from avoidance of allergens toward early exposure, providing advice on ECAP was considered non-controversial and it was widely assumed that recommendations were easy to understand and apply for parents. However, ECAP was treated as an implicit topic resonating among others like infant nutrition and hygiene. Regarding HL, our interview partners were not aware of HL as a concept. However, they deemed it necessary to somehow assess parental information level and ability to understand provided information. Formal HL screening was not applied, but implicit strategies based on intuition and experience. Concerning effective HL-sensitive communication techniques, interviewees named the adaptation of language and visual support of explanations. More advanced techniques like Teach Back were considered too time-consuming. Medical assistants were considered important in providing an HL-sensitive environment. Time constraints and the high amount of information were considered major barriers regarding HL-sensitive ECAP counseling.

Conclusion: It seems warranted to enhance professional education and training for pediatricians in HL and HL-sensitive communication, to reach all parents with HL-sensitive ECAP counseling. [HLRP: Health Literacy Research and Practice. 2024;8(2):e47-e61.].

Background: In Abidjan, Côte d'Ivoire's largest city, obesity rates among women are increasing, posing a major health challenge, especially for the working generation. Merchants represent 64.3% of working women and are a typical occupation for women with low- and middle-income. Health literacy is used to prevent and overcome chronic diseases and can be used as anti-obesity measures.

Objective: The aim of this study was to examine the relationship between obesity, health literacy, and weight perception among women merchants in Abidjan.

Methods: In this cross-sectional study, we conducted a complete enumeration survey among women merchants in a market in Abidjan from December 2020 to December 2021. In addition to anthropometric measurements, structured face-to-face interviews were conducted. The participants were asked about their weight perception, weight management behaviors, and sociodemographic attributes. They also responded to the Health Literacy Questionnaire (HLQ). Data were tabulated using descriptive statistics, and multiple logistic regression analysis was performed to examine obesity's association with HLQ scales, weight perception, and weight management behaviors.

Key results: Of the 873 participants, 259 (29.7%) were obese; 82% of them underestimated their weight. Obesity was associated with a higher rate of HLQ1 (Feeling understood and supported by health care providers) (odds ratio [OR] = 2.926, confidence interval [CI]:1.450-5.901, p = .03), a lower score of HLQ3 (Actively managing my health) (OR = 0.343, CI:0.165-0.716, p = 0.004), a lower rate of accurate weight perception (OR = 0.145, CI: 0.093-0.224, p < .001), and a lower rate of eating at least three meals per day (OR = 0.401, CI:0.260-0.617, p < .001).

Conclusions: Findings from this study of Abidjan women merchants include obese participants' lack of a proactive attitude toward personal health management, and the association of factors such as inaccurate weight perception and eating fewer than three meals per day with obesity. These finding have important implications for future anti-obesity measures. [HLRP: Health Literacy Research and Practice. 2024;8(2):e102-e112.].

Adult health outcomes are linked to childhood factors such as socioeconomic status via cultural health capital (CHC). Specifically, these factors shape opportunities for developing skills for navigating health environments via experience and the intergenerational transfer of health-related knowledge and skills. Health literacy (HL) is considered a part of and/or result of CHC. HL develops similarly to CHC via opportunities and experiences. Most research to date has ignored the effect of childhood factors on adult HL. The purpose of this study was to explore how childhood factors are related to adult HL. Data were collected from adults (N = 736, mean age = 40.65 years, standard deviation [SD] = 15.39; 52% female; 53.8% White, 31.3% Hispanic and Latino/a/e) in the United States using Qualtrics Panel. Multivariate ordinal and binary logistic regressions predicting HL (as measured by the Newest Vital Sign and Single-Item Literacy Scale) from childhood factors and accounting for demographic covariates were estimated. After accounting for covariates, such as the presence of an employed adult in a white-collar (odds ratio [OR] = 3.34) or blue-collar (OR = 3.68) occupation (versus unknown/not employed) increased the odds of being categorized as possible limited literacy and adequate literacy (versus limited literacy) as measured by the Newest Vital Sign. Similarly, having an employed adult during childhood who had a blue-collar occupation (vs. unknown/not employed) increased the odds of being categorized as adequate literacy (OR = 2.06) as measured by the Single-Item Literacy Scale. Because the adult's employment played a role in the child's adult HL after accounting for other factors and demographics, these findings support using a lifespan approach to assess and identify risk factors for lower HL. This study contributes to the growing body of evidence of how HL is interconnected with social determinants of health across the lifespan and the need to address HL skills in those with poor social determinants of health. [HLRP: Health Literacy Research and Practice. 2024;8(2):e79-e88.].

Background: Noncommunicable diseases (NCDs) account for more than 75% of deaths in Thailand, which is higher than the global average of 71%.

Objective: The aim of this study was to investigate the effects of the Digital Health Literacy (DHL) and Sufficient Health Behavior (SHB) Program on Thai working-age adults age 20 to 65 years with risk factors for NCDs (i.e., overweight and lacking physical activity), and compare the health literacy (HL) and SHB of participants living in urban and semi-urban areas at posttest.

Methods: Using the lottery method, this one-group pretest-posttest quasi-experimental design randomly selected 200 participants and assigned them to two equally sized groups. The data were gathered through surveys with an item discrimination power between .20 and .86 and a reliability of 0.94 and were statistically analyzed using t-test and F-test.

Key results: The DHL and SHB Program comprises six sessions over a 12-week period, and activities designed to enhance knowledge of NCDs, HL, health communication, and health behavior modification. It was conducted by health care workers from urban and semi-urban public hospitals via Zoom using various digital toolkits such as YouTube, animations, infographics, role-play videos, clips, and e-books. At the posttest, the participants had higher HL (t = 2.67, p = .001) and SHB (t = 3.36, p = .001). There was a difference in SHB scores (F = 4.640, p = .032) between those living in urban and those in semi-urban areas, but no difference in HL scores (F = 1.436, p = .232).

Conclusions: The DHL and SHB Program improved HL and SHB in Thai working-age adults with risk factors for NCDs in both urban and semi-urban communities. [HLRP: Health Literacy Research and Practice. 2024;8(2):e93-e101.].

Background: Research suggests that younger adult African American people (age 18-35 years) have more than double the risk of having a stroke than White people. Stroke risk education is lacking for this cohort; there is a dearth of materials that are targeted and focused for young adult African Americans. There is also little research on developing and testing age and culturally appropriate health literate materials that may help this population better understand personal risk factors for stroke.

Objective: The aim of this study was to understand factors to guide creating and disseminating plain language health messages about stroke risk awareness among young adult African Americans.

Methods: African American participants age 18 years and older completed an online survey (N = 413). Descriptive statistics, one-way analysis of variance, and two-step cluster analyses were used to evaluate stroke risk awareness, perceived risk of stroke, message creation factors, and online health information seeking behavior. Open-ended survey items described modifiable and non-modifiable reasons for perceived risk of stroke.

Key results: Participants reported differences on overall stroke risk factor awareness by perceived risk of stroke was significant (F[2, 409] = 4.91, p = .008) with the very low/low group (M = 1.66, p < .01), showing significantly lower overall stroke risk factor awareness compared to the moderate and high/very high groups. Both respondents who thought their stroke risk was very low/low and moderate/high/very high commented about family history (54.1% and 45.9%, respectively) as the reason and 88.2% of very low/low commented that they did not have risk factors for stroke because they were young. Cluster analysis indicated the Mostly Clear Preferences cluster was more likely to select mostly/very on positive, informational, and long-term messages and medical authority sources. The largest of three clusters reported medical sources as the highest rated source for both finding and trusting health information (47.2%, n = 195).

Conclusion: Young adult African Americans have a scarce understanding of modifiable stroke risk factors; health education materials should focus on positive information messaging that shows a long-term result and is presented by a medical authority. We did not observe any age or sex differences among the data, which suggests different message modalities may not be needed. [HLRP: Health Literacy Research and Practice. 2024;8(1):e38-e46.].

Background: Oral health literacy (OHL) is the ability of individuals to obtain, process, and understand oral health information and services, allowing them to make appropriate oral health decisions. The association between OHL and tooth loss and replacement have not been well understood.

Objectives: We aimed to determine the association between OHL and tooth loss and replacement in a Colombia population.

Methods: A cross-sectional study of 384 older adults age 65 to 89 years from Pasto, Colombia was carried out. The number of lost and replaced teeth was assessed intraorally; sociodemographic and prosthetic characteristics were collected, and the Health Literacy in Dentistry questionnaire was used to evaluate OHL. Generalized linear models were estimated to assess associations between independent variables (including OHL) and the number of lost and replaced teeth.

Key results: There were 224 (58.3%) men and 160 (41.7%) women. The mean (standard deviation [SD]) number of lost and replaced teeth was 27.78 (4.03) and 12.53 (9.89), respectively. One hundred fifty five (40.4%) individuals had full removable dental protheses, 122 (31.8%) partial removable dental protheses, 68 (17.7%) fixed prosthetics, and 36 (9.4%) dental implants. OHL was 33.29 (6.59) and significantly positively associated with the number of replaced teeth (β = 0.65, 95% confidence interval [CI]: 0.52-0.78, p < .001), but not with lost teeth.

Conclusions: OHL may foster individuals' capabilities to replace lost teeth, although we did not find it associated with reduced tooth loss, likely as tooth loss was highly common in this older population. [HLRP: Health Literacy Research and Practice. 2024;8(1):e21-e28.].

Background: The complexity of research informed consent forms makes it hard for potential study participants to make informed consent decisions. In response, new rules for human research protection require informed consent forms to begin with a key information section that potential study participants can read and understand. This research study builds on exiting guidance on how to write research key information using plain language.

Objective: The aim of this study was to develop a valid and reliable tool to evaluate and improve the readability, understandability, and actionability of the key information section on research informed consent forms.

Methods: We developed an initial list of measures to include on the tool through literature review; established face and content validity of measures with expert input; conducted four rounds of reliability testing with four groups of reviewers; and established construct validity with potential research participants.

Key results: We identified 87 candidate measures via literature review. After expert review, we included 23 items on the initial tool. Twenty-four raters conducted 4 rounds of reliability testing on 10 informed consent forms. After each round, we revised or eliminated items to improve agreement. In the final round of testing, 18 items demonstrated substantial inter-rater agreement per Fleiss' Kappa (average = .73) and Gwet's AC1 (average = .77). Intra-rater agreement was substantial per Cohen's Kappa (average = .74) and almost perfect per Gwet's AC1 (average = 0.84). Focus group feedback (N = 16) provided evidence suggesting key information was easy to read when rated as such by the Readability, Understandability and Actionability of Key Information (RUAKI) Indicator.

Conclusion: The RUAKI Indicator is an 18-item tool with evidence of validity and reliability investigators can use to write the key information section on their informed consent forms that potential study participants can read, understand, and act on to make informed decisions. [HLRP: Health Literacy Research and Practice. 2024;8(1):e29-e37.].