Health literacy research and practice最新文献

Background: There is a need for evidence-based medicine (EBM) education for laypersons. However, there are few materials or opportunities to learn EBM for Japanese laypersons.

Objective: The aim of this study was to develop and test the usability of e-learning material on EBM for health-conscious laypersons in Japan.

Methods: This study was conducted in two steps. First, content elements for the material were identified using purposive evaluation and a prototype of the e-learning material was developed. Following this, usability testing of the material was conducted. A questionnaire survey and qualitative semi-structured focus group interviews were conducted with health-conscious laypersons. Subsequently, the material was refined and finalized.

Key results: A total of 217 descriptions related to EBM were extracted from 12 materials and were integrated into 56 major elements. Each element was rated from the viewpoint of usefulness for laypersons and reviewed by four expert panelists, and finally 18 elements were confirmed, most of which were critical appraisal skills related to critical health literacy. For the usability testing after constructing the material, 25 laypersons participated, and 19 (76%) felt very/rather much interest in the contents of the material in the questionnaire. The results of five focus group interviews showed that the effectiveness of the e-learning material was influenced by the story and characters, and whether the contents of the material were consistent with interviewees' daily interests.

Conclusions: The e-learning material on EBM was found to be of interest to health-conscious laypersons and appeared to be useful in participants' daily lives. This study successfully developed novel e-learning material on the essential components of EBM for laypersons in Japan. [HLRP: Health Literacy Research and Practice. 2022;6(4):e290-e299.] Plain Language Summary: This study developed and tested the usability of e-learning material to encourage health-conscious laypersons in Japan to learn the fundamentals of evidence-based medicine. Most of the contents of the material are related to critical health literacy. The usability testing showed that the material was of interest to non-health professionals and useful for dealing with health information in their daily lives.

Background: Stressors related to social determinants of health (SDH), such as housing and food insecurity, are implicated in chronic disease risk. Maladaptive strategies for coping with these stressors may exacerbate risk.

Objective: Given the limited research on SDH-related stressors and maladaptive coping, this study examined the relationship between two SDH-related stressors (housing and food insecurity) and maladaptive coping behaviors (i.e., emotional eating and stress-related cigarette and alcohol use) in adults. Further, because health literacy (HL), another SDH, may be a protective factor, this study explored whether HL moderated these relationships.

Methods: Data were collected from adults (N = 500, Mean age = 49.01 years, standard deviation = 16.36; 40% White) in the United States. A series of hierarchical logistic regressions predicting maladaptive coping behaviors from demographics, SDH-related stressors (i.e., housing or food insecurity), and HL variables were estimated.

Key results: Housing insecurity was associated with increased odds of emotional eating (odds ratio [OR] = 1.48, p < .001), stress-related cigarette use (OR = 1.34, p = .001), and stress-related alcohol use (OR = 1.32, p = .001). Food insecurity was associated with increased odds of emotional eating (OR = 1.49, p = .012), stress-related cigarette (OR = 1.68, p = .002), and stress-related alcohol use (OR = 1.49, p = .013). Higher functional HL scores were associated with decreased odds of emotional eating after accounting for housing (OR = 0.79, p = .017) and food insecurity (OR = 0.76, p = .004). Communicative and critical HL moderated the relationship between food insecurity and emotional eating.

Conclusions: Examining HL in relation to SDH-related stressors and maladaptive coping behaviors is complex. HL may be less protective for maladaptive coping behaviors that are likely addictive. Because HL domains may require cooperation between individuals and systems related to stressors, multi-systemic interventions are necessary to reduce maladaptive coping behaviors. [HLRP: Health Literacy Research and Practice. 2022;6(4):e280-e289.] Plain language summary: Stress related to inadequate resources for housing and food may be related to adults' poor coping behaviors (e.g., emotional eating and stress-related cigarette and alcohol use). Adults who experienced housing and food insecurity were more likely to report emotional eating and using cigarettes and alcohol when stressed. Adults with higher functional health literacy were less likely to report emotional eating.

Background: Hypertension is the main risk factor for cardiovascular disease. Low level of health literacy is more common in people with hypertension. Evidence suggests that hypertension is preventable and can be controlled by modifying lifestyle and improving self-care behaviors.

Objective: This study aimed to determine the relationship between health literacy, self-efficacy, and self-care behaviors in older adults with hypertension.

Methods: The present study was a cross-sectional study conducted with 150 older adult patients with hypertension admitted to the Cardiac Care Unit (CCU) and post-CCU wards in East Guilan public hospitals in the north of Iran in 2020. Sampling was conducted using a convenience method based on inclusion criteria (age 60 years and older, high blood pressure and taking antihypertensive drugs for at least 6 months, ability to speak and communicate, having the suitable physical condition (not ill) to participate in research and answer questions, and having informed consent to participate in the study). The research instruments included a Health Literacy Questionnaire for Iranian Adults, a self-efficacy questionnaire in patients with hypertension, and a self-care behavior questionnaire for patients with hypertension. Descriptive statistics and multiple linear regression were used to analyze the data using SPSS software version 19.

Key results: The results showed that most patients had adequate health literacy with a mean score of 116.77 (standard deviation [SD] = 8.34), excellent self-efficacy with a mean score of 23.06 (SD = 1.99) and relatively desirable self-care behaviors with a mean score of 51.79 (SD = 4.37). Findings also indicated that health literacy can predict self-efficacy (beta = 0.262, p = .001) and self-care behaviors (beta = 0.639, p = .000).

Conclusions: Based on results, health literacy is a predictor of self-efficacy variables and self-care behaviors. Therefore, planning to improve the health literacy of the older adult to promote self-efficacy and self-care behaviors and ultimately their health is recommended. [HLRP: Health Literacy Research and Practice. 2022;6(4):e262-e269.] Plain Language Summary: This study sought to determine the role of health literacy in predicting self-efficacy and self-care behaviors in older adults with hypertension admitted to CCU and post-CCU wards in East Guilan public hospitals in the north of Iran. Findings of this research demonstrate health literacy can predict self-efficacy and self-care behaviors.

Background: Mobile health (mHealth) literacy refers to the ability to use mobile devices to search, find, understand, evaluate, and use health information to identify or solve a health problem. Health literacy skills are important for improving health information interventions and it will not be possible to investigate this skill unless a valid and reliable tool is developed.

Objective: This study aimed to investigate the psychometric properties of the Persian version of the mHealth Literacy Scale in the workers of an automotive metal sheet factory in Shahrekord, Iran.

Methods: After forward and backward translation of the scale and ensuring the accuracy of the translation, qualitative face validity was examined by an expert panel and quantitative face validity by 10 workers using the item impact score. Content validity index (CVI) and content validity ratio were investigated by seven experts on health education. To investigate construct validity, the scale was completed by 200 workers. One-factor and two-factor structures of the measure were studied using confirmatory factor analysis and the reliability was evaluated using Cronbach's alpha coefficient.

Key results: The CVI for each of the three parameter (relevance, clarity, simplicity) was rated 0.75 to 1 for each item. Confirmatory factor analysis showed that the one-factor model had a better fit to the data than the two-factor model [goodness of fit index = 0.985(>0.90), comparative fit index = 0.999 (>0.90), Tucker-Lewis index = 0.996 (>0.90), normed fit index = 0.994(>0.90), root mean square error of approximation = 0.038(< 0.08)]. Furthermore, the scale had an acceptable internal consistency (Cronbach's alpha = 0.964).

Conclusion: The Persian version of mHealth Literacy Scale has satisfactory reliability and validity and could be used as an effective tool to evaluate mHealth literacy among Iranian workers. [HLRP: Health Literacy Research and Practice. 2022;6(4):e257-e261.] Plain Language Summary: This cross-sectional study was conducted on 200 workers of an automotive metal sheet factory in southwest Iran to investigate the psychometric properties of the Persian version of the mHealth Literacy Scale. The results demonstrated that one-factor structure was more appropriate for evaluating mHealth literacy among Iranian workers.

Background: Health literacy is a critical driver of achieving an equitable world for every child and adolescent. Although the relationship between health literacy and health-related quality of life (HRQoL) has been documented, little is known among adolescents. In addition, due to lack of theory-driven empirical research, it remains unknown about the full relationship between health literacy, its antecedents, and HRQoL.

Objective: This study aimed to apply Manganello's framework to investigate how health literacy was associated with its antecedents and HRQoL in Beijing secondary students.

Methods: A cross-sectional study was conducted with 650 students in years 7 to 9 from four secondary schools in Beijing. Based on Manganello's health literacy framework, a self-administered questionnaire was used to collect information on health literacy, its antecedents (i.e., sociodemographics, self-efficacy, social support, school and community environment), and HRQoL. The 8-item Health Literacy Assessment Tool was used to measure health literacy (score range 0-37), and the KIDSCREEN-10 was used to measure HRQoL (score range 10-50). Path analysis was conducted to examine the mediating role of health literacy in the relationship between its antecedents and HRQoL.

Key results: Overall, the average score of students' health literacy and HRQoL was 26.37 (±5.89) and 37.49 (±5.78), respectively. Health literacy was positively correlated with HRQoL (r = 0.36, p < .01). In the final path model, health literacy was not associated with HRQoL. However, students' social support, school environment, and community environment were associated with HRQoL. Health literacy was affected by self-efficacy, social support, and school environment (all p < .05).

Conclusions: A range of intrapersonal, interpersonal, and environmental factors were associated with health literacy and HRQoL. A holistic approach is needed to improve health literacy and HRQoL through multilevel intervention strategies such as increasing personal self-efficacy, promoting social support, and creating positive environments. [HLRP: Health Literacy Research and Practice. 2022;6(4):e300-e309.] Plain Language Summary: We investigated how health literacy was related to its influencing factors and HRQoL among Beijing secondary students in years 7 to 9. Health literacy and HRQoL were independent outcomes affected by a range of social-ecological factors including self-efficacy, social support, and perceptions of school and community environments.

People who are deaf and hard-of-hearing (DHH) struggle with information marginalization and limited health literacy, challenging their ability to access information on preventing coronavirus disease 2019 (COVID-19). This study assessed the relationship between language preference, health literacy, and COVID-19 information barriers among parents who are DHH in the United States. Data were drawn from a larger study focused on individuals who are DHH who had given birth in the past 10 years. Respondents completed a web-based survey between March 2020 and July 2021. We segmented respondents by language preference [i.e., American Sign Language (ASL), English, or bilingual ASL/English] and used logistic regression models to test the hypothesis that language preference and health literacy were both associated with COVID-19 information marginalization. Of the total sample (N = 417), approximately 17% had limited health literacy, and 22% reported experiencing difficulty accessing information about COVID-19. In adjusted analyses, respondents with limited health literacy ([adjusted odds ratio] aOR = 2.245) and Hispanic ethnicity (aOR = 2.149) had higher risk of reporting information access barriers. There was no association between language preference and reporting COVID-19 information barriers. However, individuals who are DHH with limited health literacy were at higher risk of experiencing information marginalization during the ongoing COVID-19 pandemic, highlighting the need for tailored information based on access needs. [HLRP: Health Literacy Research and Practice. 2022;6(4):e310-e315.].

Background: Black women living with HIV (WLH) have the highest HIV infection rate, cervical cancer mortality, and the lowest cancer screening use compared to other groups. However, there is a gap in knowledge about cancer screening health literacy in the Black WLH population.

Objective: The purpose of this study was to assess the level of cancer screening health literacy, and to identify factors associated with health literacy among Black WLH.

Methods: This study used baseline data from a community-based randomized controlled trial for a health literacy intervention called CHECC-uP (community-based health literacy intervention for cancer control). We recruited a convenience sample of Black WLH (N = 123) who understand English and had no Pap testing in the prior 12 months. The outcome was cancer screening health literacy measured with a validated health literacy tool-Assessment of Health Literacy in Cancer Screening. Predictors included age, marital status, education, income, and insurance type. The association between cancer screening health literacy and predictors was assessed with multivariate logistic regression.

Key results: Almost one-half (49.6%) of study participants had a reading level at or below sixth grade. Older age (adjusted odds ratio [aOR] 1.05) and higher educational levels (aOR 5.13) were significantly associated with higher cancer screening health literacy among our sample of Black WLH in bivariate and multivariate analyses.

Conclusions: Educational materials and other approaches to empower patients should be tested with patients who have low health literacy to ensure efficacy. [HLRP: Health Literacy Research and Practice. 2022;6(3):e175-e181.] Plain Language Summary: Using a cancer screening health literacy tool, we found that about one-half of the Black WLH in the study had a reading level at or below sixth grade. Age and education level were related to their reading levels among the women. Researcher and clinicians need to test educational materials and other approaches with patients who have low health literacy to make sure they work.

Background: Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease.

Objective: The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure.

Methods: This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence.

Key results: The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence.

Conclusion: In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191-e199.] Plain Language Summary: This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.

Background: Health literacy research and practice are constantly evolving. Recent inquiry has highlighted the burdensome literacy demands faced by people with serious mental illness (SMI). Systems, organizational operations, and structures can play a role in decreasing literacy demand, thereby reducing unnecessary challenges for people with SMI. Brief Description of Activity: An organizational health literacy assessment was conducted to explore literacy demands in one mental health shelter and revealed best practice action steps for improving the literacy environment.

Implementation: The assessment included an exploration of the shelter environment using The Health Literacy Environment Activity Packet, First Impressions & Walking Interview, and a commonly used shelter document using the Simple Measure of Gobbledygook (SMOG), Suitability Assessment of Materials (SAM), and Centers for Disease Control and Prevention (CDC) Index.

Results: The literacy demands of the shelter environment and a frequently used document exceeded the literacy skills of people with SMI. Environment assessment revealed environmental facilitators (e.g., welcoming atmosphere) and barriers (e.g., unclear signage). Document assessment also revealed facilitating factors and barriers. SMOG scores ranged from 11.25 to 11.80 (median: 11.38), meaning 11th to 12th grade-level reading skills are required to understand, use, and take action on the document's content. A SAM score of 50% (adequate) and a CDC Index score of 42.1 (revise and improve) reveal materials contain both facilitating factors (e.g., chunked sections) and barriers (e.g., jargon, mismatched graphics) to use.

Lessons learned: The mismatch between system demands and the literacy skills of people with SMI is more profound than that of the general United States population. Organizational health literacy assessments are achievable and useful for both immediate and long-term action aimed at understanding and improving the organizational health literacy of mental health spaces. Further work is needed to explore the role of behavioral health services in addressing the institutional and programmatic literacy demands that inhibit treatment and recovery. [HLRP: Health Literacy Research and Practice. 2022;6(3):e167-e174.] Plain Language Summary: An organizational health literacy assessment reveals how system demands can be changed to better serve intended users. Engaging in mental health, recovery, and treatment services requires complex literacy skills. Generally, the U.S. adult population does not have the skills to meet such demands, and this is especially true among public mental health service users.

Background: Online health education and other electronic health improvement strategies are developing rapidly, highlighting the growing need for valid scales to assess health literacy (HL). One comprehensive HL scale is the Health Literacy Questionnaire (HLQ), but little is known about its measurement properties in online health education cohorts.

Objective: The purpose of this study was to determine if the multidimensional HLQ is an appropriate tool to measure HL in a cohort of Understanding Multiple Sclerosis (MS) online course enrollees.

Methods: Participants who enrolled in the first two open enrollments of the Understanding MS online course completed the HLQ (N = 1,182) in an online survey prior to beginning course materials. We used Rasch analysis to assess the measurement properties of the HLQ.

Key results: The nine Domains of the HLQ each had ordered category function and a good fit with the Rasch model. Each domain was one-dimensional and exhibited good internal consistency and reliability. None of the 44 individual items of the HLQ demonstrated item bias or local dependency. However, while the overall fit was good, few measurement gaps were identified in this cohort for participants in each of the nine Domains, meaning that the HLQ may have low measurement precision in some participants.

Conclusion: Our analysis of the HLQ indicated acceptable measurement properties in a cohort of Understanding MS online course enrollees. Although reliable information on nine separate constructs of HL was obtainable in the current study indicating that the HLQ can be used in similar cohorts, its limitations must be also considered. [HLRP: Health Literacy Research and Practice. 2022;6(3):e200-e212.] Plain Language Summary: In this study, we have shown that the HLQ is suitable for measuring HL in an online public health educational platforms for chronic diseases including multiple sclerosis. This finding adds to the evidence that the HLQ can be widely used in measuring HL in different settings, populations, and health educational platforms.