International Journal of Environmental Research and Public Health

2024

Jump to: 2022, 2021, 2020

15 pages, 2539 KiB

Open AccessReview

Health Literacy in Africa—A Scoping Review of Scientific Publications

by Kristine Sørensen, Verena Knoll, Neida Ramos, Millicent Boateng, Guda Alemayehu, Laura Schamberger and Stefanie Harsch

Int. J. Environ. Res. Public Health 2024, 21(11), 1456; https://doi.org/10.3390/ijerph21111456 - 31 Oct 2024

Viewed by 949

Abstract

Africa’s health landscape is rapidly changing, requiring new solutions such as a focus on health literacy. However, there is currently a limited overview of the development and application of health literacy in African countries and societies. This scoping review aims to analyze scientific [...] Read more.

Africa’s health landscape is rapidly changing, requiring new solutions such as a focus on health literacy. However, there is currently a limited overview of the development and application of health literacy in African countries and societies. This scoping review aims to analyze scientific publications on health literacy in Africa with regards to research approaches, historical developments, geographic origins, target populations and settings, and topical interests. The research followed Arksey and O’Malley six steps of scoping reviews and employed the Joanna Briggs Institute’s PCC method for search string formulation and the PRISMA-SCR checklist for reporting. On 11 July 2022, the following six databases were searched for scientific articles including included reports, policy briefs, book chapters, and research publications: PubMed, PsycINFO, Cochrane Library, ERIC, African Journals Online, and African Index Medicus. A total of 336 articles were identified. The research team co-developed a codebook and three researchers independently extracted data. The analysis provided the most comprehensive overview of the current scope and scale of health literacy in Africa to date. The publications represented 37 of the 54 African Union countries and dated back to 2001, although most were published in the last decade. The content analysis identified 13 broad themes, including mental health, communicable diseases, non-communicable diseases, maternal health, digital health, information and communication, health care, prevention and health promotion, conceptual perspectives, cultural perspectives, and outcomes and measurement. The analysis of target groups revealed a wide range of actors involved in different settings, mostly in health care or community settings. These comprehensive and novel findings can be used to prioritize future actions for public and professional capacity building, policy development, and improved practice to improve health literacy for all in Africa. Full article

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2022

Jump to: 2024, 2021, 2020

14 pages, 551 KiB

Open AccessArticle

Association between Health Literacy and Prevalence of Obesity, Arterial Hypertension, and Diabetes Mellitus

by Božica Lovrić, Harolt Placento, Nikolina Farčić, Metka Lipič Baligač, Štefica Mikšić, Marin Mamić, Tihomir Jovanović, Hrvoje Vidić, Sandra Karabatić, Sabina Cviljević, Lada Zibar, Ivan Vukoja and Ivana Barać

Int. J. Environ. Res. Public Health 2022, 19(15), 9002; https://doi.org/10.3390/ijerph19159002 - 24 Jul 2022

Cited by 14 | Viewed by 4751

Abstract

Background: Health literacy (HL) is linked to many health outcomes, including self-management of chronic diseases. The aim of this study was to assess the association of health literacy with the prevalence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus (T2DM). Methods: [...] Read more.

Background: Health literacy (HL) is linked to many health outcomes, including self-management of chronic diseases. The aim of this study was to assess the association of health literacy with the prevalence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional, single-center study included 500 patients (42.2% male and 57.8% females; median age, 63 years (interquartile range, 42–73)) hospitalized at General County Hospital in Požega, Croatia, between July and October 2020. The Short Assessment of Health Literacy for Croatian Adults (SAHLCA-50) questionnaire was used. Descriptive statistics (median with interquartile range (IQR), frequency, and percentages) and binary logistic regression were utilized. Results: Patients with AH had an inadequate level of health literacy as compared to those without AH (32 vs. 40 points; Mann–Whitney U test, p < 0.001). Patients with T2DM scored 31 points versus 39 points in patients without T2DM (Mann–Whitney U test, p < 0.001). Patients suffering from both AH and T2DM scored 31 points versus 33 points in those with either AH or T2DM and 41 points in patients without AH and T2DM (Kruskal–Wallis test, p < 0.001). There were no statistically significant differences in SAHLCA-50 scores according to the patient body mass index. Conclusions: An inadequate level of health literacy is significantly associated with AH and T2DM but not with obesity. Male gender, low level of education, rural place of residence, retirement, and older age are significant predictors of inadequate health literacy. Full article

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3 pages, 283 KiB

Open AccessCorrection

Correction: Loer et al. Subjective Generic Health Literacy and Its Associated Factors among Adolescents: Results of a Population-Based Online Survey in Germany. Int. J. Environ. Res. Public Health 2020, 17, 8682

by Anne-Kathrin M. Loer, Olga M. Domanska, Christiane Stock and Susanne Jordan

Int. J. Environ. Res. Public Health 2022, 19(3), 1848; https://doi.org/10.3390/ijerph19031848 - 7 Feb 2022

Cited by 1 | Viewed by 1712

Abstract

In the discussion chapter (page 15 ff.) of the original paper [...] Full article

19 pages, 1342 KiB

Open AccessArticle

International Understandings of Health Literacy in Childhood and Adolescence—A Qualitative-Explorative Analysis of Global Expert Interviews

by Tessa Schulenkorf, Kristine Sørensen and Orkan Okan

Int. J. Environ. Res. Public Health 2022, 19(3), 1591; https://doi.org/10.3390/ijerph19031591 - 30 Jan 2022

Cited by 12 | Viewed by 4452

Abstract

(1) Background: With regard to children and adolescents, health literacy should only not be understood as an individual ability, but rather as dependent based on its contextual determinants. The study examines how experts define health literacy in childhood and adolescence and discusses whether [...] Read more.

(1) Background: With regard to children and adolescents, health literacy should only not be understood as an individual ability, but rather as dependent based on its contextual determinants. The study examines how experts define health literacy in childhood and adolescence and discusses whether they include these factors. (2) Methods: In 48 interviews with experts from 32 countries, specific questions for defining health literacy in childhood and adolescence were analyzed. Data analysis was conducted according to the summary of the qualitative content analysis. Main categories and subcategories were developed exploratively and inductively. (3) Results: No expert had an official definition of health literacy in childhood or adolescence. There were more experts who located health literacy only at the individual level alone than those who located it at both the individual and contextual levels. On the individual level, there was a focus on information processing, knowledge, behavior, and skills. At the contextual level, system responsibility, the ability of others, and relationship between age and development were the main points. (4) Conclusions: To develop an adequate method of dealing with health literacy in the target group, there must be a target group-specific consideration of the dependencies, ages, and developmental stages of that group. While this is considered as consensus in scientific discourse, it has seemingly not yet been adopted in development-related policies internationally. Full article

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2021

Jump to: 2024, 2022, 2020

15 pages, 385 KiB

Open AccessArticle

Health Literacy and Diabetes Knowledge: A Nationwide Survey in a Multi-Ethnic Population

by P. V. Asharani, Jue Hua Lau, Kumarasan Roystonn, Fiona Devi, Wang Peizhi, Saleha Shafie, Sherilyn Chang, Anitha Jeyagurunathan, Chua Boon Yiang, Edimansyah Abdin, Janhavi Ajit Vaingankar, Chee Fang Sum, Eng Sing Lee, Rob Van Dam, Siow Ann Chong and Mythily Subramaniam

Int. J. Environ. Res. Public Health 2021, 18(17), 9316; https://doi.org/10.3390/ijerph18179316 - 3 Sep 2021

Cited by 30 | Viewed by 6828

Abstract

Health literacy is a key determinant of the public health and health climate of the nation. This study examined the functional health literacy of the nation, factors associated with health literacy, and its relationship with diabetes recognition. This cross-sectional survey recruited participants (N [...] Read more.

Health literacy is a key determinant of the public health and health climate of the nation. This study examined the functional health literacy of the nation, factors associated with health literacy, and its relationship with diabetes recognition. This cross-sectional survey recruited participants (N = 2895) who were 18 years and above from a population registry through disproportionate stratified sampling. The Brief Health Literacy Screen and other questionnaires were administered through face-to-face interviews, in one of the four national languages (English, Chinese, Malay or Tamil). The majority (80.5%) had adequate functional health literacy and were able to recognise symptoms of diabetes correctly (83.5% overall; 83.7% and 82.2% in those with adequate and inadequate health literacy, respectively). Those with inadequate health literacy had a higher incidence of chronic conditions (p < 0.001) compared to those with adequate health literacy in bivariate analysis. The majority of the sample had sufficient levels of physical activity (83.3%), and more than half reported an unhealthy lifestyle (57.4%). Older age, Chinese ethnicity, those who were employed, with lower education (secondary or below), and were married had significantly higher odds of inadequate health literacy. Health literacy was not associated with lifestyle, physical activity, chronic conditions and diabetes recognition. Health literacy interventions should focus on the disadvantaged social groups for improving their health literacy. Full article

15 pages, 1409 KiB

Open AccessArticle

The Prevalence of Limited Health Literacy and Its Associated Factors among Elderly Patients Attending an Urban Academic Primary Care Clinic in Malaysia

by Siti Nur Hidayah Abd-Rahim, Mohamed-Syarif Mohamed-Yassin, Suraya Abdul-Razak, Mohamad Rodi Isa and Noorhida Baharudin

Int. J. Environ. Res. Public Health 2021, 18(17), 9044; https://doi.org/10.3390/ijerph18179044 - 27 Aug 2021

Cited by 8 | Viewed by 3828

Abstract

Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence [...] Read more.

Limited health literacy (HL) is linked to many negative health outcomes, including poor self-management of chronic diseases and medication adherence among patients. There are a lack of data regarding HL in the elderly population in Malaysia. This study aimed to determine the prevalence of limited HL levels and its associated factors among elderly patients in an urban academic primary care clinic in Selangor, Malaysia. A cross-sectional study was conducted among 413 elderly patients (≥60 years old) who attended this academic primary care clinic between January 2020 and January 2021. Sociodemographic data, clinical characteristics, and health literacy scores were collected. Descriptive statistics (median with interquartile ranges (IQR), frequency, and percentages) and multiple logistic regression were utilized. The prevalence of limited HL in our population was 19.1% (95% CI: 15.3, 23). The middle-old (70–79 years) and very-old (≥80 years) age groups were more likely to have limited HL (aOR 4.05; 95% CI: 2.19, 7.52 and aOR 4.36; 95% CI: 1.02, 18.63, respectively). Those with at least secondary school education (aOR 0.06; 95% CI: 0.02, 0.24) and those who found medical information via the internet/television (aOR 0.21; 95% CI: 0.05, 0.93) had lower odds of having limited HL. In conclusion, having limited HL levels was not common among elderly patients in this primary care clinic. Further studies involving rural and larger primary care clinics in Malaysia are required to support these findings. Full article

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16 pages, 2038 KiB

Open AccessArticle

An Integrated Framework to Conceptualize and Develop the Vancouver Airways Health Literacy Tool (VAHLT)

by Iraj Poureslami, Jacek Kopec, Noah Tregobov, Jessica Shum, Rick Sawatzky, Richard Hohn and J. Mark FitzGerald

Int. J. Environ. Res. Public Health 2021, 18(16), 8646; https://doi.org/10.3390/ijerph18168646 - 16 Aug 2021

Cited by 8 | Viewed by 2786

Abstract

There is currently no comprehensive tool to assess the functional health literacy (HL) skills of chronic airway disease (CAD) patients. The purpose of this article is to describe the development of a new HL measure, the Vancouver Airways Health Literacy Tool (VAHLT). The [...] Read more.

There is currently no comprehensive tool to assess the functional health literacy (HL) skills of chronic airway disease (CAD) patients. The purpose of this article is to describe the development of a new HL measure, the Vancouver Airways Health Literacy Tool (VAHLT). The tool was developed through the following phases: (1) Tool conceptualization, consisting of: (A) a systematic review (SR), (B) focus group sessions with CAD patients to understand barriers and facilitators to CAD management, (C) a survey with key-informants to obtain strategies to mitigate self-management barriers and validate patient-derived topics, and (D) respiratory physicians’ review of the topics; (2) Scenario and item development; and (3) Tool testing and content validation. The SR identified the lack of a valid HL measurement tool for CAD patients. Patients provided an initial shortlist of disease-related self-care topics. Key-informants helped to finalize topics for inclusion. Respiratory physicians and patients contributed to the development of a scenario-based questionnaire, which was refined during three rounds of testing to develop a 44-item instrument comprising nine self-management passages. We highlight the holistic process of integrating information from the literature with knowledge gained from key stakeholders into our tool framework. Our approach to stakeholder engagement may be of interest to researchers developing similar tools, and could facilitate the development and testing of HL-based interventions to ultimately improve patient outcomes and reduce the burden on the healthcare system. Full article

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14 pages, 516 KiB

Open AccessArticle

The Effect of Socio-Economic Status on Health Information Literacy among Urban Older Adults: Evidence from Western China

by Chengbo Li and Yanqi Guo

Int. J. Environ. Res. Public Health 2021, 18(7), 3501; https://doi.org/10.3390/ijerph18073501 - 28 Mar 2021

Cited by 18 | Viewed by 3789

Abstract

The present study aimed to observe the effect of socio-economic status on health information literacy and to identify whether there is a social gradient for health information literacy among urban older adults in Western China. This study employed a cross-sectional research design, and [...] Read more.

The present study aimed to observe the effect of socio-economic status on health information literacy and to identify whether there is a social gradient for health information literacy among urban older adults in Western China. This study employed a cross-sectional research design, and 812 urban participants aged 60 and older were enrolled in Western China. In the current study, only 16.7% of urban older adults reported having adequate health information literacy. Binary logistic regression analysis showed that socio-economic status factors including educational attainment, ethnicity, and financial strain were significantly and tightly associated with health information literacy. Additionally, other factors including suffering from chronic diseases, information-seeking activity, reading magazines and books, and watching television were also significantly linked to health information literacy. Consistent with existing studies, the findings indicate the health information literacy deficit and demonstrate the crucial impact of socio-economic status on health information literacy, which implies a social gradient in health information literacy. The importance of other factors related to health information literacy are discussed as well. The results suggest that reducing the health information literacy deficit and social gradient in health information literacy must be considered as an important priority when developing public health and health education strategies, programs, and actions among urban older adults in Western China. Full article

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18 pages, 1670 KiB

Open AccessReview

A Multilingual Integrative Review of Health Literacy in Former Soviet Union, Russian-Speaking Immigrants

by Uliana Kostareva, Cheryl L. Albright, Eva-Maria Berens, Patricia Polansky, Deborah E. Kadish, Luba L. Ivanov and Tetine L. Sentell

Int. J. Environ. Res. Public Health 2021, 18(2), 657; https://doi.org/10.3390/ijerph18020657 - 14 Jan 2021

Cited by 8 | Viewed by 4372

Abstract

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. [...] Read more.

Large diasporas of former Soviet Union (FSU) immigrants are found in the USA, Germany, and Israel. To synthesize evidence, identify limitations, and propose future directions we conducted an integrative review on the health literacy of FSU immigrants, migrants, or refugees in four languages. Following integrative review and PRISMA guidelines, we searched four databases in English and performed supplementary searches in Russian, German, and Hebrew to identify qualitative and quantitative studies on FSU immigrants and health literacy. Six articles met inclusion criteria in English and one in German; the majority were published in the last five years. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Four articles were about immigrants with a mean age ≥50 years. All articles stressed the value of translated, culturally relevant health information. The health literacy of FSU immigrants is understudied, despite clear needs. Future research should include assessments of FSU immigrants’ health literacy and include diverse (e.g., age, gender) yet well-defined populations to determine both barriers and facilitators to their health literacy. This review, an example of a multilingual search, provided a comprehensive understanding of existing literature and is a useful approach for global health literacy research. Full article

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10 pages, 548 KiB

Open AccessArticle

Validity and Reliability of the Indian Version of the HLS-EU-Q16 Questionnaire

by Jyoshma Preema Dsouza, Stephan Van den Broucke and Sanjay Pattanshetty

Int. J. Environ. Res. Public Health 2021, 18(2), 495; https://doi.org/10.3390/ijerph18020495 - 9 Jan 2021

Cited by 17 | Viewed by 4698

Abstract

Health literacy is a key topic in public health. Several measurement tools exist that operationalize health literacy, but only a few standard tools measure health literacy at a population level, and none of those are currently available for the Indian context. This study [...] Read more.

Health literacy is a key topic in public health. Several measurement tools exist that operationalize health literacy, but only a few standard tools measure health literacy at a population level, and none of those are currently available for the Indian context. This study aimed to develop and validate an Indian version of the short form of the European Health literacy Questionnaire (HLS-EU Q16). Following the translation of the English version of the questionnaire in Hindi and Kannada by language experts and confirmation of the item content by health literacy experts, the questionnaire was administered to 158 Hindi speaking and 182 Kannada speaking individuals, selected via purposive sampling. Pearson’s correlation was used to confirm test–retest reliability, and confirmatory factor analysis was used to assess the construct validity of the scales in both languages. Cronbach’s alpha was calculated for the scales and their sub-domains, and item-total correlations were used to calculate item discriminant indices. Discriminant validity was examined by comparing scores of participant groups based on educational status and training in health care. Cronbach’s alpha for the Hindi version of the tool (HLS-IND-HIN-Q16) was 0.98, and for Kannada version (HLS-IND-KAN-Q16) 0.97. Confirmatory factor analysis produced fit indices within acceptable limits. The results allowed us to conclude that the two Indian language questionnaires allow valid and reliable measurements of health literacy among the Hindi and Kannada speaking population of India. Full article

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2020

Jump to: 2024, 2022, 2021

14 pages, 514 KiB

Open AccessArticle

Using the Brief Health Literacy Screen in Chronic Care in French Hospital Settings: Content Validity of Patient and Healthcare Professional Reports

by Adèle Perrin, Luiza Siqueira do Prado, Amélie Duché, Anne-Marie Schott, Alexandra L. Dima and Julie Haesebaert

Int. J. Environ. Res. Public Health 2021, 18(1), 96; https://doi.org/10.3390/ijerph18010096 - 25 Dec 2020

Cited by 7 | Viewed by 2899

Abstract

Person-centered care has led healthcare professionals (HCPs) to be more attentive to patients’ ability to understand and apply health-related information, especially those with chronic conditions. The concept of health literacy (HL) is essential in understanding patients’ needs in routine care, but its measurement [...] Read more.

Person-centered care has led healthcare professionals (HCPs) to be more attentive to patients’ ability to understand and apply health-related information, especially those with chronic conditions. The concept of health literacy (HL) is essential in understanding patients’ needs in routine care, but its measurement is still controversial, and few tools are validated in French. We therefore considered the brief health literacy screen (BHLS) for assessing patient-reported HL in chronic care settings, and also developed an HCP-reported version of the BHLS with the aim of using it as a research instrument to assess HCPs’ evaluation of patients’ HL levels. We assessed the content validity of the French translation of both the patient-reported and HCP-reported BHLS in chronic care within hospital settings, through cognitive interviews with patients and HCPs. We performed qualitative analysis on interview data using the survey response Tourangeau model. Our results show that the BHLS is easy and quick to administer, but some terms need to be adapted to the French chronic care settings. Health-related information was observed to be mainly communicated orally, hence a useful direction for future literacy measures would be to also address verbal HL. Full article

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14 pages, 575 KiB

Open AccessArticle

Self-Assessment Tool to Promote Organizational Health Literacy in Primary Care Settings in Switzerland

by Saskia Maria De Gani, Daniela Nowak-Flück, Dunja Nicca and Dominique Vogt

Int. J. Environ. Res. Public Health 2020, 17(24), 9497; https://doi.org/10.3390/ijerph17249497 - 18 Dec 2020

Cited by 14 | Viewed by 4467

Abstract

Dealing with health information and taking care of one’s own health are key aspects of health literacy and a difficulty for nearly half of the population in Europe. Limited health literacy often results in poorer health outcomes. Health literacy is a fundamental health [...] Read more.

Dealing with health information and taking care of one’s own health are key aspects of health literacy and a difficulty for nearly half of the population in Europe. Limited health literacy often results in poorer health outcomes. Health literacy is a fundamental health determinant, and its improvement provides great potential for addressing public health challenges. Health care organizations play an important role in improving population’s health literacy. Health literate health care organizations facilitate access, understanding and use of health information and decrease the demands and complexities of the health care system. Few efforts have been taken so far to promote organizational health literacy, especially in German-speaking countries. This project aimed at developing a self-assessment tool, which enables primary care organizations to assess and improve their level of health literacy. The self-assessment tool was developed and evaluated with general practitioners and community care organizations in Switzerland. Here the participative development process, outcomes and the three modules of the self-assessment tool are presented: (1) manual with detailed introduction and instruction, (2) checklist for self-assessment of organizational health literacy and (3) handbook with measures for improvement. The aim of this tool is that organizations are able to identify the need for action, plan and implement improvement measures. Full article

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10 pages, 334 KiB

Open AccessArticle

Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study

by Karina Friis, Anna Aaby, Mathias Lasgaard, Marie Hauge Pedersen, Richard H. Osborne and Helle Terkildsen Maindal

Int. J. Environ. Res. Public Health 2020, 17(24), 9399; https://doi.org/10.3390/ijerph17249399 - 15 Dec 2020

Cited by 17 | Viewed by 3521

Abstract

Background: The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. Methods: Data from a large Danish health [...] Read more.

Background: The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. Methods: Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. Results: Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11–1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01–2.14)), diabetes (HR 1.91 (95% CI 1.13–3.22)) and mental illness (HR 2.18 (95% CI 1.25–3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. Conclusions: Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs. Full article

11 pages, 359 KiB

Open AccessArticle

Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students

by Rafaela Rosário, Maria R. O. Martins, Cláudia Augusto, Maria José Silva, Silvana Martins, Ana Duarte, Inês Fronteira, Neida Ramos, Orkan Okan and Kevin Dadaczynski

Int. J. Environ. Res. Public Health 2020, 17(23), 8987; https://doi.org/10.3390/ijerph17238987 - 2 Dec 2020

Cited by 66 | Viewed by 7684

Abstract

We aim to evaluate the associations between digital health literacy (DHL) related to COVID-19 and online information-seeking behavior among university students. Methods: A total of 3.084 students (75.7% women), with an average age of 24.2 (SD = 7.5) participated in this cross-sectional study, [...] Read more.

We aim to evaluate the associations between digital health literacy (DHL) related to COVID-19 and online information-seeking behavior among university students. Methods: A total of 3.084 students (75.7% women), with an average age of 24.2 (SD = 7.5) participated in this cross-sectional study, most of whom (36.5%) were from social sciences and pursued a bachelor’s degree (50.7%). Data on COVID-19-related DHL and online information-seeking behavior were collected using an online questionnaire. Logistic regression models were performed. Results: As the pandemic progressed, participants showed a lower chance of achieving a sufficient DHL (OR = 0.7; 95% CI = 0.6; 0.9). Using search engines more often (e.g., Google) (OR = 0.7; 95% CI = 0.5; 0.9), Wikipedia (OR = 0.7; 95% CI = 0.6; 0.9) and social media (e.g., Facebook) (OR = 0.7; 95% CI = 0.6; 0.9) decreased the likelihood of achieving sufficient DHL related to COVID-19. More frequent use of websites of public bodies (OR = 1.7; 95% CI = 1.1; 2.5) increased the odds of reporting sufficient DHL. Conclusion: DHL is associated with university students’ online information-seeking behavior in the time of COVID-19. From a community and public health perspective, programs aiming at improving DHL should be highlighted. Full article

23 pages, 425 KiB

Open AccessArticle

Subjective Generic Health Literacy and Its Associated Factors among Adolescents: Results of a Population-Based Online Survey in Germany

by Anne-Kathrin M. Loer, Olga M. Domanska, Christiane Stock and Susanne Jordan

Int. J. Environ. Res. Public Health 2020, 17(22), 8682; https://doi.org/10.3390/ijerph17228682 - 23 Nov 2020

Cited by 19 | Viewed by 6951 | Correction

Abstract

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, [...] Read more.

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, family affluence, migration background), social (social support by family and friends) and personal (self-efficacy) factors. We conducted a representative cross-sectional online survey. Four health literacy dimensions were captured among 14–17 years old adolescents living in Germany (n = 1235) with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Descriptive, bivariate and multiple logistic regression analyses were used to analyse the data (n = 1202). We found poor health literacy levels—to varying degrees—in all examined health literacy dimensions: dealing with health-related information (8.41% with many difficulties), health-related communication skills (28.13% with low skills), attitudes toward one’s own health and health information (8.81% with passive attitudes) and health-related knowledge (22.73% with low levels). We identified significant associations between poor health literacy levels and all factors studied except for age. Our results indicate a need for the implementation of evidence-based health literacy-related promoting interventions, preferentially in education and training institutions. Full article

15 pages, 369 KiB

Open AccessArticle

Health Literacy for Cardiac Rehabilitation: An Examination of Associated Illness Perceptions, Self-Efficacy, Motivation and Physical Activity

by Ronie Walters, Stephen J. Leslie, Jane Sixsmith and Trish Gorely

Int. J. Environ. Res. Public Health 2020, 17(22), 8641; https://doi.org/10.3390/ijerph17228641 - 20 Nov 2020

Cited by 10 | Viewed by 3753

Abstract

Following a diagnosis of cardiovascular disease there is a need for patients to self-manage. Health literacy has been shown to be lower in patients with cardiovascular disease, yet research into health literacy in this population is limited. This study used the Health Literacy [...] Read more.

Following a diagnosis of cardiovascular disease there is a need for patients to self-manage. Health literacy has been shown to be lower in patients with cardiovascular disease, yet research into health literacy in this population is limited. This study used the Health Literacy Questionnaire (HLQ) to examine the health literacy and associated health, health behaviours and psychological profiles of cardiac rehabilitation patients from a remote and rural regional programme in the Scottish Highlands. Consecutive patients referred to the service in a calendar year were sent a cross-sectional questionnaire by post. Hierarchical cluster analysis grouped respondents based on their health literacy profile, and nonparametric methods were used to analyse differences between clusters on the other measures. A total of 282 participants responded (45.7%). Respondents were older (median: 71 years) and more likely to be from more affluent areas. Five health literacy clusters emerged with different profiles of health, physical activity, self-efficacy, motivation and illness perceptions. There was no difference in relation to cardiac rehabilitation attendance by health literacy cluster, but those with lower health literacy were less likely to be aware of the referral. Patterns of health literacy are associated with health, health behaviours and some psychological constructs. Knowledge of distinct cluster characteristics may help services better target interventions. Full article

12 pages, 331 KiB

Open AccessArticle

Health Literacy and Preventive Behaviors Modify the Association between Pre-Existing Health Conditions and Suspected COVID-19 Symptoms: A Multi-Institutional Survey

by Tan T. Nguyen, Nga T. Le, Minh H. Nguyen, Linh V. Pham, Binh N. Do, Hoang C. Nguyen, Huu C. Nguyen, Tung H. Ha, Hung K. Dao, Phuoc B. Nguyen, Manh V. Trinh, Thinh V. Do, Hung Q. Nguyen, Thao T. P. Nguyen, Nhan P. T. Nguyen, Cuong Q. Tran, Khanh V. Tran, Trang T. Duong, Thu T. M. Pham and Tuyen Van Duong

Int. J. Environ. Res. Public Health 2020, 17(22), 8598; https://doi.org/10.3390/ijerph17228598 - 19 Nov 2020

Cited by 16 | Viewed by 5307

Abstract

People with pre-existing health conditions (PEHC) are vulnerable to viral infection while health literacy (HL) and preventive behaviors (PB) have been shown to benefit people during the COVID-19 pandemic. The aim of this study was to examine the association between PEHC and suspected [...] Read more.

People with pre-existing health conditions (PEHC) are vulnerable to viral infection while health literacy (HL) and preventive behaviors (PB) have been shown to benefit people during the COVID-19 pandemic. The aim of this study was to examine the association between PEHC and suspected COVID-19 symptoms (S-COVID-19-S), and to investigate the modification effect of HL and PB. A cross-sectional study was conducted on 8291 participants visiting outpatient departments at 18 hospitals and health centers across Vietnam from 14 February to 31 May 2020. Data were collected regarding participant’s characteristics, HL, PB, PEHC, and S-COVID-19-S. Regression models were used for analyzing the associations. Results showed that people with PEHC had a 3.38 times higher likelihood of having S-COVID-19-S (odds ratio, OR, 3.38; 95% confidence interval, 95% CI, 3.01, 3.79; p < 0.001). In comparison to participants without PEHC and with the lowest HL score, those with PEHC and one HL score increment had a 7% lower likelihood of having S-COVID-19-S (OR, 0.93; 95% CI, 0.92, 0.94; p < 0.001). In comparison to participants without PEHC and not adhering to mask wearing, those with PEHC and adhering to mask wearing had a 77% lower likelihood of having S-COVID-19-S (OR, 0.23; 95% CI, 0.16, 0.32; p < 0.001). Higher HL and adherence to mask wearing can protect people from having S-COVID-19-S, especially in those with PEHC. Full article

18 pages, 1375 KiB

Open AccessReview

Generic Health Literacy Measurements for Adults: A Scoping Review

by Cindy Yue Tian, Richard Huan Xu, Phoenix Kit-Han Mo, Dong Dong and Eliza Lai-Yi Wong

Int. J. Environ. Res. Public Health 2020, 17(21), 7768; https://doi.org/10.3390/ijerph17217768 - 23 Oct 2020

Cited by 21 | Viewed by 4802

Abstract

Background: Generic health literacy measurement (GHLM) is an important tool to identify individuals with limited health literacy and can assist the design of tailored interventions for improving public health literacy. However, there is no consensus on measuring generic health literacy. The present study [...] Read more.

Background: Generic health literacy measurement (GHLM) is an important tool to identify individuals with limited health literacy and can assist the design of tailored interventions for improving public health literacy. However, there is no consensus on measuring generic health literacy. The present study aims to review current GHLM used for adults in the literature. Methods: A scoping review was undertaken to map the available measurements designed to assess generic health literacy. Results: The review identified 19 GHLM for adults. Most of them applied a multidimensional definition of health literacy with a focus on individuals’ abilities to access, appraise, understand, and apply health information and services. Nutbeam’s conceptual model and Sørensen’s integrated model were widely used among the identified measures as the theoretical foundation. While the social determinants of health (SDH) were acknowledged in the two models, it remains unmentioned in many of the identified measures based on the Nutbeam’s model and needs further development in the measure based on the Sørensen’s model. A total of 39 different domains were assessed in the 19 measurements: prose was identified in 8 measurements and was the most prominent domain; followed by numeracy (n = 7) and interactive (n = 7). SDH related domains such as social support (n = 3), social capital (n = 1) were seldom included in the identified measurements. Conclusions: Although current GHLM adopted a multidimensional construct, they mainly focused on individuals’ abilities and SDH has not been well-developed in the assessment. Further research is required to advance the measuring of the interaction between SDH and health literacy. Full article

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14 pages, 2156 KiB

Open AccessPerspective

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

by Shuaijun Guo, Xiaoming Yu and Orkan Okan

Int. J. Environ. Res. Public Health 2020, 17(20), 7650; https://doi.org/10.3390/ijerph17207650 - 20 Oct 2020

Cited by 10 | Viewed by 3881

Abstract

Over the past two decades, health literacy research has gained increasing attention in global health initiatives to reduce health disparities. While it is well-documented that health literacy is associated with health outcomes, most findings are generated from cross-sectional data. Along with the increasing [...] Read more.

Over the past two decades, health literacy research has gained increasing attention in global health initiatives to reduce health disparities. While it is well-documented that health literacy is associated with health outcomes, most findings are generated from cross-sectional data. Along with the increasing importance of health literacy in policy, there is a lack of specificity and transparency about how to improve health literacy in practice. In this study, we are calling for a shift of current research paradigms from judging health literacy levels towards observing how health literacy skills are developed over the life course and practised in the real world. This includes using a life-course approach, integrating the rationale of precision public health, applying open science practice, and promoting actionable knowledge translation strategies. We show how a greater appreciation for these paradigms promises to advance health literacy research and practice towards an equitable, precise, transparent, and actionable vision. Full article

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16 pages, 462 KiB

Open AccessReview

Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators

by Elham Charoghchian Khorasani, Seyedeh Belin Tavakoly Sany, Hadi Tehrani, Hassan Doosti and Nooshin Peyman

Int. J. Environ. Res. Public Health 2020, 17(20), 7544; https://doi.org/10.3390/ijerph17207544 - 16 Oct 2020

Cited by 38 | Viewed by 7002

Abstract

The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In [...] Read more.

The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. A literature search was done using six databases, the gray literature method and reference hand searches. Thirteen potentially articles with data on 1254 health organizations were included. Eight self-assessment tools and ten OHL attributes have been identified. Eleven quality-improvement characteristics and 15 key barriers were reviewed. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization’s vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes. Thus, there is a need for the healthcare system to consider HL as an organizational priority, that is, be responsive. Full article

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20 pages, 1449 KiB

Open AccessArticle

by Orkan Okan, Torsten Michael Bollweg, Eva-Maria Berens, Klaus Hurrelmann, Ullrich Bauer and Doris Schaeffer

Int. J. Environ. Res. Public Health 2020, 17(15), 5503; https://doi.org/10.3390/ijerph17155503 - 30 Jul 2020

Cited by 261 | Viewed by 23291

Abstract

There is an “infodemic” associated with the COVID-19 pandemic—an overabundance of valid and invalid information. Health literacy is the ability to access, understand, appraise, and apply health information, making it crucial for navigating coronavirus and COVID-19 information environments. A cross-sectional representative study of [...] Read more.

There is an “infodemic” associated with the COVID-19 pandemic—an overabundance of valid and invalid information. Health literacy is the ability to access, understand, appraise, and apply health information, making it crucial for navigating coronavirus and COVID-19 information environments. A cross-sectional representative study of participants ≥ 16 years in Germany was conducted using an online survey. A coronavirus-related health literacy measure was developed (HLS-COVID-Q22). Internal consistency was very high (α = 0.940; ρ = 0.891) and construct validity suggests a sufficient model fit, making HLS-COVID-Q22 a feasible tool for assessing coronavirus-related health literacy in population surveys. While 49.9% of our sample had sufficient levels of coronavirus-related health literacy, 50.1% had “problematic” (15.2%) or “inadequate” (34.9%) levels. Although the overall level of health literacy is high, a vast number of participants report difficulties dealing with coronavirus and COVID-19 information. The participants felt well informed about coronavirus, but 47.8% reported having difficulties judging whether they could trust media information on COVID-19. Confusion about coronavirus information was significantly higher among those who had lower health literacy. This calls for targeted public information campaigns and promotion of population-based health literacy for better navigation of information environments during the infodemic, identification of disinformation, and decision-making based on reliable and trustworthy information. Full article

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13 pages, 435 KiB

Open AccessArticle

Implementation of the National Action Plan Health Literacy in Germany—Lessons Learned

by Doris Schaeffer, Svea Gille and Klaus Hurrelmann

Int. J. Environ. Res. Public Health 2020, 17(12), 4403; https://doi.org/10.3390/ijerph17124403 - 19 Jun 2020

Cited by 15 | Viewed by 4751

Abstract

The promotion of health literacy (HL) has become an important task in public health. In response, in many countries, strategies and action plans to strengthen HL have been developed. Systematic discussion of implementation strategies of action plans on HL is scarce. This paper [...] Read more.

The promotion of health literacy (HL) has become an important task in public health. In response, in many countries, strategies and action plans to strengthen HL have been developed. Systematic discussion of implementation strategies of action plans on HL is scarce. This paper presents the implementation strategy and the methodical process of its realization of the National Action Plan HL in Germany which was published in 2018. The implementation strategy was based on considerations of implementation science and research. A process consisting of a continuum of various overlapping methodical and strategic steps of diffusion, dissemination and implementation based on collaboration and co-production was chosen. According to this, the Action Plan was widely diffused via various channels, disseminated through numerous publications and presentations, and implemented in several settings by holding workshops with stakeholders from politics, science and practice, as well as by cooperating with the Alliance for Health Literacy. This three-part collaborative and co-productive implementation strategy has helped to place HL and the National Action Plan on the health policy agenda in Germany. Experience demonstrates that implementation should be also considered, systematically planned, and addressed when developing strategies to strengthen HL. Full article

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14 pages, 858 KiB

Open AccessFeature PaperArticle

Fear of COVID-19 Scale—Associations of Its Scores with Health Literacy and Health-Related Behaviors among Medical Students

by Hiep T. Nguyen, Binh N. Do, Khue M. Pham, Giang B. Kim, Hoa T.B. Dam, Trung T. Nguyen, Thao T.P. Nguyen, Yen H. Nguyen, Kristine Sørensen, Andrew Pleasant and Tuyen Van Duong

Int. J. Environ. Res. Public Health 2020, 17(11), 4164; https://doi.org/10.3390/ijerph17114164 - 11 Jun 2020

Cited by 260 | Viewed by 21635

Abstract

The coronavirus disease 2019 (COVID-19) pandemic causes fear, as its immediate consequences for the public have produced unprecedented challenges for the education and healthcare systems. We aimed to validate the fear of COVID-19 scale (FCoV-19S) and examine the association of its scores with [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic causes fear, as its immediate consequences for the public have produced unprecedented challenges for the education and healthcare systems. We aimed to validate the fear of COVID-19 scale (FCoV-19S) and examine the association of its scores with health literacy and health-related behaviors among medical students. A cross-sectional study was conducted from 7 to 29 April 2020 on 5423 students at eight universities across Vietnam, including five universities in the North, one university in the Center, two universities in the South. An online survey questionnaire was used to collect data on participants’ characteristics, health literacy, fear of COVID-19 using the FCoV-19S, and health-related behaviors. The results showed that seven items of the FCoV-19S strongly loaded on one component, explained 62.15% of the variance, with good item–scale convergent validity and high internal consistency (Cronbach’s alpha = 0.90). Higher health literacy was associated with lower FCoV-19S scores (coefficient, B, −0.06; 95% confidence interval, 95%CI, −0.08, −0.04; p < 0.001). Older age or last academic years, being men, and being able to pay for medication were associated with lower FCoV-19S scores. Students with higher FCoV-19S scores more likely kept smoking (odds ratio, OR, 1.11; 95% CI, 1.08, 1.14; p < 0.001) or drinking alcohol (OR, 1.04; 95% CI, 1.02, 1.06; p < 0.001) at an unchanged or higher level during the pandemic, as compared to students with lower FCoV-19S scores. In conclusion, the FCoV-19S is valid and reliable in screening for fear of COVID-19. Health literacy was found to protect medical students from fear. Smoking and drinking appeared to have a negative impact on fear of COVID-19. Strategic public health approaches are required to reduce fear and promote healthy lifestyles during the pandemic. Full article

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