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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 32231

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Special Issue Editors

Dr. Dirk Bruland

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Guest Editor

FH Bielefeld, University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
Interests: health literacy in people with intellectual disabilities; participatory research; health promotion in vulnerable population groups

Dr. Joy Agner

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Guest Editor

USC Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA 90089, USA
Interests: health literacy and social networks; public mental health; participatory research; empowerment; health systems research

Prof. Dr. Anne-Dörte Latteck

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Guest Editor

FH Bielefeld, University of Applied Sciences, Interaktion 1, 33619 Bielefeld, Germany
Interests: health literacy in people with intellectual disabilities; participatory research; care research

Special Issue Information

Dear Colleagues,

Health literacy, defined as individuals’ ability to find, understand, critique, and use health-related information, has the potential to empower people to make positive health choices. Historically and clinically, health literacy has primarily been understood as an individual construct. However, recent research highlights the role of social contexts in acquiring knowledge and making health-related decisions. The COVID-19 pandemic has underscored the value in this research, illustrating that understanding, evaluating, and using health information is dynamic and socially determined, rather than fixed and individual. To develop successful health literacy interventions on both individual and collective levels, a more nuanced, theory- and research-based understanding of how social contexts shape health literacy is needed. To promote further exploration of this topic, we are seeking manuscripts that examine the intersection of social contexts and health literacy. We define social contexts as interpersonal relationships, organizations, communities, health and educational systems, cultural contexts, and digital interaction spaces. We invite conceptual/theoretical work, empirical articles, or reviews that can expand the knowledge of how social contexts influence access to health information, interpretation of that information, and/or health decision-making.

If you have any further queries about this Special Issue, please feel free to contact the Guest Editors for more information.

Dr. Dirk Bruland
Dr. Joy Agner
Prof. Dr. Anne-Dörte Latteck
Guest Editors

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Keywords

health literacy
social context
social practice
social networks
social relationships
organizational health literacy
distributed health literacy
community health literacy
digital health literacy
culture and health literacy

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Published Papers (12 papers)

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Editorial

Jump to: Research, Review

14 pages, 723 KiB

Open AccessEditorial

An Introduction to Health Literacy and Social Contexts with Recommendations for Health Professionals and Researchers

by Joy Agner, Katharine Elizabeth Bau and Dirk Bruland

Int. J. Environ. Res. Public Health 2024, 21(2), 240; https://doi.org/10.3390/ijerph21020240 - 19 Feb 2024

Cited by 1 | Viewed by 3203

Abstract

Rarely do individuals seek, obtain, and understand health information in a solitary void [...] Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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Research

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17 pages, 741 KiB

Open AccessArticle

Health Literacy, Social Networks, and Health Outcomes among Mental Health Clubhouse Members in Hawai‘i

by Joy Agner, Monet Meyer, Tyra Mahealani Kaukau, Maileen Liu, Lisa Nakamura, Adriana Botero and Tetine Sentell

Int. J. Environ. Res. Public Health 2023, 20(1), 837; https://doi.org/10.3390/ijerph20010837 - 2 Jan 2023

Cited by 8 | Viewed by 3187

Abstract

Health literacy is the ability to obtain and utilize health information to make health-related decisions and to navigate health systems. Although health literacy has traditionally been understood as an individual-level construct, current research is revealing the impact that social networks can have on health literacy. To date, no studies have examined associations between health literacy and social networks among people with serious mental illness (PWSMI), who are at high risk of physical illness and premature mortality. To begin to fill this gap, this study explores associations between health literacy, relationships with health discussion partners, and self-reported health outcomes in a racially diverse sample of Clubhouse members in Hawai‘i. Clubhouses are community mental health centers that promote recovery from mental illness through destigmatization, meaningful activity, and strong social relationships. Health literacy was assessed using two single-item screeners (SILS). In a sample of 163 members, 56.2% reported adequate ability to understand health-related instructions or pamphlets, and 43.3% reported adequate confidence filling out medical forms independently. This is consistent with other health literacy studies with PWSMI in the United States, and indicates lower health literacy within this group than is reported in national averages. Multivariate logistic regression revealed a larger Clubhouse staff social network and completing high school were significantly associated with requiring less help to read materials. Higher age, male gender, and being Native Hawaiian and/or Pacific Islander were associated with less confidence filling out medical forms, while higher self-efficacy was associated with higher confidence filling out medical forms. This study provides preliminary evidence that relationships fostered within Clubhouses are associated with health literacy among PWSMI, and highlights the need for more research to examine how social networks and health literacy interventions can be leveraged in community mental health settings to improve health outcomes within this vulnerable population. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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26 pages, 2369 KiB

Open AccessArticle

Recognising Basic Health Literacy Capabilities: An Explorative Study on the Relevance of Health-Related Information in the Support of People with Profound Intellectual and Multiple Disabilities

by Timo Dins and Caren Keeley

Int. J. Environ. Res. Public Health 2022, 19(24), 16874; https://doi.org/10.3390/ijerph192416874 - 15 Dec 2022

Cited by 4 | Viewed by 2048

Abstract

Background: People with profound intellectual disabilities represent a vulnerable and heterogeneous population whose health-related needs and questions often remain unheard. One reason for this is that they are usually unable to participate in verbal communication. However, there is also a lack of suitable approaches to communicate health-related information to them according to their capabilities. The research presented in this paper addresses this gap. Methods: Following grounded theory methodology, we used a multimethod approach. Based on a theoretical analysis, a Delphi study (n = 14) was conducted as a starting point to map the research field. In a second step, these findings were incorporated into an online survey targeting disability care professionals (n = 111). Three field studies supplemented the data, encompassing a variety of ethnographic methods. Results: People with PIMD have basic health-related capabilities that can improve their health literacy. Nevertheless, their support environments have to take over many health literacy-related requirements by proxy or substitution. One of the most important tasks is to engage health information in an individualised way. Conclusions: The findings underline the importance of focusing on more basic capabilities and intersubjective approaches in health literacy research and practice, especially regarding new perspectives on the inclusion of previously marginalised populations (such as people with PIMD). Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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14 pages, 361 KiB

Open AccessArticle

Social Networks, Health Information Sharing, and Pandemic Perceptions among Young Adults in Hawai’i during the COVID-19 Pandemic

by Michael M. Phillips, Rosana Hernandez Weldon, Anam Maniar, Uday Patil, Uliana Kostareva, Joy Agner, Julia Finn and Tetine Sentell

Int. J. Environ. Res. Public Health 2022, 19(24), 16833; https://doi.org/10.3390/ijerph192416833 - 15 Dec 2022

Cited by 2 | Viewed by 1670

Abstract

Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai’i residents aged 18–35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2–3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others’ health, women and those with chronic diseases listened to a greater number. Understanding young adults’ social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

17 pages, 909 KiB

Open AccessArticle

Health Literacy of People with Substitutive Private Health Insurance in Germany and Their Assessment of the Health System Performance According to Health Literacy Levels: Results from a Survey

by Katharina Achstetter, Julia Köppen, Matthias Haltaufderheide, Philipp Hengel, Miriam Blümel and Reinhard Busse

Int. J. Environ. Res. Public Health 2022, 19(24), 16711; https://doi.org/10.3390/ijerph192416711 - 13 Dec 2022

Cited by 4 | Viewed by 2056

Abstract

Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous research has shown that low HL is more prevalent among, e.g., people with lower social status, lower educational level, and among the elderly. In Germany, people with substitutive private health insurance (PHI) account for 11% of the population and tend to have a higher level of education and social status, but in-detail assessments of their HL are missing so far. Therefore, this study aimed to investigate the HL of PHI insureds in Germany, and to analyze their assessment of the health system according to their HL level. In 2018, 20,000 PHI insureds were invited to participate in a survey, which contained the HLS-EU-Q16, and items covering patient characteristics and the World Health Organization health systems framework goals (e.g., access, quality, safety, responsiveness). Low HL was found for 46.2% of respondents and was more prevalent, e.g., among men and insureds with a low subjective social status. The health system performance was perceived poorer by respondents with low HL. Future initiatives to strengthen health systems should focus on promoting HL. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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20 pages, 835 KiB

Open AccessArticle

How Do Primary Care Organizations Rate Their Level of Organizational Health Literacy? Results of a Swiss Pilot-Study

by Anna-Sophia Beese, Dunja Nicca, Rebecca Jaks, Natascha Stuermer and Saskia Maria De Gani

Int. J. Environ. Res. Public Health 2022, 19(23), 16139; https://doi.org/10.3390/ijerph192316139 - 2 Dec 2022

Cited by 5 | Viewed by 1788

Abstract

Primary care organizations offer a suitable setting to promote organizational health literacy (OHL) since they are a crucial interface for patients and clients. However, a clear picture on the OHL situation in primary care is lacking. The aim of this study was to assess OHL in Swiss primary care organizations by evaluating (i) how they rate their level of OHL and which improvement measures they accordingly plan (organizational level), (ii) what knowledge and attitudes among health professionals in primary care regarding OHL exist (individual level) and (iii) how teams working in general practitioners’ practices and a home care service organization differ regarding OHL (organizational and individual level). The research design included an online survey (N = 74, health professionals) on the individual level and a checklist and intervention documentation (N = 10, primary care teams) on the organizational level. The study reveals a crucial demand regarding organizationally embedded OHL practices in the participating primary care teams, despite a rather comprehensive understanding of the concept. The greatest need for action was identified in strengthening health literacy of staff members, which underlines the necessity to develop interventions to systematically strengthen the health literacy of health professionals. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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13 pages, 659 KiB

Open AccessArticle

Health Literacy of People with Intellectual Disabilities: How Meaningful Is the Social Context for a Target Group-Oriented Model of Health Literacy?

by Nils Sebastian Vetter, Karina Ilskens, Norbert Seidl, Änne-Dörte Latteck and Dirk Bruland

Int. J. Environ. Res. Public Health 2022, 19(23), 16052; https://doi.org/10.3390/ijerph192316052 - 30 Nov 2022

Cited by 6 | Viewed by 2280

Abstract

Health literacy is primarily understood as an individual construct. People with intellectual disabilities still seem to be a “hidden” population in health literacy research. A target-orientated health literacy approach for this population is needed for developing precise and effective interventions that consider social context dimensions. Therefore, the following research question was answered: Which dimensions influence the health literacy of people with intellectual disabilities? A secondary data analysis containing 38 guided interviews with people with mild to moderate intellectual disabilities was conducted. The analysis followed the content analysis by Schreier (2012). Six main dimensions were inductively outlined, which are “interpersonal relationship”, “organizations and communities”, “healthcare system”, “education”, “digital interaction spaces”, “politics”, and “cultural contexts”. All these dimensions influence people with intellectual disabilities on an individual level regarding their level of health literacy. The importance of these single dimensions becomes clear, although for now, the link between all these dimensions is not yet considered. In future research, the focus should be on how to develop interventions considering social context dimensions. Furthermore, analyzing the connection between those dimensions seems promising. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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22 pages, 1011 KiB

Open AccessArticle

Health Professionals’ Experience with the First Implementation of the Organizational Health Literacy Self-Assessment Tool for Primary Care (OHL Self-AsseT)—A Qualitative Reflexive Thematic Analysis

by Natascha Stuermer, Saskia Maria De Gani, Anna-Sophia Beese, Jennifer Giovanoli Evack, Rebecca Jaks and Dunja Nicca

Int. J. Environ. Res. Public Health 2022, 19(23), 15916; https://doi.org/10.3390/ijerph192315916 - 29 Nov 2022

Cited by 4 | Viewed by 3110

Abstract

Organizational health literacy (OHL) is crucial for public health, in turn health care organizations play vital roles in improving populations’ health literacy. Therefore, the aim of this qualitative study was to explore how the organizational health literacy self-assessment tool (OHL Self-AsseT) was implemented, used, and understood by primary care teams from a network of general practices and a Home Care Service Organization in Zurich, Switzerland. Reflexive thematic analysis with a constructivist orientation was used to analyze data from 19 interviews pre- and post-OHL Self-AsseT use. Normalization Process Theory supported structuring of inductively developed themes. Findings show that the participants experienced working with the OHL Self-AsseT meaningful, as it helped with “Addressing OHL construction sites” so that they could “build momentum for change”. The experience of “Succeeding together in construction” led to a “feeling of team-efficacy during change”. Practical use of the tool and/or discussions about OHL led to a growing conceptual understanding, which was described as “Using a construction plan–making sense of ongoing OHL activities”. To conclude, the OHL Self-AsseT encouraged teams to initiate change, led to greater team-efficacy and supported the construction of OHL. Improved implementation strategies will support this intervention’s scale-up as a base for effectiveness testing. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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19 pages, 440 KiB

Open AccessArticle

Do Health Information Sources Influence Health Literacy among Older Adults: A Cross-Sectional Study in the Urban Areas of Western China

by Chengbo Li, Mengyao Liu, Jin Zhou, Mei Zhang, Huanchang Liu, Yuting Wu, Hui Li, George W. Leeson and Tingting Deng

Int. J. Environ. Res. Public Health 2022, 19(20), 13106; https://doi.org/10.3390/ijerph192013106 - 12 Oct 2022

Cited by 7 | Viewed by 2823

Abstract

Background: Previous studies have found that the dissemination pattern and delivery mechanism of information can provide crucial resources and empowerment for individuals to the promotion of health literacy. The present study investigates how health information sources are associated with health literacy among older adults in west China, and tries to explain the mechanisms underlying the link between health information sources and health literacy in the Chinese context. Methods: The cross-sectional study employed a representative sample of 812 urban citizens aged 60 and older in 2017 in Western China. Results: We found that health information sources including healthcare practitioners (B = 4.577, p < 0.001), neighbors (B = 2.545, p < 0.05), newspapers (B = 4.280, p < 0.001), and television (B = 4.638, p < 0.001) were positively associated with health literacy. Additionally, age (B = −1.781, p < 0.001) was negatively associated with health literacy, and the socio-economic status factors including minority (B = −10.005, p < 0.001), financial strain status of perceived very difficult (B = −10.537, p < 0.001), primary school (B = 11.461, p < 0.001), junior high school (B = 18.016, p < 0.001), polytechnic school or senior high school (B = 21.905, p < 0.001), college and above (B = 23.433, p < 0.001) were significantly linked to health literacy, and suffering from chronic diseases (B = 3.430, p < 0.01) was also positively related to health literacy. Conclusions: Health information sources including healthcare practitioners, neighbors, newspapers, and television have a strong influence on health literacy, which implies that the four main types of sources are the important patterns of health information dissemination in the reinforcement of health literacy. In addition, the present findings also indicate age, minority and disease differences in health literacy and confirm the influence of enabling factors including educational attainment and financial strain on health literacy. Based on these findings and their implications, specific evidence is presented for the reinforcement of health literacy in interpersonal and mass communication, and in the educational and financial settings in the Chinese context. The present results also suggest that the age-specific, minority-specific and disease-specific measures should be taken to promote health literacy among older adults. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

14 pages, 794 KiB

Open AccessFeature PaperArticle

Public Libraries as Supportive Environments for Children’s Development of Critical Health Literacy

by Catherine L. Jenkins, Susie Sykes and Jane Wills

Int. J. Environ. Res. Public Health 2022, 19(19), 11896; https://doi.org/10.3390/ijerph191911896 - 20 Sep 2022

Cited by 7 | Viewed by 2918

Abstract

Critical health literacy enables individuals to use cognitive and social resources for informed action on the wider determinants of health. Promoting critical health literacy early in the life-course may contribute to improved health outcomes in the long term, but children’s opportunities to develop critical health literacy are limited and tend to be school-based. This study applies a settings-based approach to analyse the potential of public libraries in England to be supportive environments for children’s development of critical health literacy. The study adopted institutional ethnography as a framework to explore the public library as an everyday setting for children. A children’s advisory group informed the study design. Thirteen children and 19 public library staff and community stakeholders were interviewed. The study results indicated that the public library was not seen by children, staff, or community stakeholders as a setting for health. Its policies and structure purport to develop health literacy, but the political nature of critical health literacy was seen as outside its remit. A supersetting approach in which children’s everyday settings work together is proposed and a conceptual model of the public library role is presented. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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21 pages, 1118 KiB

Open AccessArticle

eHealth Literacy of Australian Undergraduate Health Profession Students: A Descriptive Study

by Carey Ann Mather, Christina Cheng, Tracy Douglas, Gerald Elsworth and Richard Osborne

Int. J. Environ. Res. Public Health 2022, 19(17), 10751; https://doi.org/10.3390/ijerph191710751 - 29 Aug 2022

Cited by 9 | Viewed by 2596

Abstract

Rapid growth in digital health technologies has increased demand for eHealth literacy of all stakeholders within health and social care environments. The digital future of health care services requires the next generation of health professionals to be well-prepared to confidently provide high-quality and safe health care. The aim of this study was to explore the eHealth literacy of undergraduate health profession students to inform undergraduate curriculum development to promote work-readiness. A cross-sectional survey was undertaken at an Australian university using the seven-domain eHealth Literacy Questionnaire (eHLQ), with 610 students participating. A one-way Multivariate Analysis of Variance (MANOVA) with follow-up univariate analysis (ANOVA) was used to determine if there were differences in eHLQ scores across 11 sociodemographic variables. Students generally had good knowledge of health (Scale 2); however, they had concerns over the security of online health data (Scale 4). There were also significant differences in age and ownership of digital devices. Students who were younger reported higher scores across all seven eHLQ scales than older students. This research provided an understanding of eHealth literacy of health profession students and revealed sub-groups that have lower eHealth literacy, suggesting that digital health skills should be integrated into university curriculums, especially related to practice-based digital applications with special focus to address privacy and security concerns. Preparation of health profession students so they can efficiently address their own needs, and the needs of others, is recommended to minimise the digital divide within health and social care environments. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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Review

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11 pages, 492 KiB

Open AccessReview

Qualitative Research Studies Addressing Patient-Practitioner Communication about Online Health Information

by Cathrin Brøndbo Larsen and Heidi Gilstad

Int. J. Environ. Res. Public Health 2022, 19(21), 14004; https://doi.org/10.3390/ijerph192114004 - 27 Oct 2022

Cited by 4 | Viewed by 2837

Abstract

Modern healthcare is becoming increasingly technologized, knowledge-intensive, and specialized, which has consequences for communication between patients and practitioners in clinical encounters. Health information is increasingly accessible to patients through online resources. The objective of this paper is to provide an overview of existing studies that address how patients communicate with practitioners about online health information and to identify the key topics raised in these studies. With the concept of eHealth literacy as its point of departure, this paper specifically highlights the eHealth literacy topic of how patients comprehend, appraise and communicate online health information before and during the encounter with the healthcare professionals. In the literature search, we focus on qualitative studies that consider patients’ and/or practitioners’ reflections on online health information. We searched PUBMED, SCOPUS and Web of Science to capture research from various fields. Sixteen studies were included that met the following criteria: Qualitative study, focus on patient-practitioner communication, eHealth literacy and online information. The results show that the vast majority of studies were based on qualitative interviews, addressing patients’ and practitioners’ perspectives. Key topics in studies addressing patient perspectives were: reasons for seeking online information; calibrating understanding of online information with the practitioner; and barriers to discussing online information with practitioners. Key topics raised in studies focusing on practitioners were: trust in the patient and the online health information he/she presented as well as strategies to respond to patients who referred to online health information. The review highlights the need for further qualitative studies, preferably observational studies from authentic clinical communication situations, in order to capture how patients and practitioners communicate about online health information. Full article

(This article belongs to the Special Issue Health Literacy and Social Contexts)

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