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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 Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (26 February 2021) | Viewed by 64016

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Dr. Paulo Santos

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Department of Medicine of Community, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
Interests: preventive medicine; primary health care; ethics
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Inês Rosendo

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Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
Interests: health literacy

Dr. Daniel Beirão

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Department of Medicine of Community, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
Interests: health literacy; economic evaluation in health

Special Issue Information

Dear Colleagues,

Medicine has always aimed at efforts to cure diseases, both as a therapeutic strategy and as a preventive approach. Traditionally, a good doctor was one who made the correct diagnosis and prescribed the best medicines, whether medication or counseling. In recent years, the idea has emerged that there is a ceiling for medical efficiency for which the boundary is defined by the patients and the way in which they adhere to medical advice. Paternalism has given way to shared decision making, and it is necessary to improve the knowledge of patients so that they can be prepared to discuss their options with their doctors.

As noted above, this is a fairly recent idea. The MeSH term “health literacy” was only introduced in 2010 in PubMed. Health literacy is defined as the degree to which patients can obtain, process, and understand the basic health information and services needed to make the most appropriate choices about their care.

The aim is not only to teach patients about health issues but also to encourage them to develop attitudes and skills that will facilitate reasoned decision making. Although it is important to improve a patient’s adherence to medications from the curative perspective, this approach is far more relevant in preventive medicine, where the options of today will have a great impact on the future, for good and for bad.

The empowerment of patients is crucial, and the way to achieve it is the object of research.

The aim of this Special Issue is to assemble a set of articles that discuss the ways in which we may improve health literacy in patients, applying health strategies designed for the population to the individual. Original articles, significant case reports, and comprehensive reviews are welcome.

Prof. Dr. Paulo Santos
Prof. Dr. Inês Rosendo
Dr. Daniel Beirão
Guest Editors

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Keywords

health Literacy
preventive medicine
health knowledge, attitudes, practice
patient compliance

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Published Papers (11 papers)

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12 pages, 954 KiB

Open AccessArticle

The Impact of Health Literacy on Knowledge and Attitudes towards Preventive Strategies against COVID-19: A Cross-Sectional Study

by Maria João Silva and Paulo Santos

Int. J. Environ. Res. Public Health 2021, 18(10), 5421; https://doi.org/10.3390/ijerph18105421 - 19 May 2021

Cited by 56 | Viewed by 6440

Abstract

The coronavirus disease 2019 (COVID-19) pandemic introduced a set of mitigation measures based on personal behavior and attitudes. In the absence of vaccination or specific treatment, it became essential to comply with these measures to reduce infection transmission. Health literacy is the basis for changing behaviors. AIM: To characterize the impact of literacy on knowledge and attitudes towards preventive strategies against COVID-19. METHODS: This cross-sectional study involved an online questionnaire applied to students of the University of Porto, Portugal, containing questions about knowledge and attitudes towards COVID-19 based on European guidelines. Health literacy was assessed through the Newest Vital Sign questionnaire. Logistic regression estimated the relationship between health literacy and both knowledge and attitudes. RESULTS: We included 871 participants (76.3% female), with a median age of 22 years old. We found adequate literacy in 92% of our sample, irrespective of gender and age. In the global analysis, 78.6% of the participants had adequate knowledge, and 90.4% had adequate attitudes. We found that better literacy was significantly associated with attitudes towards COVID-19, but not with better knowledge. In a model adjusted for gender, age, and previous education in the health field, female gender and previous education in the health field were associated with better knowledge and attitudes. CONCLUSION: Better health literacy is associated with better attitudes towards preventive strategies against COVID-19. We should invest in ways to improve health literacy, so we can improve people’s attitudes and consequently reduce coronavirus’ transmission. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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9 pages, 575 KiB

Open AccessArticle

Development and Validation of a Food Literacy Assessment Tool for Community-Dwelling Elderly People

by Hyeona So, Dahyun Park, Mi-Kyung Choi, Young-Sun Kim, Min-Jeong Shin and Yoo-Kyoung Park

Int. J. Environ. Res. Public Health 2021, 18(9), 4979; https://doi.org/10.3390/ijerph18094979 - 7 May 2021

Cited by 5 | Viewed by 3399

Abstract

Food literacy refers to the knowledge, skills, and attitudes required for individuals to choose foods that promote health. As the rate of diet-related diseases increases, food literacy is becoming more important. However, there are no tools available to evaluate food literacy among the Korean elderly. We derived 547 questions from a literature review and, after three rounds of Delphi surveys, selected 33 preliminary questions. We calculated the content validity ratio of the questions and applied a face validity procedure. We then selected 32 questions, assessed their validity, and distributed them as a questionnaire to 205 elderly people. We then conducted exploratory factor analysis (EFA) to determine the validity of the questionnaire and used an internal consistency index (Cronbach’s α coefficient) to determine reliability. Based on the factor analysis, 13 questions were selected, distributed among three factors, and evaluated using the Kaiser–Meyer–Olkin (KMO) and Bartlett sphericity tests. The factor analysis showed that KMO was 0.872, which is a highly acceptable score, and the Bartlett sphericity test was χ² = 1,374.69 at p = 0.00. The food literacy questionnaire developed in this study will likely be helpful for improving the healthcare of elderly people. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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14 pages, 964 KiB

Open AccessArticle

Impact of Pharmacists’ Interventions and Patients’ Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review

by Kingston Rajiah, Shreeta Sivarasa and Mari Kannan Maharajan

Int. J. Environ. Res. Public Health 2021, 18(9), 4392; https://doi.org/10.3390/ijerph18094392 - 21 Apr 2021

Cited by 34 | Viewed by 5372

Abstract

Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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14 pages, 359 KiB

Open AccessArticle

Health Literacy, Self-Perceived Health, and Substance Use Behavior among Young People with Alcohol and Substance Use Disorders

by Gabriela Rolova, Beata Gavurova and Benjamin Petruzelka

Int. J. Environ. Res. Public Health 2021, 18(8), 4337; https://doi.org/10.3390/ijerph18084337 - 19 Apr 2021

Cited by 24 | Viewed by 4536

Abstract

Licit and illicit substance use is one of the major public health issues with severe negative health consequences for individuals and society. Health literacy is essential for improving one’s health and navigation in the healthcare system. However, the evidence of health literacy in people with substance use disorders is limited. This study aims to examine health literacy and its socio-demographic, health-related, and substance use-related correlates in young people with alcohol (AUD) and substance use disorders (SUD). In this study, cross-sectional data of young people undergoing addiction treatment for AUD (N = 201, mean age 37.6) and SUD (N = 165, mean age 31.1) were used. Health literacy was assessed using the HLS-EU-Q47. Simple and multiple linear regression was performed to estimate the correlates of health literacy. In total, 37.8% of participants with AUD and 41.8% of SUD had limited health literacy. In participants with AUD, living condition factors, self-perceived health indicators, and frequency of alcohol use showed a significant effect on health literacy. In participants with SUD, financial factors, self-perceived health indicators, and injection sharing showed a significant effect. Increasing health literacy might contribute to improved health outcomes and decreased high-risk substance use-related behavior in people undergoing addiction treatment. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

24 pages, 1043 KiB

Open AccessArticle

Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease: An Integrative Review

by Vestina Vainauskienė and Rimgailė Vaitkienė

Int. J. Environ. Res. Public Health 2021, 18(5), 2247; https://doi.org/10.3390/ijerph18052247 - 24 Feb 2021

Cited by 38 | Viewed by 9692

Abstract

The non-development of the concept of patient knowledge empowerment for disease self-management and the non-development of the theory of patient knowledge empowerment in patients with chronic diseases, cause methodological inconsistency of patient empowerment theory and does not provide a methodological basis to present patient knowledge empowerment preconditions. Therefore, the aim of the present integrative review was to synthesize and critically analyze the patient knowledge enablers distinguished in the public health management theory, the knowledge sharing enablers presented in the knowledge management theory and to integrate them by providing a comprehensive framework of patient knowledge enablers. To implement the purpose of the study, in answering the study question of what patient knowledge empowerments are and across which levels of patient knowledge empowerment they operate, an integrative review approach was applied as proposed by Cronin and George. A screening process resulted in a final sample of 78 papers published in open access, peer-review journals in the fields of public health management and knowledge management theories. Based on the results of the study, the Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease Framework was created. It revealed that it is important to look at patient knowledge empowerment as a pathway across the empowerment levels through which both knowledge enablers identified in public health management theory and knowledge sharing enablers singled out in knowledge management theory operate. The integration of these two perspectives across patient empowerment levels uncovers a holistic framework for patient knowledge empowerment. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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14 pages, 398 KiB

Open AccessArticle

Building a House of Skills—A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary

by Andrea Klinovszky, Orsolya Papp-Zipernovszky and Norbert Buzás

Int. J. Environ. Res. Public Health 2021, 18(4), 1547; https://doi.org/10.3390/ijerph18041547 - 6 Feb 2021

Cited by 10 | Viewed by 3193

Abstract

The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman’s rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (β = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman’s rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants’ behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

13 pages, 634 KiB

Open AccessArticle

Attitudes towards Risk Prediction in a Help Seeking Population of Early Detection Centers for Mental Disorders—A Qualitative Approach

by Pauline Katharina Mantell, Annika Baumeister, Stephan Ruhrmann, Anna Janhsen and Christiane Woopen

Int. J. Environ. Res. Public Health 2021, 18(3), 1036; https://doi.org/10.3390/ijerph18031036 - 25 Jan 2021

Cited by 5 | Viewed by 2525

Abstract

Big Data approaches raise hope for a paradigm shift towards illness prevention, while others are concerned about discrimination resulting from these approaches. This will become particularly important for people with mental disorders, as research on medical risk profiles and early detection progresses rapidly. This study aimed to explore views and attitudes towards risk prediction in people who, for the first time, sought help at one of three early detection centers for mental disorders in Germany (Cologne, Munich, Dresden). A total of 269 help-seekers answered an open-ended question on the potential use of risk prediction. Attitudes towards risk prediction and motives for its approval or rejection were categorized inductively and analyzed using qualitative content analysis. The anticipated impact on self-determination was a driving decision component, regardless of whether a person would decide for or against risk prediction. Results revealed diverse, sometimes contrasting, motives for both approval and rejection (e.g., the desire to control of one’s life as a reason for and against risk prediction). Knowledge about a higher risk as a potential psychological burden was one of the major reasons against risk prediction. The decision to make use of risk prediction is expected to have far-reaching effects on the quality of life and self-perception of potential users. Healthcare providers should empower those seeking help by carefully considering individual expectations and perceptions of risk prediction. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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17 pages, 1781 KiB

Open AccessArticle

Core Values that Influence the Patient—Healthcare Professional Power Dynamic: Steering Interaction towards Partnership

by Angela Odero, Manon Pongy, Louis Chauvel, Bernard Voz, Elisabeth Spitz, Benoit Pétré and Michèle Baumann

Int. J. Environ. Res. Public Health 2020, 17(22), 8458; https://doi.org/10.3390/ijerph17228458 - 15 Nov 2020

Cited by 16 | Viewed by 6666

Abstract

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, globalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic between patients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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21 pages, 919 KiB

Open AccessArticle

Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration using Partial Least Squares Structural Equation Modeling

by Jun-Hao Lim, Karuthan Chinna, Pramod Khosla, Tilakavati Karupaiah and Zulfitri Azuan Mat Daud

Int. J. Environ. Res. Public Health 2020, 17(20), 7479; https://doi.org/10.3390/ijerph17207479 - 14 Oct 2020

Cited by 13 | Viewed by 5190

Abstract

Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110–0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103–0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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17 pages, 1868 KiB

Open AccessArticle

Conceptualization, Development and Psychometric Evaluations of a New Medication-Related Health Literacy Instrument: The Chinese Medication Literacy Measurement

by Hsiang-Wen Lin, Elizabeth H. Chang, Yu Ko, Chun-Yu Wang, Yu-Shan Wang, Okti Ratna Mafruhah, Shang-Hua Wu, Yu-Chieh Chen and Yen-Ming Huang

Int. J. Environ. Res. Public Health 2020, 17(19), 6951; https://doi.org/10.3390/ijerph17196951 - 23 Sep 2020

Cited by 7 | Viewed by 3987

Abstract

There is a need for valid and reliable instruments to focus on medication aspects of health literacy and help healthcare professionals address patients’ barriers to medication use. This cross-sectional study describes the conceptualization, development, and psychometric properties of the first Chinese Medication Literacy Measurement (ChMLM) to assess the level of health literacy on medication use. The 17-item ChMLM (ChMLM-17) and its short form, 13-item ChMLM (ChMLM-13), consist of four sections (vocabulary, over-the-counter labels, prescription labels, and advertisements) to cover six domains of medication-related health literacy. Multistage stratified quota sampling was attempted to recruit a representative sample in Taiwan. Receiver operating characteristic curves were used to identify the cut-off point for differentiating high and low medication literacy. Psychometric analyses were performed (n = 1410) to assess the reliability and validity separately on all samples and sociodemographic subgroups. The 17- and 13-item versions both had high construct validity among all patients and patients with low medication literacy. The developed ChMLM-17 and ChMLM-13 is expected to help healthcare providers and researchers to accurately measure medication-related health literacy and improve medication use in the real-world practice. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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18 pages, 670 KiB

Open AccessSystematic Review

Health Literacy in Pregnant Women: A Systematic Review

by Farah Nawabi, Franziska Krebs, Vera Vennedey, Arim Shukri, Laura Lorenz and Stephanie Stock

Int. J. Environ. Res. Public Health 2021, 18(7), 3847; https://doi.org/10.3390/ijerph18073847 - 6 Apr 2021

Cited by 59 | Viewed by 11402

Abstract

Health literacy plays a crucial role during pregnancy, as the mother’s health behavior influences both her own health and that of her child. To the authors’ best knowledge, no comprehensive overview on evidence of the health literacy of pregnant women and its impact on health outcomes during pregnancy exists. Therefore, this review aims to assess health literacy levels in pregnant women, whether health literacy is associated with outcomes during pregnancy and whether effective interventions exist to improve the health literacy of pregnant women. A systematic literature search was conducted in PubMed and EBSCO, resulting in 14 studies. The results show mixed levels of health literacy in pregnant women. Limited health literacy is associated with unhealthy behaviors during pregnancy. Mixed health literacy levels can be attributed to the recruitment site, the number of participants and the measurement tool used. Quality assessment reveals that the quality of the included studies is moderate to good. The review revealed that randomized controlled trials and interventions to improve health literacy in pregnant women are rare or do not exist. This is crucial in the light of the mixed health literacy levels found among pregnant women. Healthcare providers play a key role in this context, as pregnant women with limited health literacy rely on them as sources of health information. Full article

(This article belongs to the Special Issue Health Literacy, Patient Empowerment and Preventive Medicine)

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