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Health Literacy: Measurements, Interventions and Evaluation

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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 "Global Health".

Deadline for manuscript submissions: closed (31 August 2024) | Viewed by 14223

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Special Issue Editors

Prof. Dr. Jürgen Pelikan

*
E-Mail Website
Guest Editor

Gesundheit Österreich GmbH (GÖG), 1010 Wien, Austria
Interests: health literacy; health promotion; settings approach; salutogenesis
* We dedicate the memory of the editor, Jürgen Pelikan, who passed away during this special issue period.

Prof. Dr. Diane Levin-Zamir

E-Mail Website
Guest Editor

Department of Health Education and Promotion, Clalit Health Services, Tel-Aviv 62098, Israel
Interests: health literacy; digital health literacy; health promotion; cultural appropriateness
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Orkan Okan

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Guest Editor

Department of Sport and Health Sciences, Technical University Munich, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80092 Munich, Germany
Interests: health literacy; school health promotion; child and adolescent health
Special Issues, Collections and Topics in MDPI journals

Dr. Kristine Sorensen

E-Mail Website
Guest Editor

Global Health Literacy Academy, Viengevej 100, 8240 Risskov, Denmark
Interests: health literacy; global health; SDGs; qualitative research methods; conceptual frameworks; future scenario planning; co-production; public health; capacity-building
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Stephen Van Den Broucke

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Guest Editor

Psychological Sciences Research Institute, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
Interests: health promotion; health literacy; behavior change; capacity building

Special Issue Information

Dear Colleagues,

Health literacy (HL) is a fast-evolving area of research, practice, and policy. Over the past years, three main trends have emerged in this field.

There has been a widening of the understanding of HL, regarding both its “health” and its “literacy” components. Apart from referring to the presence or absence of disease, HL has broadened to include positive health, reflecting a salutogenic approach. As such, it is not only relevant to health care, but also to public health. Regarding the “literacy” aspect, the term has expanded from merely referring to functional skills to also include interactive and critical competences. So, in addition to understanding health-relevant information it also refers to the full process of accessing, evaluating, and applying health information throughout the life course and in specific situations and contexts, such as the COVID-19 infodemic.

As a more comprehensive concept, the conceptualization, definitions, and measurement tools for HL differentiate between specific aspects of HL as related to specific populations, lifestyles, stages in the life course, health and disease issues, and when applying both conventional and more innovative health information sources.

Finally, HL is now understood not only as a personal competence, but as a relational, interactive concept. While personal HL is dependent on the individual’s specific context in which HL is applied, the interactive nature of the concept is shown in the development of concepts, definitions, measurement tools and interventions for organizational HL, as exemplified by organizations, settings, and systems which are health literate, health literacy friendly, and health literacy responsive.

This Special Issue of IJERPH will highlight these new developments in HL. Therefore, we particularly invite the submission of articles presenting the development, validation, and use of new measurement instruments for general, comprehensive, or specific aspects of personal HL and for the measurement of organizational HL, as well as evaluated and innovative interventions to improve personal HL, organizational HL, or both.

Prof. Dr. Jürgen Pelikan
Prof. Dr. Diane Levin-Zamir
Prof. Dr. Orkan Okan
Dr. Kristine Sorensen
Prof. Dr. Stephen Van Den Broucke
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

health literacy
measurement
interventions
evaluation
personal health literacy
organizational health literacy

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Published Papers (5 papers)

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Research

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14 pages, 1182 KiB

Open AccessArticle

Evaluation of the Psychometric Properties of the Digital Health Literacy Instrument (DHLI-BrA) for Use in Brazilian Adolescents

by Mariane Carolina Faria Barbosa, Ana Luiza Peres Baldiotti, Ramon Targino Firmino, Saul Martins Paiva, Ana Flávia Granville-Garcia and Fernanda de Morais Ferreira

Int. J. Environ. Res. Public Health 2024, 21(11), 1458; https://doi.org/10.3390/ijerph21111458 - 31 Oct 2024

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Abstract

This study evaluated the psychometric properties of the Portuguese version of Digital Health Literacy Instrument for Brazilian Adolescents (DHLI-BrA). Two hundred and sixty Brazilian adolescents answered the DHLI-BrA and the Brazilian version of quality-of-life and health literacy instruments: WHOQOL-Bref, eHEALS-BrA, NVS-BR, and REALMD-20. Then, they answered a questionnaire on sociodemographics, health, Internet access, and digital health aspects. The data collection was conducted between September and December of 2022.The statistical test assessed internal consistency, stability, discriminant and convergent validities, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Item response theory (IRT) analysis using 2PL was applied to performance-based DHLI-BrA. The DHLI-BrA self-reported questions demonstrated almost perfect internal consistency (α and ω = 0.83) and good stability (ICC = 0.906; 95% CI: 0.75–0.95). In EFA and CFA, the best-adjusted model was composed of six factors (χ² = 229.173 (df = 174, p = 0.003), CFI = 0.944, TLI = 0.933, RMSEA = 0.035, and RMSR = 0.047). The performance-based DHLI-BrA demonstrated moderate internal consistency (α = 0.57 and KR20 = 0.56) and good stability (ICC = 0.86, 95% CI: 0.76–0.92). In EFA and CFA, the best-adjusted model was composed of a single factor (χ² = 17.901 (df = 14, p = 0.2113), CFI = 0.952, TLI = 0.927, RMSEA = 0.033, and RMSR = 0.038). IRT analyses revealed item discrimination ranging from −0.71 to 1.83 and difficulty from −1.53 to 1.02. Convergent validity of the self-reported DHLI-BrA was obtained by its correlation with the eHEALS-BrA (r = 0.45) and REALMD-20 (r = 0.19), besides the performance-based DHLI-BrA with its correlation with the NVS (r = 0.47) and REALMD-20 (r = 0.44). The DHLI-BrA demonstrated adequate psychometric properties to measure the self-reported, performance-based digital health literacy of Brazilian typically developing adolescents. Full article

(This article belongs to the Special Issue Health Literacy: Measurements, Interventions and Evaluation)

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13 pages, 1218 KiB

Open AccessArticle

The Brief Health Literacy Scale for Adults: Adaptation and Validation of the Health Literacy for School-Aged Children Questionnaire

by Stinne Eika Rasmussen, Anna Aaby, Anne Søjbjerg, Anna Mygind, Helle Terkildsen Maindal, Olli Paakkari and Kaj Sparle Christensen

Int. J. Environ. Res. Public Health 2023, 20(22), 7071; https://doi.org/10.3390/ijerph20227071 - 16 Nov 2023

Cited by 3 | Viewed by 2753

Abstract

The Health Literacy for School-Aged Children (HLSAC) is a brief, generic instrument measuring health literacy among school-aged children. Given its brevity and broad conceptualization of health literacy, the HLSAC is a potentially valuable measuring instrument among adults as well. This validation study aimed to adapt the HLSAC questionnaire to an adult population through assessment of content validity and subsequently determine the structural validity of the adapted instrument, the Brief Health Literacy scale for Adults (B-HLA). The content validity of the HLSAC was assessed through interviews with respondents and experts, and the structural validity of the adapted instrument (B-HLA) was evaluated using Rasch analysis. The content validity assessment (n = 25) gave rise to adjustments in the wording of five items. The B-HLA demonstrated an overall misfit to the Rasch model (n = 290). Items 6 and 8 had the poorest individual fits. We found no signs of local dependency or differential item functioning concerning sex, age, education, and native language. The B-HLA demonstrated unidimensionality and ability to discriminate across health literacy levels (PSI = 0.80). Discarding items 6 or 8 resulted in an overall model fit and individual fit of all items. In conclusion, the B-HLA appears to be a valid and reliable instrument for assessing health literacy among adults. Full article

(This article belongs to the Special Issue Health Literacy: Measurements, Interventions and Evaluation)

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16 pages, 2194 KiB

Open AccessArticle

Shifts in Diabetes Health Literacy Policy and Practice in Australia—Promoting Organisational Health Literacy

by Giuliana O. Murfet, Shanshan Lin, Jan C. Ridd, Gunhild H. Cremer, Susan Davidson and Danielle M. Muscat

Int. J. Environ. Res. Public Health 2023, 20(10), 5778; https://doi.org/10.3390/ijerph20105778 - 10 May 2023

Cited by 2 | Viewed by 3091

Abstract

Improving organisational health literacy ensures people can navigate, understand and use essential health information and services. However, systematic reviews have identified limited evidence for practical approaches to implementing such organisational change, particularly at a national level. This study aimed to (a) investigate the approach taken by an Australian national diabetes organisation—Diabetes Australia, as the administrator of the National Diabetes Services Scheme (NDSS)—to improve organisational health literacy over a 15-year-period and (b) examine the impact of organisational changes on the health literacy demands of health information. We performed an environmental scan, examining the websites of the NDSS, Diabetes Australia and the Australian government for reports and position statements describing organisational health literacy policies and practices between 2006 and 2021. The Patient Education Materials Assessment Tool (PEMAT) was applied to consecutively published NDSS diabetes self-care fact sheets (n = 20) to assess changes in the health literacy demands (understandability and actionability) of these fact sheets over the same period. We identified nine policies resulting in 24 health literacy practice changes or projects between 2006 and 2021, applied using a streamlined incremental approach and group reflexivity. The incremental approach focused on (1) increasing audience reach, (2) consistency and branding, (3) person-centred language and (4) the understandability and actionability of health information. The PEMAT scores of fact sheets improved between 2006 and 2021 for understandability (53% to 79%) and actionability (43% to 82%). Diabetes Australia’s information development process leveraging national policies, employing an incremental approach and group reflexivity has improved the health literacy demands of diabetes information and serves as a template for other organisations seeking to improve their organisational health literacy. Full article

(This article belongs to the Special Issue Health Literacy: Measurements, Interventions and Evaluation)

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23 pages, 1127 KiB

Open AccessArticle

The HLS₁₉-COM-P, a New Instrument for Measuring Communicative Health Literacy in Interaction with Physicians: Development and Validation in Nine European Countries

by Hanne Søberg Finbråten, Peter Nowak, Robert Griebler, Éva Bíró, Mitja Vrdelja, Rana Charafeddine, Lennert Griese, Henrik Bøggild, Doris Schaeffer, Thomas Link, Zdenek Kucera, Julien Mancini and Jürgen M. Pelikan

Int. J. Environ. Res. Public Health 2022, 19(18), 11592; https://doi.org/10.3390/ijerph191811592 - 14 Sep 2022

Cited by 5 | Viewed by 2930

Abstract

Background: Sufficient communicative health literacy (COM-HL) is important for patients actively participating in dialogue with physicians, expressing their needs and desires for treatment, and asking clarifying questions. There is a lack of instruments combining communication and HL proficiency. Hence, the aim was to establish an instrument with sufficient psychometric properties for measuring COM-HL. Methods: The HLS₁₉-COM-P instrument was developed based on a conceptual framework integrating HL with central communicative tasks. Data were collected using different data collection modes in nine countries from December 2019 to January 2021 (n = 18,674). Psychometric properties were assessed using Rasch analysis and confirmatory factor analysis. Cronbach’s alpha and Person separation index were considered for reliability. Results: The 11-item version (HLS₁₉-COM-P-Q11) and its short version of six items (HLS₁₉-COM-P-Q6) fit sufficiently the unidimensional partial credit Rasch model, obtained acceptable goodness-of-fit indices and high reliability. Two items tend to under-discriminate. Few items displayed differential item functioning (DIF) across person factors, and there was no consistent pattern in DIF across countries. All items had ordered response categories. Conclusions: The HLS₁₉-COM-P instrument was well accepted in nine countries, in different data collection modes, and could be used to measure COM-HL. Full article

(This article belongs to the Special Issue Health Literacy: Measurements, Interventions and Evaluation)

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Review

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Open AccessReview

Current Situations and Challenges in the Development of Health Information Literacy

by Qiulin Wang, Chunhua Tao, Yuan Yuan, Song Zhang and Jingyan Liang

Int. J. Environ. Res. Public Health 2023, 20(3), 2706; https://doi.org/10.3390/ijerph20032706 - 2 Feb 2023

Cited by 2 | Viewed by 3053

Abstract

Health information literacy (HIL) is a significant concept that has gradually become known to the broader public in recent years. Although the definitions of HIL and health literacy seem to overlap, as an independent subconcept, HIL still shows a unique influence on improvements in people’s health and health education. Remarkable evidence indicates that online health information (OHI) can effectively enrich people’s knowledge and encourage patients to actively join the medical process, which is also accompanied by the emergence of various assessment tools. Although the current assessment tools, to a certain extent, can help people identify their shortcomings and improve their HIL, many studies have indicated that the deficiencies of the scales induce incomplete or unreal results of their HIL. In addition, continuing research has revealed an increasing number of influencing factors that have great effects on HIL and even regulate the different trends in doctor–patient relationships. Simultaneously, most of the uncensored OHI broadcasts have also affected the improvement in HIL in various ways. Thus, this review aims to summarize the assessment tools, influencing factors and current situations and challenges related to HIL. Further studies are required to provide more trusted and deeper references for the development of HIL. Full article

(This article belongs to the Special Issue Health Literacy: Measurements, Interventions and Evaluation)

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