International Journal of Environmental Research and Public Health

Editorial

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3 pages, 221 KiB

Open AccessEditorial

Health Literacy in Context

by Don Nutbeam, Diane Levin-Zamir and Gill Rowlands

Int. J. Environ. Res. Public Health 2018, 15(12), 2657; https://doi.org/10.3390/ijerph15122657 - 27 Nov 2018

Cited by 41 | Viewed by 6064

Abstract

Health literacy has been defined and conceptualized in multiple ways, but almost all definitions have similar core elements describing the personal skills that enable individuals to obtain, understand, and use information to make decisions and take actions that will have an impact on [...] Read more.

Health literacy has been defined and conceptualized in multiple ways, but almost all definitions have similar core elements describing the personal skills that enable individuals to obtain, understand, and use information to make decisions and take actions that will have an impact on their health. [...] Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

Research

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8 pages, 292 KiB

Open AccessArticle

Developing and Applying Geographical Synthetic Estimates of Health Literacy in GP Clinical Systems

by Gill Rowlands, David Whitney and Graham Moon

Int. J. Environ. Res. Public Health 2018, 15(8), 1709; https://doi.org/10.3390/ijerph15081709 - 10 Aug 2018

Cited by 2 | Viewed by 3218

Abstract

Background: Low health literacy is associated with poorer health. Research has shown that predictive models of health literacy can be developed; however, key variables may be missing from systems where predictive models might be applied, such as health service data. This paper [...] Read more.

Background: Low health literacy is associated with poorer health. Research has shown that predictive models of health literacy can be developed; however, key variables may be missing from systems where predictive models might be applied, such as health service data. This paper describes an approach to developing predictive health literacy models using variables common to both “source” health literacy data and “target” systems such as health services. Methods: A multilevel synthetic estimation was undertaken on a national (England) dataset containing health literacy, socio-demographic data and geographical (Lower Super Output Area: LSOA) indicators. Predictive models, using variables commonly present in health service data, were produced. An algorithm was written to pilot the calculations in a Family Physician Clinical System in one inner-city area. The minimum data required were age, sex and ethnicity; other missing data were imputed using model values. Results: There are 32,845 LSOAs in England, with a population aged 16 to 65 years of 34,329,091. The mean proportion of the national population below the health literacy threshold in LSOAs was 61.87% (SD 12.26). The algorithm was run on the 275,706 adult working-age people in Lambeth, South London. The algorithm could be calculated for 228,610 people (82.92%). When compared with people for whom there were sufficient data to calculate the risk score, people with insufficient data were more likely to be older, male, and living in a deprived area, although the strength of these associations was weak. Conclusions: Logistic regression using key socio-demographic data and area of residence can produce predictive models to calculate individual- and area-level risk of low health literacy, but requires high levels of ethnicity recording. While the models produced will be specific to the settings in which they are developed, it is likely that the method can be applied wherever relevant health literacy data are available. Further work is required to assess the feasibility, accuracy and acceptability of the method. If feasible, accurate and acceptable, this method could identify people requiring additional resources and support in areas such as medical practice. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

13 pages, 302 KiB

Open AccessArticle

Barriers to Breast Cancer Screening among Diverse Cultural Groups in Melbourne, Australia

by Jonathan O’Hara, Crystal McPhee, Sarity Dodson, Annie Cooper, Carol Wildey, Melanie Hawkins, Alexandra Fulton, Vicki Pridmore, Victoria Cuevas, Mathew Scanlon, Patricia M. Livingston, Richard H. Osborne and Alison Beauchamp

Int. J. Environ. Res. Public Health 2018, 15(8), 1677; https://doi.org/10.3390/ijerph15081677 - 7 Aug 2018

Cited by 37 | Viewed by 10266

Abstract

This study explored the association between health literacy, barriers to breast cancer screening, and breast screening participation for women from culturally and linguistically diverse (CALD) backgrounds. English-, Arabic- and Italian-speaking women (n = 317) between the ages of 50 to 74 in [...] Read more.

This study explored the association between health literacy, barriers to breast cancer screening, and breast screening participation for women from culturally and linguistically diverse (CALD) backgrounds. English-, Arabic- and Italian-speaking women (n = 317) between the ages of 50 to 74 in North West Melbourne, Australia were recruited to complete a survey exploring health literacy, barriers to breast cancer screening, and self-reported screening participation. A total of 219 women (69%) reported having a breast screen within the past two years. Results revealed that health literacy was not associated with screening participation. Instead, emotional barriers were a significant factor in the self-reported uptake of screening. Three health literacy domains were related to lower emotional breast screening barriers, feeling understood and supported by healthcare providers, social support for health and understanding health information well enough to know what to do. Compared with English- and Italian-speaking women, Arabic-speaking women reported more emotional barriers to screening and greater challenges in understanding health information well enough to know what to do. Interventions that can improve breast screening participation rates should aim to reduce emotional barriers to breast screening, particularly for Arabic-speaking women. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

12 pages, 301 KiB

Open AccessArticle

Beyond Reading and Understanding: Health Literacy as the Capacity to Act

by Jany Rademakers and Monique Heijmans

Int. J. Environ. Res. Public Health 2018, 15(8), 1676; https://doi.org/10.3390/ijerph15081676 - 7 Aug 2018

Cited by 60 | Viewed by 9458

Abstract

Many health literacy interventions have a limited focus on functional/cognitive skills. In psychosocial models, the capacity to act however is seen as a major driver of behavioural change. This aspect is often lacking in health literacy concepts. In this study, we examine the [...] Read more.

Many health literacy interventions have a limited focus on functional/cognitive skills. In psychosocial models, the capacity to act however is seen as a major driver of behavioural change. This aspect is often lacking in health literacy concepts. In this study, we examine the impact of both aspects of health literacy (functional/cognitive and capacity to act) on specific healthcare outcomes (healthcare use, experiences with patient-centered care, shared-decision making, and self-management). In a sample of a national panel of people with a chronic disease (NPCD), questions about health literacy, patient activation, and outcomes were asked. The results indicated that 39.9% had limited HL levels and 36.9% had a low activation score. Combined, 22.7% of the sample scored low on both aspects, whereas 45.8% had adequate levels on both. Patients who score low on both use more healthcare and have less positive experiences with patient-centered care, shared decision making, and self-management. Patients who have adequate competency levels in both respects have the best outcomes. Both cognitive and non-cognitive aspects of health literacy are important, and they enhance each other. The capacity to act is especially important for the extent to which people feel able to self-manage. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

13 pages, 326 KiB

Open AccessArticle

Understanding Educational and Psychosocial Factors Associated with Alcohol Use among Adolescents in Denmark; Implications for Health Literacy Interventions

by Claudia König, Mette V. Skriver, Kim M. Iburg and Gillian Rowlands

Int. J. Environ. Res. Public Health 2018, 15(8), 1671; https://doi.org/10.3390/ijerph15081671 - 6 Aug 2018

Cited by 11 | Viewed by 5517

Abstract

Background. Alcohol misuse is a global public health priority, with a variation in prevalence and impact between countries. Alcohol misuse in adolescence is associated with adverse psychological, social and physical health. Adolescents in Denmark have higher alcohol consumption and problematic alcohol use than [...] Read more.

Background. Alcohol misuse is a global public health priority, with a variation in prevalence and impact between countries. Alcohol misuse in adolescence is associated with adverse psychological, social and physical health. Adolescents in Denmark have higher alcohol consumption and problematic alcohol use than adolescents in other European countries. Associations between social determinants of health (SDH), psycho-social factors and alcohol consumption are complex and influenced by national context and cultures. This study explored these associations in Danish adolescents. Method. The European School Survey Project on Alcohol and Other Drugs (ESPAD) survey collects data on alcohol and substance use among 15–16-year-old European students. Data contributed by Danish students to the 2011 survey were analyzed. The outcomes of interest were alcohol consumption (any, intoxication and problematic). Health literacy was not directly measured, so self-described educational performance and knowledge about alcohol were used as proxies for health literacy. Exploratory factors thus included socio-demographic, health literacy-related (knowledge about alcohol, educational performance) and psycho-social factors, as well as expectancies of the effect of alcohol (both positive and negative) and self-reported health. Univariate and multivariate logistic regression analyses were undertaken. Results. Of the 2768 adolescents who participated in the survey, 2026 (80%) consumed alcohol during the last 30 days, 978 (38%) were intoxicated at least once during the last 30 days, and 1050 (41%) experienced at least one problem because of alcohol use during the last 12 months. Multivariable analysis showed that the factors associated with higher alcohol intake were gender, poor relationships with parents, expectancies of the impact of alcohol (both positive and negative), and the influence of peers and their alcohol use. Higher school performance was related to lower alcohol consumption. Low socio-demographic status was not associated with higher alcohol consumption. Conclusions. This study confirmed the high levels of alcohol intake, intoxication, and problem drinking amongst the Danish students in the survey and the complexity of the socio-demographic, psychosocial, health literacy-related, and environmental factors associated with alcohol behaviours. Approaches to addressing the issue of alcohol use in Danish adolescents will need to be multi-factorial, including supporting students to develop alcohol-related health literacy skills to enable them to make informed choices. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

11 pages, 866 KiB

Open AccessArticle

Effects of the Conceptual Model of Health Literacy as a Risk: A Randomised Controlled Trial in a Clinical Dental Context

by Linda Stein, Maud Bergdahl, Kjell Sverre Pettersen and Jan Bergdahl

Int. J. Environ. Res. Public Health 2018, 15(8), 1630; https://doi.org/10.3390/ijerph15081630 - 1 Aug 2018

Cited by 5 | Viewed by 4759

Abstract

Numerous conceptual models of health literacy have been proposed in the literature, but very few have been empirically validated in clinical contexts. The aim of this study was to test the effects of the conceptual model of health literacy as a risk in [...] Read more.

Numerous conceptual models of health literacy have been proposed in the literature, but very few have been empirically validated in clinical contexts. The aim of this study was to test the effects of the conceptual model of health literacy as a risk in a clinical dental context. A convenience sample of 133 Norwegian-speaking adults was recruited. Participants were randomly allocated to an intervention group (n = 64, 54% women, mean age = 50 years) and a control group (n = 69, 49% women, mean age = 46 years). Clinical measurements were conducted pre-intervention and six months post-intervention. In the intervention group, communication regarding patients’ oral health was tailored to their health literacy levels using recommended communication techniques, whereas the control group received brief information not tailored to health literacy levels. The ANCOVA showed significant between-group effects, finding reduced post-intervention mean gingival (p < 0.000) and mean plaque (p < 0.000) indices in the intervention group when controlling for baseline index scores. The adjusted Cohen’s d indicated large effect sizes between the intervention group and the control group for both the mean gingival index (−0.98) and the mean plaque index (−1.33). In conclusion, the conceptual model of health literacy as a risk had a large effect on important clinical outcomes, such as gingival status and oral hygiene. The model may be regarded as a suitable supplement to patient education in populations. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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17 pages, 315 KiB

Open AccessArticle

Progress in Implementing National Policies and Strategies for Health Literacy—What Have We Learned so Far?

by Anita Trezona, Gill Rowlands and Don Nutbeam

Int. J. Environ. Res. Public Health 2018, 15(7), 1554; https://doi.org/10.3390/ijerph15071554 - 23 Jul 2018

Cited by 55 | Viewed by 10592

Abstract

Health literacy has been a prominent issue on the agenda of the World Health Organization (WHO) for almost two decades. WHO recently established a strong global mandate for public policy action on health literacy by positioning it as one of three key pillars [...] Read more.

Health literacy has been a prominent issue on the agenda of the World Health Organization (WHO) for almost two decades. WHO recently established a strong global mandate for public policy action on health literacy by positioning it as one of three key pillars for achieving sustainable development and health equity in the Shanghai Declaration on Health Promotion. Several countries have national health literacy policies, with many others expected to develop them in the immediate future. It is, therefore, timely to examine current policy approaches to health literacy. The purpose of this study was to analyze a selection of existing policy documents for their strengths, limitations and themes, and offer observations about their potential to improve health literacy and health outcomes. In doing so our intention is to offer lessons and advice from early adopters that will have usefulness for future policy development and implementation. We selected six policies for review; Australia, Austria, China, New Zealand, Scotland, and the United States. We used a set of criteria to guide a systematic analysis of policy documents for their context, intended target audiences, objectives, proposed actions and interventions, evidence of financial investment and intentions to monitor outcomes. We observed a number of common features that provide helpful signposting for future policy development in other countries. All represent a response to perceived deficiencies in the quality of patient communication and patient engagement. Most present health literacy as a universal challenge, with some also identifying groups who are of higher priority. They all recognize the importance of professional education in improving the quality of communication, and most recognize that the health literacy responsiveness of the health system needs to be improved. However, there was significant variability in linking resources to specific strategies and actions, as well as in the systems for monitoring progress and accountability for progress. This variability reflects important contextual differences between countries and health systems. However, this lack of specificity will likely have an impact on the priority given to improving health literacy and on the long-term sustainability of defined actions to improve health literacy in populations. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

12 pages, 566 KiB

Open AccessArticle

The Measurements and an Elaborated Understanding of Chinese eHealth Literacy (C-eHEALS) in Chronic Patients in China

by Angela Chang and Peter J. Schulz

Int. J. Environ. Res. Public Health 2018, 15(7), 1553; https://doi.org/10.3390/ijerph15071553 - 23 Jul 2018

Cited by 50 | Viewed by 6706

Abstract

The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients’ combined knowledge and perceived skills at finding [...] Read more.

The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients’ combined knowledge and perceived skills at finding and applying electronic health information to health problems. A valid sample of 352 interviewees responded to the online questionnaire, and their responses were analyzed. The C-eHEALS, by showing high internal consistency and predictive validity, is an effective screening tool for detecting levels of health literacy in clinical settings. Individuals’ sociodemographic status, perceived health status, and level of health literacy were identified for describing technology users’ characteristics. A strong association between eHealth literacy level, media information use, and computer literacy was found. The emphasis of face-to-face inquiry for obtaining health information was important in the low eHealth literacy group while Internet-based technologies crucially affected decision-making skills in the high eHealth literacy group. This information is timely because it implies that health care providers can use the C-eHEALS to screen eHealth literacy skills and empower patients with chronic diseases with online resources. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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12 pages, 345 KiB

Open AccessFeature PaperArticle

Is It Possible to “Find Space for Mental Health” in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program

by Luísa Campos, Pedro Dias, Ana Duarte, Elisa Veiga, Cláudia Camila Dias and Filipa Palha

Int. J. Environ. Res. Public Health 2018, 15(7), 1426; https://doi.org/10.3390/ijerph15071426 - 6 Jul 2018

Cited by 55 | Viewed by 12821

Abstract

Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion [...] Read more.

Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion of mental health literacy (MHL) in young people (“Finding Space for Mental Health”). A sample of 543 students (22 classes), aged between 12 and 14 years old, participated in the study. Each class of students was randomly assigned to the control group (CG; n = 284; 11 classes) or the experimental group (EG; n = 259; 11 classes). MHL was assessed using the Mental Health Literacy questionnaire (MHLq), which is comprised of three dimensions—Knowledge/Stereotypes, First Aid Skills and Help Seeking, and Self-Help Strategies. The scores on these dimensions can also be combined to give an overall or total score. Participants from the EG attended the MHL promotion program (two sessions, 90 min each) delivered at one-week intervals. Sessions followed an interactive methodology, using group dynamics, music, and videos adapted to the target group. All participants responded to the MHLq at three points in time: pre-intervention assessment (one week prior to the intervention), post-intervention assessment (one week after the intervention) and follow-up assessment (six months after the intervention). The intervention effectiveness and the differential impact of sociodemographic variables on the effectiveness of the program were studied using a Generalized Estimation Equation (GEE). Results revealed that participants from the EG demonstrated, on average, significantly higher improvement in MHL from pre-intervention to follow-up when compared to participants from the CG. Different sociodemographic variables affected the effectiveness of the program on distinct dimensions of the MHLq. Overall, “Finding Space for Mental Health” showed efficacy as a short-term promotion program for improving MHL in schools. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

16 pages, 1878 KiB

Open AccessArticle

Conditions and Dynamics That Impact Maternal Health Literacy among High Risk Prenatal-Interconceptional Women

by Suzanne D. Thomas, Sandra C. Mobley, Jodi L. Hudgins, Donald E. Sutherland, Sandra B. Inglett and Brittany L. Ange

Int. J. Environ. Res. Public Health 2018, 15(7), 1383; https://doi.org/10.3390/ijerph15071383 - 2 Jul 2018

Cited by 13 | Viewed by 5562

Abstract

The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development [...] Read more.

The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development (LCHD) Model, conditions were risk and protective factors that impacted health. Dynamics drove the complex, epigenetic relationships between risk and protective factors. Maternal health literacy promotion helped participants address conditions and dynamics to create positive life changes. This research was a retrospective, mixed methods study of women’s service records documenting care from prenatal admission to 24 months post-delivery. The Life Skills Progression Instrument (LSP) was scored to measure maternal health literacy progression. Ethnographic content analysis of visit notes triangulated with quantitative data enabled specificity of critical data elements. Subsequently, a complementary focus group was conducted with the Registered Nurse Case Managers (RNCM). Severe social conditions included devastating poverty, low educational achievement, transient housing, unstable relationships, incarceration, lack of continuous health insurance, and shortage of health care providers. Dynamics included severe psycho-social stressors, domestic violence, lack of employment, low income, low self-esteem and self-expectations, and social/family restraints upon women’s intended positive changes. An important protective factor was the consistent, stable, evidence-informed relationship with the RNCM. Findings from the focus group discussion supported content analysis results. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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13 pages, 436 KiB

Open AccessArticle

Mental Health Literacy in Young Adults: Adaptation and Psychometric Properties of the Mental Health Literacy Questionnaire

by Pedro Dias, Luísa Campos, Helena Almeida and Filipa Palha

Int. J. Environ. Res. Public Health 2018, 15(7), 1318; https://doi.org/10.3390/ijerph15071318 - 23 Jun 2018

Cited by 75 | Viewed by 17064

Abstract

Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous [...] Read more.

Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous beliefs concerning mental health issues, to inform the development of interventions aimed at promoting mental health literacy as well as the evaluation of these interventions. Recently, we developed a new self-reporting measure (MHLq) for assessing mental health literacy in young people (12–14 years-old), meeting the need to assess MHL from a comprehensive perspective of the construct instead of focusing on a restricted number of mental disorders or specific dimensions (e.g., knowledge concerning specific disorders; stigma). The present study aimed to adapt the MHLq for the young adult population and to examine its psychometric properties, according to the following steps: (1) item adaptation, using a think aloud procedure (n = 5); (2) data collection (n = 356, aged between 18 and 25 years old; and (3) psychometric analyses (exploratory factor analysis and internal consistency analysis). The final version of the questionnaire included 29 items (total scale α = 0.84), organized by four dimensions: (1) knowledge of mental health problems (α = 0.74); (2) erroneous beliefs/stereotypes (α = 0.72); (3) help-seeking and first aid skills (α = 0.71); and (4) self-help strategies (α = 0.60). The results suggest that the MHLq-adult form is a practical, valid, and reliable screening tool for identifying gaps in knowledge, beliefs, and behavioral intentions related to mental health and mental disorders, planning promotion programs, and evaluating intervention effectiveness. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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11 pages, 1517 KiB

Open AccessArticle

Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model

by Bas Geboers, Sijmen A. Reijneveld, Jaap A. R. Koot and Andrea F. De Winter

Int. J. Environ. Res. Public Health 2018, 15(6), 1268; https://doi.org/10.3390/ijerph15061268 - 15 Jun 2018

Cited by 55 | Viewed by 13827

Abstract

Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We [...] Read more.

Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We used a multimethod approach, consisting of (1) a literature review of articles listed in MEDLINE, presenting HL intervention models, (2) online consultation of international HL experts, and (3) two consensus meetings with members (n = 36 and 27) of a consortium studying HL among older adults (50+) in Europe. In our literature review, we identified twenty-two HL models, only a few of which focused explicitly on interventions. Sixty-eight health literacy experts took part in the online survey. The results from all three methods came together in a comprehensive HL intervention model. This model conceptualized interventions as potentially targeting five factors affecting HL outcomes: (1) individuals’ personal characteristics, (2) individuals’ social context, (3) communication between individuals and health professionals, (4) health professionals’ HL capacities, and (5) health systems. Our model is the first comprehensive HL model focused specifically on interventions. The model can support the further development of HL interventions to improve the health outcomes of people with low HL. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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19 pages, 326 KiB

Open AccessArticle

A Qualitative Study of the Development of Health Literacy Capacities of Participants Attending a Community-Based Cardiovascular Health Programme

by Verna B. McKenna, Jane Sixsmith and Margaret M. Barry

Int. J. Environ. Res. Public Health 2018, 15(6), 1157; https://doi.org/10.3390/ijerph15061157 - 2 Jun 2018

Cited by 11 | Viewed by 4941

Abstract

Health literacy is a critical determinant of health, which can empower individuals and lead to engagement in collective health promotion action and is also a crucial component in the self-management of illness. The current study moves beyond a focus on functional health literacy [...] Read more.

Health literacy is a critical determinant of health, which can empower individuals and lead to engagement in collective health promotion action and is also a crucial component in the self-management of illness. The current study moves beyond a focus on functional health literacy and presents findings from a longitudinal qualitative (LQ) study consisting of three phases. This paper presents findings from the second phase of the study, which assessed the development of health literacy capacities of individuals attending a structured cardiovascular risk reduction programme in Ireland. The study objectives were to: explore perceptions of changes in interactions and information exchange within health consultations; identify the facilitators associated with changes in health literacy capacities; assess developments in engagement with broader contexts for health literacy capacities. A LQ study design was undertaken, which employed repeat interview methodology with 19 participants (aged 36–76 years) 12 weeks after beginning a structured cardiovascular risk reduction programme. Health literacy levels were assessed using the HLS-EU 47 item instrument in phase 1 (68% limited health literacy (HL), 32% adequate health literacy). A semi-structured interview guide, (informed by Sørensen’s conceptual model of health literacy), was used to explore the development of health literacy and to identify changes in knowledge, attitudes and experiences over time. Thematic analysis was used, informed by aspects of Saldaña’s framework for longitudinal qualitative data analysis. All participants reported having acquired increased understanding of issues relevant to their health and self-care. Participants described health literacy capacities that incorporate aspects of all levels of health literacy (functional, interactive and critical). Core themes were identified corresponding to changes in these levels: re-engagement with health information and increased understanding of risk and protective factors (changes in functional health literacy); changes in interactions with healthcare providers (HCP) (changes in interactive health literacy); enhanced psychological insights and understanding the broader determinants of health (changes in critical health literacy). Findings support the development of health literacy capacities across the functional, interactive and critical health literacy domains. Participants are capable of locating responsibility for health beyond the individual level and are making sense of knowledge within their own social contexts. Individuals, regardless of their initial health literacy levels, are capable of engaging with broader issues that can impact on their health and can be supported to develop these critical health literacy capacities. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

13 pages, 342 KiB

Open AccessArticle

Understanding of Information about Medicines Use among Parents of Pre-School Children in Serbia: Parental Pharmacotherapy Literacy Questionnaire (PTHL-SR)

by Stana Ubavić, Nataša Bogavac-Stanojević, Aleksandra Jović-Vraneš and Dušanka Krajnović

Int. J. Environ. Res. Public Health 2018, 15(5), 977; https://doi.org/10.3390/ijerph15050977 - 14 May 2018

Cited by 12 | Viewed by 3985

Abstract

Parental health literacy plays an important role in children’s health. Experiences from pharmacy practice show that is necessary to check if parents understand instructions about use of medicines for children. This study aimed to assess pharmacotherapy literacy of parents of pre-school children and [...] Read more.

Parental health literacy plays an important role in children’s health. Experiences from pharmacy practice show that is necessary to check if parents understand instructions about use of medicines for children. This study aimed to assess pharmacotherapy literacy of parents of pre-school children and to examine association of parental pharmacotherapy literacy level with parent’s socio-demographic characteristics. The study was cross-sectional, conducted among parents of pre-school children (1–7 years of age), in kindergartens in several municipalities of Belgrade, Serbia, during regular parents meetings, from May to October 2016. Functional health literacy was measured by the Serbian version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Parental pharmacotherapy literacy was assessed with newly constructed PTHL-SR questionnaire with good psychometric characteristics (Parental pharmacotherapy literacy questionnaire—Serbian). Overall, 813 parents participated in the study, mostly females (81.30%), between 30 to 40 years of age (70.85%) with two children (56.70%). Almost all of our study participants (99%) had adequate health literacy as assessed by S-TOFHLA. Mean score on PTHL-SR was 72.83% (standard deviation was 13.37), with better results among females than males (72% of women were in the group of highest PTHL-SR results). Our study showed that many parents (76.5%) knew the appropriate usage of non-prescription medicine for children, 57.2% parents were able to correctly calculate the dose of oral syrup for a child, and only 43.3% were able to interpret non-prescription dosage information written on the package. The majority of parents (61.3%) would make a dosage to child based on age and not on their weight. Every fifth parent with adequate functional health literacy measured by S-TOFHLA test, achieved the lowest results measured by PTHL-SR. Higher performance of the PTHL-SR was significantly correlated with education (p < 0.001), female sex (p < 0.001), married parents and those living in common-law (p < 0.001), older parents (p < 0.05) and parents who have more children (p < 0.05), and are non-smokers (p < 0.05). These results provide evidence that limitations in understanding common information about use of medicines are widespread among parents of pre-school children and encourage efforts for further investigation. PTHL-SR questionnaire may be a useful tool for identification of parents who need more instructions and assistance from healthcare providers, above all in providing better communication, written or spoken at community pharmacy settings. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

14 pages, 664 KiB

Open AccessArticle

Do Low Income Youth of Color See “The Bigger Picture” When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign

by Dean Schillinger, Jessica Tran and Sarah Fine

Int. J. Environ. Res. Public Health 2018, 15(5), 840; https://doi.org/10.3390/ijerph15050840 - 24 Apr 2018

Cited by 17 | Viewed by 6096

Abstract

As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as [...] Read more.

As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. Methods: We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Results: Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Conclusion: Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Practice Implications: Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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14 pages, 518 KiB

Open AccessArticle

The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis

by Chiara Lorini, Francesca Ierardi, Letizia Bachini, Martina Donzellini, Fabrizio Gemmi and Guglielmo Bonaccorsi

Int. J. Environ. Res. Public Health 2018, 15(4), 798; https://doi.org/10.3390/ijerph15040798 - 19 Apr 2018

Cited by 24 | Viewed by 5378

Abstract

This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was [...] Read more.

This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was measured using the 47-item HLS-EU questionnaire (HLS-EUQ47) and the Newest Vital Sign (NVS). The two measures stood in significant correlation to the outcomes of the sub-discipline of the Euro Health Consumer Index (r = 0.790 for HLS-EUQ47; r = 0.789 for NVS). The HLS-EUQ47 also stood in correlation to the percentage of population with post-secondary education (r = 0.810), the reading performance for 15-year-old students (r = 0.905), the presence of a national screening program for breast (r = 0.732) or cervical cancer (r = 0.873). The NVS stood in correlation with the unemployment rate (r = −0.778), the Gross Domestic Product (r = 0.719), the Gini coefficient (r = −0.743), the rank of the Euro Patient Empowerment Index (r = −0.826), the expenditure on social protection (r = 0.814), the Consumer Empowerment Index (r = 0.898), the percentage of adults using the internet for seeking health information (r = 0.759), the prevalence of overweight individuals (r = −0.843), the health expenditure (r = 0.766), as well as the percentage of individuals using the internet for interacting with public authorities (r = 0.755). This study provides some preliminary considerations regarding alternative means by which to study HL and proposes new methods for experimentation. The methods and the results could offer a means by which the relationship between society and overall healthcare protection could be strengthened. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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Open AccessArticle

Effective Partnership in Community-Based Health Promotion: Lessons from the Health Literacy Partnership

by Emee Vida Estacio, Mike Oliver, Beth Downing, Judy Kurth and Joanne Protheroe

Int. J. Environ. Res. Public Health 2017, 14(12), 1550; https://doi.org/10.3390/ijerph14121550 - 11 Dec 2017

Cited by 35 | Viewed by 12849

Abstract

This paper aims to explore key elements needed to successfully develop healthy partnerships and collaborative working in community-based health promotion. It draws upon the lessons learned from a case study with the Health Literacy Partnership in Stoke-on-Trent, UK in developing the health literacy [...] Read more.

This paper aims to explore key elements needed to successfully develop healthy partnerships and collaborative working in community-based health promotion. It draws upon the lessons learned from a case study with the Health Literacy Partnership in Stoke-on-Trent, UK in developing the health literacy strategy in the area. The process was underpinned by respect for diverse yet complementary perspectives and skills from the grassroots up. This involved engagement with key stakeholders, development and support for community projects, and sharing of good practice with other national and local organizations. Stakeholders involved in developing the strategy also had a keen interest in health literacy and a strong commitment to promoting health and well-being in the area. Through patience, perseverance, and continuous open communication and learning, the health literacy strategy in Stoke-on-Trent, UK is beginning to have a ripple effect into local practice, and will potentially influence policy in the future. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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Open AccessReview

Media Health Literacy, eHealth Literacy, and the Role of the Social Environment in Context

by Diane Levin-Zamir and Isabella Bertschi

Int. J. Environ. Res. Public Health 2018, 15(8), 1643; https://doi.org/10.3390/ijerph15081643 - 3 Aug 2018

Cited by 172 | Viewed by 20982

Abstract

Health literacy describes skills and competencies that enable people to gain access to, understand and apply health information to positively influence their own health and the health of those in their social environments. In an increasingly media saturated and digitized world, these skill [...] Read more.

Health literacy describes skills and competencies that enable people to gain access to, understand and apply health information to positively influence their own health and the health of those in their social environments. In an increasingly media saturated and digitized world, these skill sets are necessary for accessing and navigating sources of health information and tools, such as television, the Internet, and mobile apps. The concepts of Media Health Literacy (MHL) and eHealth Literacy (eHL) describe the specific competencies such tasks require. This article introduces the two concepts, and then reviews findings on the associations of MHL and eHL with several contextual variables in the social environment such as socio-demographics, social support, and system complexity, as a structural variable. As eHL and MHL are crucial for empowering people to actively engage in their own health, there is a growing body of literature reporting on the potential and the effectiveness of intervention initiatives to positively influence these competencies. From an ethical standpoint, equity is emphasized, stressing the importance of accessible media environments for all—including those at risk of exclusion from (digital) media sources. Alignment of micro and macro contextual spheres will ultimately facilitate both non-digital and digital media to effectively support and promote public health. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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18 pages, 1026 KiB

Open AccessCommentary

The Health Literacy of U.S. Immigrant Adolescents: A Neglected Research Priority in a Changing World

by Maricel G. Santos, Anu L. Gorukanti, Lina M. Jurkunas and Margaret A. Handley

Int. J. Environ. Res. Public Health 2018, 15(10), 2108; https://doi.org/10.3390/ijerph15102108 - 25 Sep 2018

Cited by 16 | Viewed by 5829

Abstract

Immigrant adolescents are the fastest-growing sector among U.S. youth, but they receive little attention in health literacy research. Immigrant adolescents are a diverse population tasked with mastering new literacies while also navigating new social systems. Many immigrant adolescents serve as important linguistic and [...] Read more.

Immigrant adolescents are the fastest-growing sector among U.S. youth, but they receive little attention in health literacy research. Immigrant adolescents are a diverse population tasked with mastering new literacies while also navigating new social systems. Many immigrant adolescents serve as important linguistic and cultural resources in their families and local communities, and yet their contributions (and struggles) as new navigators of our health care system remain invisible. In this commentary article, we argue that health literacy researchers need to devote more attention to immigrant adolescents and the pathways by which they learn new language and literacy skills while also developing their own health habits and behaviors. We contend that the study of immigrant adolescents provides a critical window into health literacy as a socially and historically situated practice, specifically how immigrant adolescents’ transnational experiences shape their learning of new health literacy practices. With a coordinated interdisciplinary research agenda on immigrant adolescents, the health literacy field will expand its empirical base for what becoming “health literate” looks like in today’s globalizing world. Full article

(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)

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