Exploring the potential of virtual reality for the self-management of chronic pain: A scoping review of its use to address health literacy

Health literacy, empowerment, and self-care activities are likely the crucial concepts affecting the quality of life and glycemic control in people with type 2 diabetes (T2D). However, evidence demonstrating the mechanisms underlying these concepts is scarce. The aim of this study was to test the serial mediation roles of empowerment and self-care activities on the relationships between health literacy and quality of life and between health literacy and hemoglobin A1c (HbA1c) in people with T2D. A cross-sectional study was conducted among 319 people with T2D in Guangzhou, China, from July 2019 to January 2020. Data were collected using the Health Literacy Scale, the Diabetes Empowerment Scale-Short Form, the Summary of Diabetes Self-Care Activities Measure, and the Adjusted Diabetes-Specific Quality of Life Scale. RStudio 4.2.1 was used for serial mediation analysis. The dimension of communicative health literacy accounted for the most total variance (β = 0.810, p < .001) in the construct of health literacy. The serial multiple mediation of empowerment and self-care activities in the associations between health literacy and quality of life (β = -.046, p = .019) and between health literacy and HbA1c (β = -.045, p = .005) were statistically significant. This study emphasized the vital role of communicative health literacy when improving health literacy in people with T2D. Diabetes care and education specialists could implement empowerment approaches and flexible self-care strategies to improve the quality of life and glycemic control in people with T2D. Enhancing health literacy was suggested as a favorable strategy for promoting empowerment and self-care activities in people with T2D.

Introduction: Chronic pain requires individuals to develop self-management skills that rely on health literacy and, more recently, eHealth literacy. Very few studies have investigated potential predictors of eHealth literacy in chronic pain patients. Therefore, the purpose of this study is to explore potential predictors of eHealth literacy among individual characteristics and pain-related clinical factors, as a preliminary step to understanding the multi-variable relationships that could be examined in a larger study. Methods: A cross-sectional online survey was distributed to adults living in the United States with various chronic pain conditions using Amazon’s Mechanical Turk. A convenience sample of 196 participants was recruited. The independent variables of interest regarding their relationship with eHealth literacy (dependent variable) included demographics, health literacy, chronic pain severity, pain attitudes and coping skills. Chi square tests of association, and independent samples t-tests were used to examine the bivariate relationships. Results: The majority of the sample suffered from chronic pain for more than 2 years with 48% suffering from chronic back pain. Most of the sample (n=184, 93.9%) had high eHealth literacy. Significant relationships were found between eHealth literacy and the following variables: marital status, education level, and age, as well as health literacy, chronic pain interference with activities and chronic pain attitudes. These warrant further exploration in a larger study using logistic regression. Conclusions: our findings provide new information on the relationship between eHealth literacy levels, pain-related individual factors such as attitudes toward pain, and clinical outcomes, i.e., pain interference with physical and psychological function. Although further research is needed to investigate eHealth literacy predictors and mediators, these findings promote the evidence-based development and evaluation of interventions enhancing eHealth literacy skills, as well as self-management skills of chronic pain patients.

Health Literacy, Diabetes Prevention, and Self-Management.

Impact of Health Literacy on Eye Health Disparities

Chronic pain and narcotics: a dilemma for primary care.

Introduction Life after stroke may entail several lifestyle changes and new routines. Hence, it is imperative for people with stroke to understand and make use of health information, i.e. to have sufficient health literacy. This study aimed to explore health literacy and its associations with outcomes at 12-months post-discharge regarding depression symptoms, walking ability, perceived stroke recovery, and perceived participation in people with stroke. Methods This was a cross-sectional study of a Swedish cohort. Data were collected at 12 months post-discharge using European Health Literacy Survey Questionnaire, the Hospital Anxiety and Depression Scale, the 10-m walk test, and the Stroke Impact Scale 3.0. Each outcome was then dichotomized into favorable versus unfavorable outcome. Logistic regression was performed to assess the association between health literacy and favorable outcomes. Results The participants, n = 108, were on average 72 years old, 60% had mild disability, 48% had a university/college degree, and 64% were men. At 12 months post-discharge, 9% of the participants had inadequate health literacy, 29% problematic health literacy, and 62% sufficient health literacy. Higher levels of health literacy were significantly associated with favorable outcomes relating to depression symptoms, walking ability, perceived stroke recovery, and perceived participation in models adjusted for age, sex, and education level. Conclusion The association between health literacy and mental, physical, and social functioning 12-months post-discharge suggests that health literacy is an important factor to consider in post-stroke rehabilitation. Longitudinal studies of health literacy in people with stroke are warranted to explore the underlying reasons for these associations.

Health literacy in people living with mental illness: A latent profile analysis

Virtual reality (VR) is a developing technology that has recently attracted the attention of healthcare practitioners. Recently, VR systems have been used to treat pain symptoms. The present study aims to evaluate the VR effectiveness on chronic pain management. A systematic literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were used to discover the potentially eligible studies. The primary focus of the present investigation was to evaluate the possible effect of VR-assisted treatments on chronic pain, especially in the commonly occurring low back and neck pain. Nine studies reporting randomized controlled trials were included in the present study. VR-mediated interventions demonstrated significant improvement for pain symptoms in patients experiencing chronic pain. In addition, VR-mediated therapy decreased pain intensity and disability in the case of chronic neck pain compared to control conditions. However, the VR interventions showed a statistically non-significant improvement in chronic low back pain when experimental groups were compared with controls. VR therapy positive effect on chronic pain did not differ from the one reported for other types of interventions for pain management, as physical exercise and laser therapy. Taken together, these findings showed that currently available lines of evidence on the effect of VR-mediated therapy in chronic pain management, despite pointing towards possible therapeutical benefits of the VR-based intervention, are overall inconclusive and that more research on VR-assisted therapy for chronic pain is needed.

Purpose This study investigates the impact of health literacy and knowledge on undergraduates’ mental health and attitude towards help-seeking in public universities in Ekiti State, Nigeria; with gender and age serving as moderating factors. Design/methodology/approach The study adopted the correlational research design. The population of the study comprised undergraduates in public universities in Ekiti State, Nigeria. In all, 601 undergraduates (with respect to their gender) constituted the study’s sample. The instruments used for this study’s data collection were the Health Literacy Questionnaire (r = 0.87), Health Knowledge Questionnaire (r = 0.94), Mental Health Questionnaire (r = 0.91) and Attitude towards Help-Seeking Questionnaire (r = 0.84). Data were analysed at a 5% significance level, using the Hayes macro process in SPSS version 26.0. Findings Findings indicate a direct, positive and significant relationship exists among undergraduates’ health literacy, health knowledge, mental health and attitude towards help-seeking. Health literacy significantly impacts undergraduates’ mental health and attitude towards help-seeking. Gender (in favour of males) has a significant moderating effect on the relationship between health literacy, mental health, and attitude toward help-seeking among undergraduates. Originality/value Undergraduates’ health literacy significantly impacts their mental health and attitude towards help-seeking, with gender having a significant moderating effect. Concerted efforts of governments and health and education stakeholders should be concentrated on creating and promoting health literacy and knowledge as well as mental health and positive help-seeking attitudes among undergraduates with special attention to gender parity, irrespective of age. Future research could focus on this study’s concerns for younger learners, especially early childhood as well as the effect of undergraduates’ socioeconomic and family status, such as poverty and disabilities, on mental health and attitudes towards help-seeking.

BackgroundEmerging research has identified health literacy as an important resource for individual health care and disease prevention. In the context of COVID-19, People with limited HL are less likely to follow preventive measures such as wearing masks, social isolation, or taking the vaccination. However, the pathways of how health literacy affects decision-making have remained unclear.MethodsWith a cross-sectional study, a total of 613 responses (mean age is 25.64 ± 6.46 years) were collected. The relationship between health literacy and health behaviors under COVID-19 was examined, and the potential mediation pathways were assessed based on the health belief model.ResultsWith linear regression, it was found that health literacy has a direct effect on health behaviors and three constructs in the health belief model, i.e., perceived susceptibility, perceived severity, perceived barriers, as well as an indirect effect on health behaviors via increasing perceived barriers related with COVID-19 preventive measures. The results showed that health literacy only goes through the pathway of perceived barriers to influence health behaviors, and the indirect effects via other pathways were not significant.ConclusionsThe research addressed the mediation model underlying the effects of health literacy on health behaviors and identified a partial mediation role of perceived barriers. Health literacy could promote individual health behavior by reducing the perceived barriers to forming a healthy lifestyle and making health decisions. Future health promotion interventions increasing people's health literacy should be advocated to promote health initiatives in the whole population.

In this research, it was aimed to evaluate the effect of emergency department history on health literacy level and the role of digital literacy. A total of 454 participants were subjected to survey including health literacy scale, the digital literacy scale, and the demographic information form. Participants were divided into 2 groups as emergency medicine service (EMS) history (n = 269) and no EMS history (n = 185) groups. Health literacy, attitude, cognitive, and total digital literacy level of EMS history group were significantly higher than no EMS history group (P < .05). Social dimension of digital literacy scale was significantly higher in no EMS history group (P < .05). In no EMS history group, health literacy was significantly correlated with attitude (r = 0.298; P < .01), technical (r = 0.157; P < .01), cognitive (r = 0.369; P < .01), social (r = -0.302; P < .01) dimensions, and total score of digital literacy (r = 0.213; P < .01). In EMS history group, health literacy was significantly correlated with attitude (r = 0.553; P < .01), technical (r = 0.488; P < .01), cognitive (r = 0.555; P < .01) dimensions, and total score of digital literacy (r = 0.514; P < .01). Digital literacy had significant and positive effect on health literacy for all participants (OR = 0.126; P < .01), no EMS history (OR = 0.059; P < .01) and EMS history group (OR = 0.191; P < .01). People's health literacy skills are positively impacted if they have ever received medical attention from EMS units, regardless of the reason. Furthermore, among those who have used emergency medical services in the past, the impact of digital literacy on health literacy is statistically substantially larger.

Indonesia, the fourth most populated country in the world, has experienced a fivefold increase in Human Immunodeficiency Virus (HIV)‐infected individuals since 2001. Little is known about health literacy in people living with HIV (PLHIV) in Indonesia. This study aimed to determine the level of health literacy among PLHIV in Indonesia and assess associations between sociodemographic variables, beliefs about medicines, stigma and health literacy. We conducted a cross‐sectional study using questionnaires in PLHIV in Papua, Indonesia. The short version of the Test of Functional Health Literacy in Adults (S‐TOFHLA), Beliefs about Medicines Questionnaire (BMQ) and HIV stigma scale as well as questions on demographic information were completed by the participants from two hospitals in Papua, Indonesia. In a multivariate logistic regression analysis, we assessed the association between sociodemographic variables, stigma, beliefs about medicine and low health literacy. Overall, 331 participants were included, 62.0% female, 67.0% Papuans. A total of 38.5% of participants had low health literacy. PLHIV with multi‐dose regimen were less likely to have low health literacy than those taking a fixed‐dose combination (OR = 0.51; 95%CI = 0.32–0.82). PLHIV who had social support in medicine‐taking were more likely to have low health literacy (OR = 1.78; 95%CI = 1.07–2.97). More awareness about medication overuse (OR = 1.17; 95%CI = 1.06–1.29) and medication harm (OR = 1.10; 95%CI = 1.01–1.20) were also associated with having low health literacy. Overall, interventions targeting health literacy may be a promising strategy to improve self‐management.

BackgroundPeople with hearing impairment have many problems with healthcare use, which is associated with health literacy. Research on health literacy is less focused on people with hearing impairments. This research aimed to explore the levels of health literacy in people with hearing impairment, find the barriers to health literacy, and summarize methods for improving health literacy.MethodsA systematic review was conducted using three databases (PubMed, Cochrane, and Embase) to search the relevant articles and analyze them. The studies were selected using pre-defined inclusion/exclusion criteria in two steps: first, selection by examining the title and abstract; and second, after reading the study in full. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was used to assess the quality of the articles.ResultsTwenty-nine studies were synthesized qualitatively. Individuals with hearing impairment were found to have lower health literacy, when compared to those without impairment, which can lead to a higher medical cost. Most of the people with hearing impairment faced barriers to obtaining health-related information and found it difficult to communicate with healthcare providers. To improve their health literacy, it is essential to explore new ways of accessing health information and improving the relationship between patients and healthcare providers.ConclusionsOur findings show that people with hearing impairment have lower health literacy than those without. This suggests that developing new technology and policies for people with hearing impairment is necessary not to mention promoting provision of information via sign language.Trial registrationOSF: https://doi.org/10.17605/OSF.IO/V6UGW. PROSPERO ID: CRD42023395556.

Validation of the Short Assessment of Health Literacy in Portuguese-speaking Adults in Portugal

In recent years, the frequent occurrence of public health emergencies has posed serious threats to human health, leading to a broad international consensus on the necessity of enhancing national health literacy. In response, the Chinese government has integrated health education into the national education system as a key strategic measure aimed at improving population health. The health literacy level of physical education (PE) teachers, who serve as primary agents in implementing school-based health education, is essential for ensuring the delivery of high-quality health education. Functional health literacy, as the foundational component of overall health literacy, plays a critical role in the development and enhancement of individual health competencies. In this study, we developed a structural model of functional health literacy specific to Chinese PE teachers, aiming to evaluate their own literacy levels and their contributions to school-based health education. Qualitative data were primarily collected through semi-structured interviews. A total of 16 PE teachers from 11 provinces across China mainland were purposively selected as study participants. We employed a grounded theory technical approach to analyze the data using NVIVO 20.0 qualitative analysis software. The functional health literacy model for PE teachers comprises four core dimensions: reading and understanding health knowledge, numerating and calculating health data, communicating and appreciating health performance, recognizing and valuing health values. Reading and understanding health knowledge contains four categories: Health and safety emergency method, health concepts and general knowledge, sports-related health knowledge, medical health knowledge. Numerating and calculating health data include two categories: body mass index and indicators, physical fitness test data. Communicating and appreciating health performance contains three categories: health communication, health identification, health performance. Recognizing and valuing health values contains two categories: health responsibility awareness, significance and value of health. The proposed model offers a theoretical framework to support the professional transition of Chinese PE teachers into dual-role educators specializing in both physical education and health instruction. Applying this model with teacher education programs is expected to enhance the quality and effectiveness of health education in Chinese primary and secondary schools.