Health literacy, does it make a difference?

Considerations on Health Literacy and Hearing Aid Use

BackgroundLarge-scale health communication challenges during the COVID-19 pandemic, such as widespread misinformation and distrust in health care professionals, have influenced reluctance to take the COVID-19 vaccine, also known as vaccine hesitancy. Trust in health professionals, adequate health literacy, and high self-efficacy are key components of actively pursuing preventative and protective health care measures. These factors may be associated with intentions to seek and complete a COVID-19 vaccine dosing.ObjectiveThe objective of this analysis was to identify factors associated with COVID-19 vaccine hesitancy.MethodsIn February 2021, US adults (N=5872) responded to a web-based survey on COVID-19 vaccine hesitancy and components of health communication (trust in sources of health information, health literacy, and self-efficacy). Multivariable logistic regression models were used to explore associations between these factors and vaccine hesitancy while adjusting for key demographics. We hypothesized that low levels of trust, health literacy, and self-efficacy would be associated with increased vaccine hesitancy.ResultsThe adjusted odds of vaccine hesitancy was greater among those who placed little to no trust in health professionals compared to those who held a lot of trust (adjusted odds ratio [AOR] 8.54, 95% CI 6.52-11.19). The odds of vaccine hesitancy was also greater among those who felt frustrated about finding health information compared to those who did not (AOR 2.10, 95% CI 1.62-2.70). Participants who had little to no confidence in receiving health advice or information had greater odds of vaccine hesitancy compared to those who had a lot of confidence (AOR 3.05, 95% CI 2.34-3.97).ConclusionsThis study underscores the importance of trust between health professionals and their patients, and a need for improving health literacy regarding vaccines. Perceptions of mistrust and low levels of health literacy were associated with high levels of vaccine hesitancy, providing empirical support of framing these factors as perceived barriers to vaccine uptake.

Background: Inadequate health literacy is associated with worse health outcomes and carries high financial burden on both patients and healthcare system. There is insufficient data about health literacy among the hypertensive patients in Saudi Arabia. The aim of this study is to measure health literacy among hypertensive patients attending the primary health care clinics at King Abdulaziz Medical City, Riyadh (KAMC-R). Methodology: This study is a cross-sectional study that aims to identify the effect of various factors on health literacy among hypertensive patients attending the primary health care clinic at KAMC-R. Data was collected using a self-administered questionnaire shortly before the patient encountered their treating physician. The questionnaire is comprised of two parts. The first part deals with the patient’s characteristics and demographic data. The second part of the questionnaire assesses health literacy utilizing the Arabic version of the Single Item Literacy Screener (SILS). Results: In this study 395 responses were obtained, of which, 55.7 % were female patients. The data were collected from 3 different centers (Health Care Specialty Center (HCSC) 39% , Iskan clinics 31% and Um-Alhamam center 30%). Of the participants, 34.2 % reported that they never needed help with reading drug leaflet and medical instructions, while 33.4 % reported always needing help, 11.9 % sometimes need help, 10.4 % usually need help and 10.1 % rarely need help. The study showed that maleshad higher level of good health literacy with about 64.1 %, compared with 45.1 % of females (P=0.00). The health literacy among hypertensive patients is affected proportionally by education level, monthly income, and level of exercise and affected inversely by age. Conclusion: The study showed that a high percentage of hypertensive patients had low health literacy. Those who were females, less educated, old, and patients with sedentary lifestyle are more likely to have a low level of health literacy. We recommend that physicians should confirm that their patients have full understanding of the nature of the disease, and the correct timing and dosage of medications with frequent reassessment. Keywords: Health literacy, hypertensive patients, primary healthcare, Riyadh, Saudi Arabia

Failure to adhere to fluid restrictions negatively affects the quality of life and increases the risk of complications among hemodialysis patients. In chronic diseases, including chronic kidney disease, health literacy plays a crucial role in mitigating disease complications. The level of health literacy in chronic diseases such as chronic kidney disease can play a significant role in reducing the complications of the disease. This study aimed to assess the relationship between fluid control and health literacy in hemodialysis patients, representing the first such research in Turkey. This descriptive, cross-sectional, and correlational study was conducted in all dialysis centers in Bolu province, Turkey, from September 2022 to August 2023. The study included 144 hemodialysis outpatients meeting the inclusion criteria. Patient fluid control and health literacy were assessed using the "Fluid Restriction Scale in Patients Receiving Hemodialysis Treatment" and the "Turkey Health Literacy Scale-32". Statistical analysis was performed using SPSS version 25.0. The mean total score on the Health Literacy Scale was 22.6 ± 10.2, indicating a relatively low level of health literacy among the hemodialysis patients. 54.2% of patients receiving hemodialysis treatment exhibited inadequate health literacy. The mean score on the Fluid Restriction Scale was 50.4 ± 8.63, suggesting moderate fluid control adherence among the study population. 56.3% of hemodialysis patients had moderate levels of fluid control. A statistically significant moderate positive correlation was found between fluid control and health literacy levels (r = 0.456, p < 0.001). Health literacy scores accounted for 20.2% of the variance in fluid restriction scores (R 2 = 0.20), indicating a moderate contribution of health literacy to fluid control adherence. This study revealed a positive correlation between health literacy and fluid control adherence. Therefore, it is recommended that hemodialysis nurses concurrently assess patients' health literacy and fluid control and develop tailored educational programs based on these assessments.

Health Literacy among Spanish-Speaking Patients in the Emergency Department

BACKGROUND:Low levels of health literacy are related with riskier health behaviors and poorer health outcomes. Biological science contributes significantly to students’ health literacy, as many biology topics are directly related to health issues. This research aims to analyze the health literacy of high school students, focusing on three health domains: health promotion, disease prevention, and healthcare.METHODS AND MATERIAL:A total of 570 students contributed to this study, selected through convenience sampling. Thirteen test items were administered to the students via Google Forms. Data were analyzed by calculating the scores obtained, which were then categorized into performance levels.RESULTS:The findings revealed that overall, students’ health literacy and their performance in the three health domains were at the basic level. Female students consistently achieved higher scores for health literacy and in the health promotion domain (Sig. <0.05) but were not significant in the healthcare and disease prevention domains compared to males. However, both genders fell within the basic category. Notably, male students performed below basic level in the domain of disease prevention. Among age groups, 17-year-old students performed at the basic level, while students aged 15, 16, and 18 scored below basic in disease prevention. The lowest scores were observed among 18-year-old students. The calculation results show that health literacy and healthcare domains significantly differ based on age, but the other two do not.CONCLUSIONS:The high school students generally possess a basic level of health literacy, with female students outperforming their male counterparts. Additionally, health literacy appears to decline slightly with age in this study.

Background:Hypertension is the main risk factor for cardiovascular disease. Low level of health literacy is more common in people with hypertension. Evidence suggests that hypertension is preventable and can be controlled by modifying lifestyle and improving self-care behaviors.Objective:This study aimed to determine the relationship between health literacy, self-efficacy, and self-care behaviors in older adults with hypertension.Methods:The present study was a cross-sectional study conducted with 150 older adult patients with hypertension admitted to the Cardiac Care Unit (CCU) and post-CCU wards in East Guilan public hospitals in the north of Iran in 2020. Sampling was conducted using a convenience method based on inclusion criteria (age 60 years and older, high blood pressure and taking antihypertensive drugs for at least 6 months, ability to speak and communicate, having the suitable physical condition (not ill) to participate in research and answer questions, and having informed consent to participate in the study). The research instruments included a Health Literacy Questionnaire for Iranian Adults, a self-efficacy questionnaire in patients with hypertension, and a self-care behavior questionnaire for patients with hypertension. Descriptive statistics and multiple linear regression were used to analyze the data using SPSS software version 19.Key Results:The results showed that most patients had adequate health literacy with a mean score of 116.77 (standard deviation [SD] = 8.34), excellent self-efficacy with a mean score of 23.06 (SD = 1.99) and relatively desirable self-care behaviors with a mean score of 51.79 (SD = 4.37). Findings also indicated that health literacy can predict self-efficacy (beta = 0.262, p = .001) and self-care behaviors (beta = 0.639, p = .000).Conclusions:Based on results, health literacy is a predictor of self-efficacy variables and self-care behaviors. Therefore, planning to improve the health literacy of the older adult to promote self-efficacy and self-care behaviors and ultimately their health is recommended. [HLRP: Health Literacy Research and Practice. 2022;6(4):e262–e269.]Plain Language Summary:This study sought to determine the role of health literacy in predicting self-efficacy and self-care behaviors in older adults with hypertension admitted to CCU and post-CCU wards in East Guilan public hospitals in the north of Iran. Findings of this research demonstrate health literacy can predict self-efficacy and self-care behaviors.

Introduction: It is estimated that almost 40% of American adults have limited health literacy. Adults with limited health literacy report being less knowledgeable about disease management, healthy behaviors, and they are less likely to utilize preventive services. Racial and ethnic minorities are disproportionately affected by limited health literacy. The objective of this study was to assess health literacy level and medication adherence among African Americans with hypertension receiving health care through Medicaid. Hypothesis: We hypothesize that lower health literacy may be associated with lower hypertensive medication adherence among African Americans. Moreover, we predict that African American men may have lower levels of health literacy and medication adherence in comparison to African American women. Methods: We conducted a cross-sectional case-control study. The participants were African American adults, recipients of Medicaid with hypertension living in Delaware. Data were obtained from Medicaid and secondary data sources. Variables included demographic characteristics, medication adherence, health literacy, and cardiovascular disease health outcomes. Adherence was based on the days of prescription refill controlling for the number of days eligible. Health literacy was obtained from the Health Literacy Data Map from the University of North Carolina Chapel Hill. Results: Within our sample, the mean health literacy score for those without hypertension, normotensive was slightly higher than those with hypertension. (Normotensive: 234.9 vs Hypertension: 233.7, p= .0001). Women were more likely to adhere to their medication than men (OR: 0.83, 95% CI: 0.75-0.92, p&lt;=.001) Study participants reporting having a basic level of health literacy reported lower medication adherence than those with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, p=&lt;0.001). Conclusion: Within our sample of African Americans with hypertension receiving health care through Medicare, lower health literacy was associated with lower adherence to medication. Our study highlights the necessity of providing literacy assistance and health education to promote healthy behaviors and lifestyle change such as medication adherence.

BackgroundDysphagia, or swallowing disorders, has become a growing concern due to the aging population, and health literacy plays a crucial role in active aging. However, the relationship between them remains unclear.AimsTo investigate the association between health literacy and dysphagia among community-dwelling older adults in China.MethodsA survey was conducted on 4462 older adults aged 65 and above in a community in Yiwu City, China, from May 2021 to January 2022. Swallowing problems were assessed using a 30 ml water swallowing test (WST) and the Eating Assessment Tool-10 questionnaire (EAT-10). The participants' health literacy was evaluated using the Chinese Health Literacy Scale (CHLS). Logistic regression and t tests were employed to measure the association between them.ResultsThe prevalence of dysphagia was 5.70% and 7.85% as determined by EAT-10 and 30 ml-WST, respectively. The health literacy level of community-dwelling older adults was 24.4 ± 4.93 (9–45). Participants with dysphagia exhibited lower levels of health literacy (p < 0.05). The logistic regression model demonstrated an inverse association between health literacy and dysphagia (OR = 0.94, 95%CI = 0.91–0.96 for EAT-10, and OR = 0.93, 95%CI = 0.92–0.95 for WST). Moreover, this association remained significant even after adjusting for covariates.DiscussionOlder adults with dysphagia have lower levels of health literacy, particularly in terms of their ability to seek medical advice, acquire and evaluate medical information, and access social support resources.ConclusionsHealth literacy is associated with dysphagia among community-dwelling older adults. Effective interventions should be implemented to provide support in terms of both medical services and social support for this population.

Disadvantaged populations, including unemployed adults, often exhibit low levels of health literacy. Exploring subjectively perceived health literacy needs in these populations can serve as an entry point for participatory intervention development. We aimed to assess health literacy needs of unemployed adults by triangulating qualitative interviews data and a scoping review. Using a parallel approach, we combined results of an interview study with 10 participants of a job-reintegration program in Germany and a scoping review. The interviews, conducted in early 2021, focused on health topics of interest to the participants and their sources of health-related information. Data were analysed using thematic analysis. For the scoping review, we searched MEDLINE, CINAHL, PsycInfo and SCOPUS up to January 2021 for studies containing “unemployed” AND “health literacy” in titles/abstracts. Study selection and data extraction were done independently by two researchers. Nutrition and physical activity emerged as core themes during the interviews, with some participants referring to the importance of both for mental health. Doctors and the institution running the job-reintegration program were the sources of health-related information often mentioned. The Corona pandemic was reported to have limited physical activity and affected psycho-social well-being. Five out of 2696 studies were included in the review. Four focused on mental health literacy, the fifth assessed information seeking practices in unemployed adults. The qualitative analysis revealed that health literacy needs of unemployed adults go beyond mental health literacy. As nutrition and physical activity impact mental health, interventions targeting such topics might also improve mental health literacy in unemployed adults. Study findings will be discussed with unemployed persons and social workers in co-production workshops that aim to identify and prioritize health literacy needs for intervention development. Key messages Health literacy programs for unemployed adults should target nutrition and physical activity. Workforce re-integration programs play a pivotal role in improving health literacy of unemployed adults.

Parents of children with epilepsy play a key role in the management of their child’s condition. Their level of health literacy (HL), which refers to their ability to seek, understand, assess, remember, and utilize health information, is essential for handling the child optimally. The aim of this study was to investigate characteristics associated with high and low levels of different dimensions of HL in parents. HL was assessed with the multidimensional Health Literacy Questionnaire (parents’ version) and the electronic Health Literacy Scale, using data from a cohort of 254 parents of children <12 years. Bivariate correlation and multiple hierarchal linear regression (STATA version 16 SE) were used to investigate variables associated with HL. Self-efficacy (St. β = 0.14–0.34) was the only variable that predicted higher scores on every HL scale. Being older than 35 years (St. β = 0.18–0.21), level of education (St. β = 0.16–0.27), and the child having a coordinator of services (St. β = 0.16–0.28) were associated with higher scores, while sick leave due to the child’s epilepsy (St. β = −0.13 to −0.16), child comorbidities (St. β = −0.15 to −0.19), and higher levels of mental distress (St. β = −0.13 to −0.19) were associated with lower scores in several of the different HL dimensions. A total of 44.8% of the parents scored over the cutoff (≥1.85) predicting a mental disorder on the Hopkins symptom checklist. This is the first study to investigate multidimensional parental HL in a childhood epilepsy context. Our results highlight the need to investigate multiple variables, especially mental distress, to determine characteristics that may predict low parental HL. Further qualitative studies are needed to explore the underlying reasons for the parents’ HL scores and to develop inventions tailored to meet different HL needs.

Impact of Health Literacy on Eye Health Disparities

The demographic transition has led to an increase in the older population, resulting in a rise in individuals with comorbidities and reduced self-sufficiency. Low health literacy levels are associated with poor health outcomes especially among vulnerable groups (like older individuals). Enhancing health literacy through targeted programs is crucial for improving self-care in chronic conditions. To date, in Italy, there are no validated tools to measure health literacy in older people. Thus, the aim of this study is to validate the European Health Literacy Survey Questionnaire 6 in a Tuscan (Italy) sample of senior individuals. Cross-sectional. The sample was drawn from the Surveillance System of Advancements in health of the Italian Local Healthcare Units from 2017 to 2019. Item analysis, Cronbach's alpha and confirmatory factor analysis were used to validate the scale. Additionally, associations between Health Literacy levels and sociodemographic characteristics were analyzed. A total of 11,000 subjects were interviewed, with 1,080 (10%) aged 65-69. Cronbach's alpha was 0.89. In the older subgroup, the percentage of missing responses ranged from 4.54% to 11.85%, with the fourth item having the highest percentage of missing values. The confirmatory factor analysis revealed that the three-factor model showed a better fit to the data compared to the unidimensional model. Similar findings were observed in the 18-65-year-old population. In both groups, individuals with economic difficulties or lower education were at higher risk of having inadequate levels of health literacy. Moreover, in the 18-64 age group, being female reduced the probability of having an inadequate health literacy level, while being inactive/retired or a foreigner increased it. The study provides preliminary evidence supporting the validity and reliability of the European Health Literacy Survey Questionnaire 6 for assessing health literacy in the Italian older population. Further research is necessary to confirm these findings, particularly in samples of individuals aged over 69 years.

Health literacy is increasingly being recognized as an important social determinant of health and a key initiative to reduce health disparities and promote health equity at global, national, regional, and local levels. We provide new definitions of health literacy covering both personal and organizational aspects. Individuals’ ability to use health information rather than just understand it in order to make informed decisions about their health and health care are the hallmarks of these definitions. The new definitions acknowledge the importance of organizations addressing health literacy themselves as patients should not be solely responsible for health literacy. Our analyses of two recent US databases, the 2016 Behavioral Risk Factor Surveillance System and the 2022 Health Center Patient Survey, show striking racial/ethnic and socioeconomic disparities in health literacy levels and consequent health impacts. Compared to White Americans, Asians, Native Hawaiians and Pacific Islanders, and Hispanics have markedly lower levels of health literacy as they experience greater difficulties in obtaining health information, understanding written health information, and information they receive from healthcare providers. Education and income gradients in health literacy are steep. Americans in the lowest education and income strata have 7 to 10 times greater difficulty in receiving needed medical advice or health information than those at the highest education and income levels; they score 17–20 points lower on the health literacy index than their counterparts with high education or income levels. Patients who do not receive easy-to-understand health information from their healthcare providers have significantly increased risks of poor health, serious psychological distress, and emergency care. We discuss social and health benefits and strategies for improving health literacy.

Impact of Health Literacy in Hematology Outpatients Receiving Oral Anticancer Drugs and Followed By the Oncoral Multidisciplinary City-Hospital Educational Follow-up