To explore the content, style, and initiation of medication-related discussions between nurses and patients to understand how nurses support patients with heart failure, especially those with inadequate health literacy.

A cross-sectional design was conducted to observe medication-related conversations between nurses and patients with heart failure in four Dutch outpatient clinics. Conversations were audio-recorded and analyzed using MEDICODE, focusing on content, communication style (monologue or a dialogue), and initiation of the content themes. Health literacy was assessed using the NVS-D and the SBSQ. Results between health literacy groups were compared with descriptive analyses.

A total of 56 patients and 14 nurses participated in the study. Patients classified by one or both of the instruments as having inadequate health literacy (n = 33; 59 %) were generally older, had lower educational levels, and were more often accompanied by informal caregivers. Key themes discussed in the medication-related conversations included how the medication was identified ('medication designation), its dosage and instruction, main effects, side effects, attitude or emotions and other ('various') themes. The 'medication designation' theme was significantly more frequently discussed in the group with adequate health literacy, whereas 'attitude or emotions' and 'various themes' were more commonly discussed among those with inadequate health literacy. Most conversations were nurse-initiated and tended to be monologues, with nurses mainly serving as information providers.

Nurses primarily initiated and dominated medication-related discussions with a focus on factual aspects of medication, while patients initiated more discussions about their concerns regarding medication. While there was overlap in the topics discussed, notable differences emerged between patients with adequate and inadequate health literacy.

Improving communication strategies, such as structuring conversations and adopting dialogic approaches may improve patients' engagement and understanding of medication use, leading to more effective management of their condition, particularly benefiting patients with lower health literacy.

Pregnant and breastfeeding women commonly use complementary medicine products (CMPs) (dietary supplements/herbal medicines). Maternal health literacy highlights the importance of women seeking information to benefit their own and their children's health. However, little data on women's information-seeking behaviours regarding CMPs during pregnancy and lactation exists.

Identify pregnant and breastfeeding women's CMP information and recommendation sources; determine their most trusted sources; and describe the influence of these sources on CMP use decisions during pregnancy and lactation.

This primary study utilised a national, online, cross-sectional survey conducted with pregnant and/or breastfeeding Australian women using CMPs. Purposeful and snowball recruitment were used. Screening questions ensured respondents were currently pregnant and/or breastfeeding, over 18, using CMPs, and living in Australia. Respondents reported on their use of CMP information and recommendation sources. Data were analysed using descriptive statistics and chi-square tests to compare differences between pregnant and breastfeeding cohorts.

810 women (354 pregnant, 456 breastfeeding) completed the survey; 93.3 % had adequate health literacy, 81.9 % were university educated, and 74.8 % had medium-high incomes. Almost all (99.6 %; n = 809) used dietary supplements; 57.3 % (n = 464) used herbal medicines. General practitioners (GPs) were the most trusted HCPs (27.0 %; n = 219). Significantly more breastfeeding women (p < 0.0001) trusted naturopaths, herbalists, GPs, pharmacists, child and family health nurses, and lactation consultants. Significantly more pregnant women (p < 0.0001) trusted midwives and obstetricians. Recommendations from HCPs positively influenced CMP use, while recommendations online or print media generally did not.

Pregnant and breastfeeding women seek information on CMPs from various sources but trust HCPs the most. Maternity care clinicians should consider the diverse information and recommendation sources women access when discussing CMP use.

The aim of this study is to explore how patients experience the personal nature of a personalized patient leaflet (PPL), and the role of health literacy in patients' experience.

A PPL was tailored on patients' characteristics and medical information. Semi-structured interviews were performed to capture patient experiences. Patients were recruited in four community pharmacies. Interviews were transcribed verbatim and analysed thematically.

In total, 32 participants were interviewed. Over half of them thought they received general information, and thus did not recognize the personal nature. Experience of the personal nature was mainly by patients' medication overview, name and address information and the use of vocative case ('your dosage'). Respondents with adequate health literacy recognized the personalized information better than those with limited health literacy.

Patients do not expect medication information leaflets to be personalized. Pharmacy workers should point out the personalized elements of the medicine leaflet during consultation. This might improve patients' recognition, especially for patients with limited health literacy.

Recognition of the personal nature may ensure that medicine information is better read and understood, which may positively impact correct use of medication. Patients need support to understand that the leaflet is personalized.

We aimed to determine if a graphics-based education tool (GBET) leads to improved macrosomia knowledge on risk factors/complications (RF/C) and management options (MO) for macrosomia among pregnant individuals compared to routine care.We conducted a randomized control trial (NCTO6281301). Inclusion criteria were individuals at 18 to 55 years, with singleton pregnancy delivering at ≥ 36 weeks. After consent, participants were randomized to either routine care or GBET. To assess knowledge of macrosomia, a questionnaire consisting of 17 questions relating to the RF/C (11 questions) and MO (six questions) of suspected macrosomic fetuses was administered to participants one time either directly after consent (if routine care) or directly following review of GBET. The primary outcome was the overall score on the questionnaire. Secondary outcomes were summary scores on the RF/C and MO. Descriptive statistics were used for baseline characteristics and outcomes. Chi-squared test or Fisher's exact test was used to compare categorical variables and the student's t-test for continuous variables.From January to July 2023, 232 eligible individuals were approached and 196 (84%) agreed to participate; of them, 98 received the GBET, while 98 received routine care. Baseline demographics were similar. The majority (42%) of respondents were non-Hispanic Black, 60% were employed, 56% had some level of college education, and 30% lived below the poverty line. There were 41% nulliparous, 67% with a BMI ≥ 30 kg/m2, and 16% with diabetes. The primary outcome was significantly higher in those who received the GBET (70 vs. 64%; p < 0.001). The RF/C scores were also higher in the GBET group (72 vs. 63%; p = 0.001); however, the MO scores were similar between groups (65 vs. 68%; p = 0.084).In our population, a GBET improved participant knowledge on the RF/C for macrosomia, but not their MO. · In our population, overall macrosomia knowledge was poor.. · An education tool on macrosomia improved knowledge.. · Studies ought to determine if increased knowledge improves outcomes..

Despite being a frequent entry point of care, it remains unknown if families' needs are being met across pediatric emergency departments (PEDs). Study objectives were to describe caregivers' perceived overall PED experience and needs and to what extent these needs were met.

This descriptive, cross-sectional survey with medical record review was conducted in 10 Canadian PEDs. Caregivers completed electronic surveys in the PED and within 7 days postvisit. The primary outcome was the degree to which caregivers' overall needs were met in the PED.

A total of 2005 caregivers participated; mean age was 37.8 (standard deviation 7.7) years and 74.3% (1462/1969) were mothers. Mean child age was 5.9 (standard deviation 5.1) years; 51.9% (1040/2003) were male. The median [interquartile range (IQR)] length of stay was 3.9 (2.6-6.1) hours. A total of 22.1% (322/1454) of caregivers reported that their overall needs were not adequately met (Likert scale 1-3/5). The top unmet needs during a PED visit were prompt medical care [20.3% (194/955)], access to practical items [16.8% (160/955)], and effective communication surrounding care [8.7% (83/955)]. Caregiver needs being met were associated with their child's needs being met [odds ratio (OR) 21.2 (13.1-34.2)], child's pain being well managed [OR 3.7 (2.4-5.6)], and satisfaction with overall length of stay [OR 2.6 (1.8-3.8)].

Almost one fourth of caregivers report their overall needs were not fully met. Improving the quality of PED experience through better communication (ie, wait time delays, medical updates) and earlier pain care initiation may improve family experiences while policymakers work nationally to address lengthy wait times.

Delayed diagnosis of inflammatory bowel disease (IBD) leads to prolonged symptoms and worse long-term outcomes. We sought to evaluate whether race, ethnicity, disease type, and social factors are associated with delayed diagnosis of pediatric IBD.

We performed a cross-sectional study of newly diagnosed pediatric patients with IBD at 22 United States sites from 2019 to 2022. Parents/guardians reported race, ethnicity, time between symptom onset and diagnosis, and other social determinants of health. Through bivariate and multivariable analyses using generalized estimating equations, we evaluated associations between these factors and diagnosis time defined as ≤60 days, 61 to 180 days, 181 to 365 days, and >365 days.

We enrolled 869 participants (mean age at diagnosis, 13.1 years; 52% male; 57% Crohn's disease [CD]; 34% ulcerative colitis [UC]; 8% Hispanic; 30% non-White). Overall, the mean time to diagnosis was 265.9 days. After adjustment, factors associated with longer diagnosis time included CD vs UC (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.9-3.5), 2 or more other health conditions (OR, 1.7; 95% CI, 1.1-2.7), and longer travel time to clinic (>1 hour [OR, 1.7; 95% CI, 1.2-2.4], >2 hours (OR, 1.8; 95% CI, 1.2-2.9] each vs <30 minutes). There was no association with race, ethnicity, birth country, gender, parent education, household income, insurance type, health literacy, and health system distrust.

Consistent with prior literature, diagnostic delay is longer for CD than UC. Reassuringly, time to diagnosis is equitable across racioethnic groups. New models of diagnostic care are needed for communities affected by longer travel times.

To explore patients' use of patient portals to access lab test results, their comprehension of lab test data, and factors associated with these.

An online survey was administered to 276 adults 18+ years. Multivariate logistic regression was used to determine factors associated with patient portal use to view lab test results and lab test comprehension.

The sample was predominantly White (72.5%), female (55.4%), with mean age 50.7 ± 15.5 years. Overall, participants had low numeracy (10.79 ± 2.71) and eHealth literacy skills (23.91 ± 5.29), and moderate lab test comprehension scores (18 ± 2.3). White participants with greater eHealth literacy were more likely to access lab test results via patient portals, whereas those with a college education were less likely to do so (χ2 [3]=31.23, P < .001). The regression showed that older age, fewer chronic conditions, and use of patient portals were significantly related to higher lab test comprehension scores (F [22, 250]=8.73, P <.001). Older adults performed better on comprehension tests but reported having difficulty understanding lab tests, expressing a preference for their doctors to explain them.

The findings shed light on the experiences and needs of different user groups that must be addressed to enhance their ability to effectively use patient portals for obtaining lab test results.

More research is needed to determine patient barriers to comprehending lab test results online and to develop tailored strategies to improve patients' self-efficacy to meaningfully use medical information in patient portals.

Sexual health literacy refers to the ability to find, understand, and use information and services to inform decisions and actions related to sexual health. Given the importance of sexual health literacy for improving health outcomes, it is prudent to identify sexual health literacy measures that can be used by healthcare providers, scholars and educators. To address this need, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct a systematic review. This review examined 12 databases to identify existing sexual health literacy self-report scales, subscales or individual items that were available in English, developed for scale validation purposes, and published between 2002, the year the World Health Organization convened experts to provide a clear working definition of sexual health, and 2022. We conducted a risk of bias and quality assurance assessment of the nine articles that met inclusion criteria, and coded articles along the ten components of a sexual health model used as the theoretical framework. Findings revealed mixed quality of identified measures. None of the measures received positive ratings on all eight criteria assessed or addressed all components of the sexual health model. The results from this systematic review suggest the need for a culturally sensitive, valid and reliable scale to assess sexual health literacy that can be used by sexual health professionals to promote sexual health and to reduce deleterious sexual health outcomes.

Caregivers of persons with Alzheimer disease and related dementias (ADRD) neglect their health, including by ignoring stress levels. African American women are vulnerable and susceptible to hypertension. Chronic caregiving stress and hypertension place them at high risk for cardiovascular disease. Addressing stress reactivity or resilience is vital in lessening their caregiving stress, enhancing their quality of life (QOL), and fostering healthy blood pressure (BP) self-care behaviors.

This pilot study aims to investigate the feasibility and acceptability of implementing the Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH) intervention in this population and to evaluate its effect on ADRD caregivers' stress and QOL. Additionally, it explores the mediation of stress reactivity or resilience between interventions and self-care behaviors.

A small randomized controlled trial pilot study will recruit 28 African American or Black female caregivers aged 40 years diagnosed with hypertension and on an antihypertensive medication. Participants will be randomly assigned to either the MIM DASH or the Alzheimer's Association caregiver training group (attention control). Trained facilitators will deliver both interventions over 8 weeks through 1-hour, group, internet-based sessions, via video or telephone. After completion, both groups will receive coaching calls over 9 months, beginning with 8 weekly calls followed by 4 monthly calls to encourage use of the educational materials. Primary outcome measures include feasibility (recruitment and retention) and acceptability (attendance). Secondary measures assess caregiver stress (Perceived Stress Scale), QOL, and self-care behaviors (Food Frequency Questionnaire and self-reported physical activity). Data collection occurs at baseline, 3 months, and 9 months. Quantitative data will be analyzed using descriptive statistics, CIs, and mediation models.

This study was approved by the institutional review board in April 2022 and funded in May 2022. The first data were collected in January 2023, and the last data were collected in September 2024. The completion of all aims' data analysis is anticipated in spring 2025. The participants' mean age was 62.4 (SD 7.98) years, with a mean baseline systolic BP of 128 (SD 19) mm Hg and diastolic BP of 79 (SD 10) mm Hg. Participants reported that MIM DASH was acceptable (at a mean score of 59.08, SD 7.38, compared to 60.83, SD 5.56 for caregiver training). Regarding feasibility, as reflected in attendance, MIM DASH participants had a mean attendance of 6.3 (SD 2.3) sessions, and the caregiver training group had 4.9 (SD 2.9) sessions.

This study's findings demonstrate the feasibility of conducting an internet-based intervention (MIM DASH) for African American women with hypertension who also care for families living with ADRD. These results will inform the design of a larger randomized controlled trial to evaluate the intervention's efficacy and scalability further.

ClinicalTrials.gov NCT05721482; https://clinicaltrials.gov/study/NCT05721482.

DERR1-10.2196/66975.

This study aimed to develop and validate the Menopause-Specific Health Literacy Scale (Men-HLS) for middle-aged women aged 45-64 years, utilizing an Item Response Theory (IRT) framework and traditional factor analysis.

Based on the four subdomains (access, understand, appraise, and apply) of the integrated health literacy conceptual model proposed by the European Health Literacy Consortium, we developed 73 preliminary items, combining self-reported (subjective) and performance-based (objective) measures. Content validity was assessed by an expert panel (n = 14) and face validity was evaluated by the target population (n = 15). Validity and reliability were evaluated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency, and item analysis based on classical test theory and IRT.

The scale was refined to 45 items following content and face validity assessments and reduced to 35 items through classical test theory-based item analysis and inter-item correlation. EFA removed seven cross-loaded items, resulting in three distinct factors: accessing (ACS), appraising (APR), and utilizing (UTL). The IRT analysis demonstrated high item discrimination, with four items in the UTL subdomain showing moderate discrimination. CFA confirmed a good model fit. The final Men-HLS comprised 28 items (6 for ACS, 9 for APR, and 13 for UTL) and achieved a Cronbach's alpha of 0.91.

The Men-HLS is a valid and reliable instrument for identifying health literacy challenges in middle-aged women. Further research is needed to establish its predictive validity through longitudinal data and confirm its measurement invariance across diverse sociodemographic groups.

The Men-HLS provides healthcare professionals with a practical tool for assessing the health literacy levels required to manage menopausal symptoms and chronic conditions, facilitating the development of targeted educational resources and interventions for improved health management.

To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals' health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care.

Preplanned analysis of randomised trial data comparing: the Choosing Wisely questions, a SDM video, both interventions or control (no intervention). Randomisation was stratified by participant health literacy ('adequate' vs 'limited'), as assessed by the Newest Vital Sign.

Self-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM.

1439 Australian adults, recruited online.

The effects of the Choosing Wisely questions and SDM video did not differ based on participants' health literacy for most primary or secondary outcomes (all two-way and three-way interactions p>0.05). Compared with individuals with 'adequate' health literacy, those with 'limited' health literacy had lower knowledge of SDM rights (82.1% vs 89.0%; 95% CI: 3.9% to 9.8%, p<0.001) and less positive attitudes towards SDM (48.3% vs 58.1%; 95% CI: 4.7% to 15.0%, p=0.0002). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; 95% CI: 0.33 to 0.72, p<0.001) and generated fewer questions to ask a healthcare provider which aligned with the Choosing Wisely questions (χ2 (1)=73.79, p<.001). On average, 67.7% of participants with 'limited' health literacy indicated that they would use video interventions again compared with 55.7% of individuals with 'adequate' health literacy.

Adults with limited health literacy continue to have lower scores on decision-making outcomes in the context of low value care. Ongoing work is needed to develop and test different intervention formats that support people with lower health literacy to engage in question asking and SDM.

The research and action field of health literacy and health behaviour is increasingly differentiating. General health literacy is established and focuses on population-based studies. Specific health literacy for health behaviour offers topic-related starting points for interventions and public health strategies.There are various concepts, definitions and measurement instruments for general health literacy and specific health literacy in the areas of nutrition and physical activity. These differ in terms of the levels of action and areas of application of health literacy.Most studies show a positive association between health literacy and various health behaviours. Higher health literacy is more often associated with improved health-promoting behaviour. This applies to both general as well as specific health literacy regarding nutrition and exercise (physical activity). Some studies found no correlation for certain behaviours, while others only found correlations for certain groups, which may be due to the different measuring instruments and research contexts. This points to the importance of always considering the interaction between behaviour and circumstances in order to improve the fit between the individual and the everyday demands of dealing with health information.The behavioural and cultural insights (BCI) approach can provide insights into how to promote health literacy with regard to various health behaviours, individual barriers and facilitators that arise from life circumstances and conditions, and that take social practice into account. BCI and health literacy complement each other and have the potential to make strategies for improving health behaviour more effective and targeted.

Health literacy has an essential role in heart failure (HF), contributing to medication adherence, disease self-management, and interactions with care providers. Yet, data on interventions to enhance health literacy are scarce. HF guidelines identify health literacy as an individual-level barrier to HF management but offer limited guidance on addressing limited health literacy. Healthy People 2030 recognizes individual and organizational health literacy as essential for health equity, calling on organizations to enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. This review summarizes interventions to address health literacy in individuals with HF. We identify the literature's chief limitations: heterogeneity of health literacy measurement, inconsistent outcomes, generalizability, absence of assessment of sustainability of interventions, and missing role of implementation science. In response to the limitations in the literature identified here, we articulate a call to action to develop and implement effective, sustainable, scalable interventions to address personal and organizational health literacy in HF and thereby advance health equity.

Nutrition label use among patients with coronary heart disease (CHD) is limited. This study aims to investigate the mediating effect of dietary self-efficacy on the relationship between health literacy and nutrition label use in CHD patients. This cross-sectional study recruited 350 CHD patients using convenience sampling from two hospitals in Changsha City. Data were collected using a general information questionnaire, the Newest Vital Sign Scale, the Cardiac Diet Self-efficacy Scale, and the Nutrition Label Use Questionnaire. SPSS 25.0 was used for Pearson correlation analysis and multiple linear regression analysis, while Model 4 in the SPSS macro program PROCESS was applied for mediation effect analysis. The results indicated health literacy and dietary self-efficacy were positively and significantly correlated with nutrition label use in CHD patients (P < 0.001). Bootstrap test results demonstrated that dietary self-efficacy partially mediated the relationship between health literacy and nutrition label use, with a mediation effect of 0.184 (95% CI: 0.144-0.225), accounting for 55.42% of the total effect. In conclusion, dietary self-efficacy mediates the relationship between health literacy and nutrition label use in CHD patients. Targeted interventions that address both health literacy and dietary self-efficacy are crucial for improving nutrition label use among CHD patients.

Background Health literacy is "the degree to which individuals can obtain, process, and understand basic health information and services to make appropriate health decisions." Low health literacy is associated with adverse health outcomes, such as increased risk and length of hospitalization after abdominal surgery. However, the impact of health literacy on outcomes in the spine surgery patient population is understudied. This study seeks to evaluate the relationship between patients' health literacy scores and various outcomes, primarily a patient's Patient-Reported Outcomes Measurement Information System (PROMIS) score at their baseline visit with a spine surgeon. A greater understanding of the impact of health literacy on health outcomes may improve treatment for patients with lower health literacy. Methods This is a single-center retrospective study at New York University (NYU) Langone Orthopedic Center. A health literacy measurement survey (i.e., the Newest Vital Sign survey) was administered to English-speaking adult patients aged 18 years and older who presented to two attending spine surgeons between June 1, 2022, and August 15, 2022, as new or follow-up patients. The survey consists of six questions, and patients were categorized into two different health literacy levels based on the number of correct responses. A score of 0-3 suggests limited literacy, and a score of 4-6 indicates adequate literacy. Additional data collected include PROMIS at the patient's baseline appointment with the surgeon to create consistency between new and follow-up patients. Key demographic and clinical data were also collected. Univariate associations between health literacy and PROMIS scores were investigated using the Welch Two Sample t-test and Pearson's Chi-squared test. A multivariate analysis was carried out implementing a binary logistic regression model. Results This study included 57 patients with an average age of 57 years, 29 (51%) of whom identified as female. The racial breakdown of this cohort was 33 (58%) White, 11 (19%) Black, 5 (9%) Asian, and 5 (9%) Hispanic. The health literacy survey results demonstrated that 25 (44%) had limited health literacy, and 32 (56%) had adequate health literacy. Limited literacy patients were older (mean age of 62 years for Limited vs. 54 years for Adequate, P=0.024) and more likely to be patients of color (either Asian, Black, or Hispanic) (15 (60%) Limited vs. 6 (19%) Adequate, P = 0.002). Limited literacy patients also, on average, had a lower self-reported physical health score (36.6 for Limited vs. 41.2 for Adequate, P=0.050) and were more likely to have hypertension (20 (80%) Limited vs. 10 (31%) Adequate, P<0.001). A logistic regression model yielded an odds ratio of 1.16 between patient-reported physical health and health literacy, indicating that the odds of having adequate health literacy increase by about 16% for each unit increase in the Physical Health score. A Variance Inflation Factor (VIF) test was used and demonstrated minimal multicollinearity among the variables in the logistic regression. Conclusion This study shows that health literacy plays a significant role in health outcomes, especially in chronic health conditions like physical health for spine surgery patients and hypertension. These results align with the literature, showing how lower health literacy correlates with worse physical health scores and a greater incidence of hypertension.

A significant proportion of many populations remain uninsured. The aim of the study was to assess differences in breast cancer outcomes before and after the implementation of an innovative approach to the multidisciplinary treatment of uninsured breast cancer patients.

Retrospective review was performed of patients seen at a safety net hospital from January 2000 to December 2020. Beginning July 2006, an innovative approach was implemented to lower patient costs and facilitate care of uninsured patients.

The study included 1,797 patients, 661 patients before the changes (BCS), and 1136 patients after implementation of the new cost saving approach (ACS). The mean age was 53 years. The majority were uninsured (56%) or insured by Medicaid (31%). Only 18% underwent screening mammography. The ACS group had a higher rate of breast conservation (75% vs 47%, p < 0.001). A higher percentage of the ACS group received adjuvant therapy: Chemotherapy (91% vs 70%, p < 0.001), Radiation therapy (91% vs 70%, p < 0.001), and initiated endocrine therapy (87% vs 67%, p < 0.001). After follow-up of 8 years, these changes resulted in lower ipsilateral breast tumor recurrence (2% vs 16%, p < 0.001) and chest wall recurrence (5% versus 8%) and improvement in overall survival (90% vs 81%, p < 0.001).

Peer-reviewed literature is replete of studies documenting disparities in breast cancer treatment. The current study describes a successful cost-limiting method which takes advantage of existing financial assistance programs to improve care in uninsured patients.

A patient-centered care (PCC) environment allows athletic trainers (ATs) to develop trusting relationships with patients, enabling them to make the most informed care decisions. To provide PCC, the AT should assess health literacy and deliver quality patient education.

To explore the lived experiences of ATs from different job settings to identify how they deliver PCC specific to health literacy and patient education.

Qualitative.

Virtual interviews.

Twenty-seven ATs (age = 34 ± 10 years; women = 15, men = 12) from the physician practice (n = 10), college (n = 9), and secondary school (n = 8) settings.

We interviewed the participants using a semistructured interview protocol. Three researchers coded the transcripts after the consensual qualitative research process for each job setting. Trustworthiness was achieved through multianalyst triangulation, member checking, and internal auditing.

Four domains emerged from all interviews: (1) work environment, (2) essential traits and skills, (3) health literacy assessment strategies, and (4) patient education materials and delivery. In the work environment, ATs described the patient load, interprofessional relationships, and patient characteristics across settings. Essential traits and skills varied widely between settings, and ATs needed different strategies based on differing patient needs. For health literacy assessment strategies, ATs did not formally assess health literacy and relied on perceptions and assumptions. Effective digital information and health informatics strategies were described for patient education materials and delivery.

ATs from physician practice, college, and secondary school settings describe using various strategies to create a patient-centered environment. Participants shared their behaviors in assessing health literacy and delivering patient education from various job settings.

People from ethnic minority backgrounds are exposed to greater risk of patient safety events (such as healthcare-acquired infections and medication errors) occurring in their healthcare. However, evidence of the type and frequency of patient safety events occurring in cancer care among patients from ethnic minority background is lacking. This study sought to address this evidence gap.

A two-stage retrospective medical record review was conducted at four cancer services in two Australian states. Eligible medical records at each service that were identified as belonging to ethnic minority patients were reviewed by two clinician researchers in stage one, followed by authentication of extracted data by a site-specific cancer clinician in stage two. Descriptive statistics were used to report the frequency and type of safety events. Chi-square and independent sample T-tests were used to examine the association between safety events and patient socio-cultural indicators.

A total of 628 patient records were included. Of the 628 patient records, 212 (33.75%) documented at least one safety event. A total of 410 safety events were documented in the 212 patient records. Medication-related safety events were most commonly documented (121/410, 29.5%), followed by clinical process/procedure-related safety events (76/410, 18.5%) and patient accidents (60/410, 14.6%). The occurrence of a safety event was associated with patient records that documented 'no interpreter was required'.

Patient safety events in cancer care occur frequently among patients from ethnic minority backgrounds. Unsafe cancer care for this population is associated with inadequate use of interpreters, lack of shared understanding and expectations of care processes linked to cultural and linguistic barriers. Approaches to enhance engagement are required.

Completely switching from cigarette smoking to electronic nicotine delivery systems (ENDS) reduces exposure to toxic substances. Yet, many smokers believe that ENDS are at least as harmful as smoking, making them less likely to switch from cigarettes to ENDS. Effectively communicating reduced-exposure information is critical, but such messages must be properly understood. This online study evaluated comprehension of a factual message, indicating that smokers who switch completely away from smoking to JUUL-brand ENDS can reduce their exposure to harmful chemicals in cigarette smoke. Participants were 12 557 adults 18+ years (smokers, dual users and former and never users of tobacco) randomized to see the reduced-exposure message or to a Control condition. After exposure to the message, the majority of smokers (89%) understood the need to switch completely from cigarettes to JUUL to achieve reduced exposure. Most smokers and nonusers (>75%) did not misperceive JUUL as completely eliminating exposure to harmful chemicals, and >85% understood that using JUUL has risk. Exposure to the message improved understanding of the intended audience for JUUL. Individuals with limited health literacy showed modestly lower comprehension, regardless of condition. Ensuring adequate comprehension of messages about reduced exposure from ENDS is important to ensuring that such messaging can benefit public health.

In the context of People Living with HIV (PLWH), poor health literacy (HL) seems to be linked to poorer health outcomes and reduced engagement in care. Additionally, the level of HL can affect HIV knowledge and may impact adherence to antiretroviral therapy (ART). This research explored the connection between ART adherence, HL, and engagement in care in a cohort of 250 PLWH receiving ART in Italy.

A questionnaire was given to PLWH at Policlinico Gemelli in Rome to assess their health literacy and adherence to therapy. The Brief Health Literacy Screening (BHLS) and the Newest Vital Sign (NVS) were used to evaluate subjective and objective HL. Adherence levels were self-reported as poor, good, or excellent, and the assessment included the Patient Health Engagement Scale (PHE-S).

Notably, the majority of the sample comprised male individuals (67.9%), with 69.2% reporting a 10-years or longer duration between their HIV diagnosis and their initiation of ART. It was found that PLWH with poor adherence had low schooling, had been living with HIV for 1-5 years, were HCV co-infected, had a viremia >50 copies/mL, poor health status, poor engagement in care, and poor HL (p = <0.001). They exhibited lower mean scores on the subjective HL scale and lower CD4 T-cell counts and nadir CD4 T-cell counts (p < .001).

Our study demonstrated a positive correlation between higher HL levels and improved disease management, treatment adherence, and overall physical and mental well-being. Enhanced HL capabilities are paramount in bolstering health management and treatment adherence.

Limited health literacy (HL) leads to poor health outcomes, psychological stress, and misutilization of medical resources. Although interventions aimed at improving HL may be effective, identifying patients at risk of limited HL in the clinical workflow is challenging. With machine learning (ML) algorithms based on readily available data, healthcare professionals would be enabled to incorporate HL screening without the need for administering in-person HL screening tools.

Develop ML algorithms to identify patients at risk for limited HL in spine patients.

Between December 2021 and February 2023, consecutive English-speaking patients over the age of 18 and new to an urban academic outpatient spine clinic were approached for participation in a cross-sectional survey study. HL was assessed using the Newest Vital Sign and the scores were divided into limited (0-3) and adequate (4-6) HL. Additional patient characteristics were extracted through a sociodemographic survey and electronic health records. Subsequently, feature selection was performed by random forest algorithms with recursive feature selection and five ML models (stochastic gradient boosting, random forest, Bayes point machine, elastic-net penalized logistic regression, support vector machine) were developed to predict limited HL.

Seven hundred and fifty-three patients were included for model development, of whom 259 (34.4%) had limited HL. Variables identified for predicting limited HL were age, Area Deprivation Index-national, Social Vulnerability Index, insurance category, Body Mass Index, race, college education, and employment status. The Elastic-Net Penalized Logistic Regression algorithm achieved the best performance with a c-statistic of 0.766, calibration slope/intercept of 1.044/-0.037, and Brier score of 0.179.

Elastic-Net Penalized Logistic Regression had the best performance when compared with other ML algorithms with a c-statistic of 0.766, calibration slope/intercept of 1.044/-0.037, and a Brier score of 0.179. Over one-third of patients presenting to an outpatient spine center were found to have limited HL. While this algorithm is far from being used in clinical practice, ML algorithms offer a potential opportunity for identifying patients at risk for limited HL without administering in-person HL assessments. This could possibly enable screening and early intervention to mitigate the potential negative consequences of limited HL without taxing the existing clinical workflow.

Improving health literacy can improve health. This essay reviews the resources available to help improve epilepsy health literacy, including websites, drug inserts/labels/information leaflets, patient educators, handouts, plain language, lay summaries, and other efforts to close the gaps between research and epilepsy health literacy.

Below adequate health literacy is common and linked to increased risk of adverse health outcomes. Supporting optimal health following kidney transplantation requires the capacity to understand health information and make decisions about care. The impact of low health literacy in the context of pediatric kidney transplant has not previously been studied.

This retrospective cohort study sought to determine the relationship between caregiver or patient health literacy and healthcare utilization (outpatient hospital visits, days in hospital) and to explore relationships between health literacy and adherence to tacrolimus (trough level coefficient of variation) and allograft function post-transplant.

Forty patients were included in the analysis. 60% were identified as having adequate literacy using the Newest Vital Sign (NVS). Lower health literacy was significantly correlated with increased healthcare utilization in the first 3 months post-transplant (rs = -0.36, p = 0.024) and in the first year post-transplant (rs = -0.35, p = 0.029). No association was demonstrated between health literacy level and number of days admitted to the hospital (rs = -0.16, p = 0.321), adherence to tacrolimus 6-12 months post-transplant (rs = 0.078, p = 0.68), or change in allograft function 2 years post-transplant (rs = -0.13, p = 0.43).

Limited health literacy is common in pediatric kidney transplant recipients and families and is associated with increased frequency of hospital and outpatient clinic department visits early post-transplant. In this small-sized cohort, we did not identify a relationship between health literacy level and hospitalization days, allograft function, or tacrolimus adherence. Larger studies are needed to evaluate the relationship between health literacy and transplant outcomes in children and test interventions that may improve communication and optimize care.

Patients have difficulties in understanding how to manage their liver cirrhosis. This highlights a need for support in comprehending health-related information, which remains largely lacking within liver cirrhosis care. Involvement of registered nurses (RNs) in outpatient liver cirrhosis care has potential to improve quality of care and reduce patient mortality. However, the benefits of nursing care on patients' health-related quality of life (HRQoL) are scarcely studied. This study compared HRQoL in patients receiving either standard medical outpatient care or adjunctive, nurse-led care. The risk of malnutrition, decompensation events and mortality were also compared between the two study groups.

This was a pragmatic, multicentre, randomised trial, which enrolled 167 patients with liver cirrhosis. The primary outcome measure, HRQoL, was assessed using the RAND-36 questionnaire. The physical component summary (PCS) and the mental component summary (MCS) scores of RAND-36 were compared, using linear mixed-effects models for repeated measures, at 12 and 24 months.

83 patients received standard medical care, and 84 patients received adjunctive, nurse-led care for 24 months. Due to unforeseen circumstances, the final study population of 167 participants was less than the intended 500. Group comparisons were non-significant of the PCS and MCS scores (-1.1, p=0.53 and -0.7, p=0.67, respectively), malnutrition (p=0.62) and decompensation events (p=0.46), after 24 months. However, mortality was three times higher in the control group compared with the intervention group (12 vs 4, p=0.04) after 24 months.

In this study, adjunctive nurse-led care was not superior to standard medical outpatient care regarding HRQoL, risk of developing malnutrition or decompensation. However, RN involvement contributed to early identification of decompensation and reduced mortality.

NCT02957253.

Excess weight and obesity are increasing among children. Health literacy has been suggested as a feasible concept for enabling informed health choices in weight management interventions for children and their parents. Knowledge of the skills necessary for a child to maintain new health behaviors is limited and the role of health literacy remains unclear. Thus, there is a need to summarize the effects of and experiences with interventions that include health literacy components to guide the development of effective, future weight-related interventions.

This review aims to identify how health literacy is integrated into studies of interventions targeting children with excess weight or obesity and/or their parents and to appraise the identified literature.

We conducted a systematic mixed methods review, with searches in Medline, CINAHL, Cochrane, EMBASE, ERIC, PsycINFO, and Web of Science. We included studies of interventions published after 2013 that targeted children under 19 years with excess weight or obesity and/or their parents, where health literacy played a role. Results from the included studies were integrated using qualitative data transformation techniques, followed by a narrative summary.

We identified 7,910 citations. Four reports met our inclusion criteria and were included for review. These reports included a total of 402 children. Health literacy was assessed at baseline in two studies and measured as an outcome over time in one study. Methodological quality varied among the retained reports, with differences observed in study design, risk of bias and data collection methods. The reports highlight the need to adapt weight management treatments to the individual level of health literacy in children and their families to first ensure active participation in their treatment and second ensure long-term compliance with necessary lifestyle-related changes.

Surprisingly, little attention has been paid to the importance of health literacy in weight management programs targeting children and their families. Seemingly, treatments tailored to the individual level of health literacy have not been prioritized in research. Addressing health literacy in children's weight management continues to be a multifaceted and ambitious mission. Future research should focus on integrating health literacy into weight management interventions in a systematic and theory-driven manner, ensuring that these interventions are tailored to the specific needs of children and their families and can sustain behavior change over time.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=478957, identifier: CRD42023478957.

Digital health literacy is emerging as an important element in chronic illness management, yet its relationship with clinical outcomes remains unclear. Utilizing data from the ongoing EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care trial, this cross-sectional, correlational study explored the association between digital health literacy, health literacy, and patient outcomes, specifically blood pressure and hemoglobin A1c levels in 76 patients managing comorbid type 2 diabetes and hypertension. Results indicate patients had moderate digital health literacy, which was not significantly correlated with health literacy (r = 0.16, P = .169). Both bivariate and covariate-adjusted regression models indicated that digital health literacy was not significantly associated with patient outcomes (all P > .05, small effects). These findings suggest that although patients from diverse sociodemographic backgrounds may possess the digital health literacy to engage with digital health tools, this alone may not improve clinical outcomes. Although digital health literacy may not be directly related to improved clinical outcomes, future research should explore how digital health tools can be optimized to enhance patient engagement and address complex challenges in diverse populations managing chronic conditions.

The health literacy of staff in preschool childcare institution is an important issue to consider in providing healthcare for children aged 3-6 years, which could contribute to reducing incidence of diseases and accidental injuries as well as maintaining children's good health. Seldom instruments have been designed to measure health literacy across this group. This research aims to develop a health literacy scale for staff in preschool childcare institutions and validate its psychometric properties.

The scale was developed through four phases. In Phase 1, an item pool was developed mainly based on literature review and kindergarten work; In Phase 2, the initial items were reviewed by fifteen experts and content validity analysis was conducted; In Phase 3, a pilot study was conducted involving 30 kindergarten staff, which aimed to further modify the scale; In Phase 4, a psychometric validation study involving 466 kindergarten staff was conducted through a cross-sectional survey in May 2023. Item analysis was performed through critical ration, correlation analysis, and Cronbach's alpha if item deleted. Construct validity was performed through exploratory (n = 190) and confirmatory factor analyses (n = 276). Convergent and discriminant validity were evaluated. Reliability was evaluated through internal consistency, split-half reliability, and test-retest reliability.

The final Health Literacy Scale consisted of 28 items, including dimensions of Basic Health Knowledge (11 items), Functional Health Literacy Skills (3 items), Communicative Health Literacy (5 items), and Critical Health Literacy (9 items). Principal component analysis revealed a four-factor structure that explained 80.092% of the total variance. The goodness-of-fit indices signified an adequate model fit (χ2/df = 2.093, RMSEA = 0.063, RMR = 0.031, GFI = 0.852, CFI = 0.958, NFI = 0.923, IFI = 0.958, TLI = 0.953, PCFI = 0.844). Cronbach's alpha showed a good internal consistency reaching a value of 0.921. The split-half reliability was 0.805, and the test-retest reliability was good with an intraclass correlation coefficient of 0.885 (P < 0.001).

The Health Literacy Scale developed in this research focuses on health literacy issues related to children aged 3-6 years. The scale is demonstrated to be valid and reliable for assessing the health literacy of staff in preschool childcare institutions. It could potentially be used as an effective instrument for targeted development of health literacy intervention.

The main objectives of our study are evaluating the health literacy level among women with gestational diabetes mellitus (GDM) in Southwest China and explore the influencing factors, using a multidimensional health literacy assessment scale (Chinese version of the HLS-14). Given that the HLS-14 has not been used in GDM previously, its reliability and validity testing was included as a secondary objective.

It was a cross-sectional survey with 565 GDM pregnancies. The Maternal and child health information access questionnaire, Chinese version of the HLS-14, Perceived Social Support Scale (PSSS) and General Self-efficacy Scale (GSES) was used to collect health information access behaviors, health literacy, social support and self-efficacy levels, respectively. SPSS 21.0 was used for descriptive statistical, multiple stepwise linear regression analysis and exploratory factor analysis (EFA). Amos 26.0 was used for confirmatory factor analysis (CFA).

The Chinese version of HLS-14 has good reliability and validity in GDM pregnancies. The Cronbach's α are 0.849, 0.866, 0.859, and 0.883, respectively. The exploratory factor analysis extracted three common factors with a cumulative variance contribution rate of 68.405%. The confirmatory factor analysis model fit was good (χ2/df = 2.595, RMSEA = 0.055, IFI = 0.970, TLI = 0.963, CFI = 0.970). The HL level in pregnancies with GDM was moderate with a mean score of 3.26 ± 0.41, of which 24.10% had limited HL, 41.87% had moderate HL, and 34.03% had adequate HL. Regression analysis showed that the women with higher family support (β = 0.298, p < 0.001), recording pregnancy management diary (β = 0.199, p < 0.001), higher the family income (β = 0.140, p < 0.001), lower pre-pregnancy BMI (β = -0.116, p = 0.004), longer time spent searching for health information (β = 0.111, p = 0.006), and searching for health information through a medical health information website (β = 0.093, p = 0.019) had higher HL levels. These variables explained 23.1% of the variance in HL.

The Chinese version of the HLS-14 has good applicability in the GDM pregnancies. The HL level of them is moderate, needs to be improved. Healthcare professionals should focus on the GDM population with low family income and high pre-pregnancy BMI, fully mobilize their social support system, provide reliable access to information, encourage all GDM pregnancies to use pregnancy management diaries to record their self-management behaviors, and ensure the effectiveness of health education.

The US Food and Drug Administration (FDA) is developing front-of-package nutrition labels for packaged foods. Identifying the most promising type of label among Latino adults could inform federal regulation, given high rates of diet-related disease in Latino populations. Additionally, exploring English-language label effects among populations with limited English proficiency could inform equitable label design. We examined whether text, icon, or graphic nutrition labels attract attention among Latino populations and whether label effects differed by English proficiency. In 2023, we recruited 63 adults in North Carolina identifying as Latino/a/é (hereinafter "Latino"); 48% had limited English proficiency. Participants viewed four labels on a can of soup in random order: a barcode label (control) and text, icon, and graphic labels reading, "WARNING: High in sodium." Eye trackers measured time spent viewing the label (dwell time), number of times viewing the label (fixation count), and time to first fixation on the label. A survey assessed secondary outcomes. Dwell time was highest for the graphic label (mean = 2.58 s (s)), followed by icon (mean = 2.34s), text (mean = 1.94s), and control labels (mean = .96s; p for each label vs. control <.001). The impact of label type on dwell time did not differ by English proficiency (p = .669). Fixation count was highest for the graphic label, followed by the icon, text, and control labels (p for each label vs. control <.001). Participants viewed the graphic and text labels more quickly than control (ps = .01). Self-reported attention, perceived message effectiveness, and understandability were higher for graphic, icon, and text labels than control (all p < .001 vs. control). This study suggests that front-of-package labels signaling that foods are high in nutrients of concern can attract consumers' attention, especially when the labels include images or icons.

The aim of this study was to evaluate health literacy in orthopedic shoulder and elbow patients.

This retrospective cross-sectional study included all new English-speaking adult patients presenting to two fellowship-trained shoulder and elbow surgeons from October 2020-July 2021. Patients who did not complete the Brief Health Literacy Screen Tool (BRIEF) were excluded, leaving 594 patients. Patient demographics and patient-reported outcome scores were also collected.

Average BRIEF score was 18.7 (range, 4-20), with limited health literacy (BRIEF <17) in 84 patients (14.1%). Patients with limited health literacy were significantly older (58 ± 18 vs. 54 ± 15 years, p = 0.03), less likely to be employed (34 [40%] vs. 332 [65%], p < 0.001), and less likely to have private insurance (35 [42%] vs. 330 [65%], p < 0.001). Average area deprivation index percentile was significantly higher (more deprivation) with limited (38 ± 20) compared to adequate health literacy (32 ± 21; p = 0.027). PROMIS physical (40.5 ± 8.5 vs. 45.5 ± 7.6, p = 0.001) and mental health scores (46.9 ± 10.5 vs. 51.0 ± 8.6, p = 0.015) and pain visual analog scale scores (5.3 ± 2.9 vs. 4.6 ± 2.7, p = 0.017) were significantly worse with limited health literacy.

Limited health literacy is present in shoulder and elbow patients and may affect patient-reported outcomes. Surgeons must recognize this in order to provide high-level equitable care.

Level III, retrospective cohort.

Caregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use.

This sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method.

The response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2 years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta.

Almost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.

Healthy People 2030 highlights the importance of both personal and organizational health literacy (HL) to improving population health. Yet, most research focuses on personal-level HL or fails to study the effect of both types of HL on health behavior. This study explored the relationships between organizational HL (Healthy People 2030 objective: decrease the proportion of adults who report poor communication with their health care provider), personal-level HL, and cancer prevention and screening behaviors. Data were collected using Qualtrics Panel. Participants who indicated they had a non-emergency room provider visit in the last 12 months were included in the analyses. Participants (n=549, Mean age = 41.44 years, SD = 15.91; 51.9% female; 54.3% White, 28.8% Hispanic/Latino/a/x) completed measures of personal and organizational HL and reported on their cancer prevention (e.g., cigarette smoking) and screening (e.g., mammogram) behaviors. Hierarchical linear and logistic regressions predicting cancer prevention and screening behaviors, respectively, from organizational HL, personal HL, and demographic covariates, were estimated. Regarding the results, higher organizational HL was related to higher fruit and vegetables consumption and physical activity after accounting for personal-level HL and demographic covariates. Higher personal-level HL was related to lower physical activity, binge-drinking, and cigarette smoking, and higher odds of pap smear screening, prostate-specific antigen testing, and completing all eligible screenings after accounting for organizational-level HL and demographic covariates. The findings support that personal-level and organizational HL may be differentially important to improving cancer prevention and screening behaviors. Policies that address improving both personal-level and organizational-level HL are needed.

Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups.

To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians.

Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024.

In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449).

The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity.

Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]).

A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity.

ClinicalTrials.gov Identifier: NCT04042467.

Health literacy assessment is key to better meeting family needs and developing informed strategies to promote positive health outcomes for children. The objective of this study was to describe the health literacy of caregivers who use Canadian pediatric emergency departments and relate it to demographic and visit-specific variables.

This study utilized a descriptive, cross-sectional survey design with medical record review. A bilingual survey was electronically administered to caregivers presenting to 10/15 Canadian pediatric emergency departments. Health literacy was assessed using the Newest Vital Sign tool.

1957 caregivers completed the Newest Vital Sign assessment. Caregivers' mean age was 37.8 ± 7.7 years, 74.3% (1449/1950) were mothers and 51.9% (993/1912) had a university/professional degree. 12.0% (235/1957) had a high likelihood of limited health literacy, 16.5% (323/1957) had possible limited health literacy and 71.5% (1399/1957) demonstrated adequate health literacy. Adequate health literacy scores were associated with having a university/professional degree [aOR 1.47 (95% CI 1.11-1.94)] and having a household annual income of over $25,000 [aOR 4.10 (2.66-6.31)]; they were inversely associated with having a total of 4 or more children [aOR 0.61 (0.40-0.91)] and having a main language at home other than English or French [aOR 0.32 (0.23-0.43)].

With over 1/4 caregivers facing health literacy challenges, health care providers in emergency departments must be cognizant of their communication and education approach when caring for families and providing at-home care guidance. Clinicians should consider applying health literacy principles to all family encounters to help address healthcare disparities.

To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL).

5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics.

The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants.

This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL.

Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.

Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non-text-based dietary intervention.

This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed.

We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls.

In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol.

Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases.

Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach's alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman's R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76-0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r =0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.

Occupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the Occupational Risk Factor Questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP.

Forward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach's alpha) and test-retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient-ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman's correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP.

Cross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity.

Prospective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ.

Health literacy is a critical health determinant, for which few computerized, self-administered assessments exist. This study adapted and tested the reliability of the Newest Vital Sign© (NVS) as a computerized, self-administered health literacy screener.

Phase one involved 33 participants to create response options for a computerized, self-administered NVS (C-NVS). Phase two was a randomized crossover trial to test the consistency of C-NVS and original, interviewer-administered NVS (I-NVS) scores in 89 participants.

Linear mixed-effects regression model results showed a significant carryover effect (p < .001). Crossover trial data from time 1 showed that participants who initially received the C-NVS had significantly higher average scores (M = 5.7, SD = 0.6) than participants who received the I-NVS (M = 4.5, SD = 1.5; t(87) = 5.25, p < .001). Exploratory analysis results showed that when the washout period was longer than 33 days (75th percentile) the carryover effect was not statistically significant (p = .077).

Findings suggest learning can occur when health literacy screeners are administered more than once in less than a month's time and computerized, self-administered health literacy screeners may produce ceiling effects. A universal precautions approach to health literacy therefore remains germane.

Little experimental research has evaluated whether the effects of cigarette package inserts with efficacy messages and/or pictorial health warning labels (PHWLs) differ across key subgroups of adults who smoke.

Adults who reported currently smoking (n = 367) were randomly assigned to one of four groups: Small text-only HWLs on pack sides (control); inserts with efficacy messages and small HWLs (inserts-only); PHWLs showing harms of smoking (PHWLs-only); both (inserts + PHWLs). Participants received a 14-day supply of cigarettes labeled to reflect their group. Every evening over 2 weeks, participants reported forgoing and stubbing out cigarettes before they finished smoking over the prior 24 hours, combined into a binary indicator of either behavior (eg, forgoing/stubbing). Separate mixed-effects logistic models were estimated to evaluate moderation of labeling group contrasts (ie, PHWLs vs not; inserts vs. not; inserts-only vs. inserts + PHWLs; PHWLs-only vs. inserts + PHWLs) by baseline covariates (self-efficacy to quit, intention to quit, education, health literacy, and time discounting), predicting day-level forgoing/stubbing.

Education moderated PHWL effects, with PHWLs predicting more forgoing/stubbing only among those with low education (OR = 4.68, p < .001). Time discounting moderated insert effects, with inserts promoting forgoing/stubbing only among those with low time discounting (ie, lower impulsivity; OR = 4.35, p < .001).

Inserts with efficacy messages appear effective mostly among people with low time discounting, whereas PHWLs appear most effective among those with low education, suggesting their potential to address education-related disparities. Labeling strategies appeared equally effective across subgroups defined by self-efficacy to quit, quit intention, and health literacy. Combining inserts with PHWLs did not appear to mitigate moderation effects.

This randomized trial with adults who smoke suggests that cigarette packs with inserts describing cessation benefits and tips can promote cessation-related behaviors (ie, forgoing or stubbing out cigarettes) among those with low-time discounting (ie, low impulsivity). Alternative interventions may be needed for people with high-time discounting, as found in cessation trials. PHWLs appear most effective among those with low education, potentially addressing education-related disparities. No differential effects were found for those with different levels of self-efficacy to quit, quit intentions, or health literacy. Combining inserts and PHWLs may not be more effective than either alone.