The association of acculturation and health literacy, numeracy and health-related skills in Spanish-speaking caregivers of young children

The Use of a Spanish-Translated PrEP Stigma Scale among the Latino Sample of the UNITE Cohort Study

Pre-Exposure Prophylaxis (PrEP) related stigma is linked to inadequate PrEP uptake, yet there are no validated scales to test this association among Spanish-speaking LSMM. The current study examined if the Spanish-translated PrEP Stigma Scale (PSS) was psychometrically appropriate for implementing in Spanish language dominant Latino/e/x Sexual Minority Men (SMM). Recruitment was conducted using geosocial networking applications, social media sites, and e-mail blasts (N=3,049). First, we utilized Item Response Theory (IRT) modeling to evaluate the reliability of the PSS items and the latent construct across both language groups (nEnglish = 2844 and nSpanish = 205). Subsequently, we applied the PSS scale in a theoretical application by examining its association with key steps in the PrEP uptake cascade (i.e., perceived PrEP candidacy, PrEP willingness, PrEP intentions, and having spoken to provider about PrEP) stratified by language. Results of the IRT analyses provided evidence that the translated version of the PSS was appropriate for use among this sample. Further, among English respondents, PrEP stigma was negatively associated with perceived PrEP candidacy (B=-0.30, p=<.001), PrEP willingness (B=-0.46, p=<.001), and PrEP intentions (B=-0.23, p=.003). PrEP stigma, among Spanish respondents, was not significantly associated with any of the PrEP cascade steps. This study demonstrated that the PSS scale performs adequately for both English and Spanish-speaking Latino SMM. However, researchers and health professionals alike should pay close attention to the nuanced effects in U.S. based English and Spanish language samples as PrEP stigma may impact the PrEP cascade for one language sample and not the other.

Socioeconomic and racial disparities in revisits, indication, and readmission or reoperation in pediatric tonsillectomy

INTRODUCTION

Pediatric tonsillectomy is a frequent otolaryngologic procedure. This study aimed to characterize disparities in post-tonsillectomy revisits, including emergency department evaluation, readmission, or reoperation as well as indication for revisit.

METHODS

Cases of inpatient and ambulatory pediatric tonsillectomy in New York and Florida in 2016 constituted the analytic sample. Patients were extracted from the State Ambulatory Surgery Databases (SASD) and State Inpatient Databases (SID) and linked to the SID and State Emergency Department Database (SEDD) and SASD. Outcomes include 3 types of revisits within 30 days: ED visits, hospital readmissions, and reoperation. Indication for revisit was also analyzed. Multivariable analysis determined the association of each outcome with gender, age, race/ethnicity, primary payer, urbanicity, and zip code median household income quartile. The Holm Bonferroni test was used to correct for multiple hypothesis testing.

RESULTS

15,264 pediatric tonsillectomies were included. The revisit rate was 6.77% (N = 1,034, 49.1% female; 6 years median age [interquartile range: 5]). The 30-day ED revisit rate was 4.85%, readmission rate was 1.27%, and reoperation rate was 0.65%. On multivariate analysis, Latinx patients (OR = 3.042, 95% CI = 1.393-6.803) and those who identify as other race/ethnicity (OR = 6.116, 95% CI = 1.989-19.245) have greater odds of requiring inpatient care for indications including pain, dehydration, nausea, and vomiting compared to white patients. No significant differences in tier of care for the management of post-tonsillectomy hemorrhage were identified.

CONCLUSION

Disparities in pediatric post-tonsillectomy ED presentation, readmission and reoperation demonstrate opportunities to improve patient safety and equity.

Social determinants of health literacy among parents and caregivers in the US-Affiliated Pacific

Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross-sectional study analyzed several SDOH indicators-acculturation, use of food assistance programs and demographic characteristics (race and ethnicity, household income, primary language spoken at home and educational attainment)-and their relationship to health literacy among 1305 parents/caregivers of young children ages 2-8 years old who participated in the Children's Healthy Living (CHL) program in Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawai'i. Significantly increased odds of low health literacy were found among parents/caregivers with households where a language other than English was the primary language compared to English-only households (OR = 1.86, 95% CI = 1.22, 2.82), household income of <$35 000 compared to ≥$35 000 (OR = 2.15, 95% CI = 1.13, 4.07), parents/caregivers of Asian children compared to parents/caregivers of White children (OR = 2.68, 95% CI = 1.05, 6.84), parent/caregivers with less than or some high school education compared to high school completion (1st- to 8th-grade OR = 4.46, 95% CI = 2.09, 9.52; 9th- to 11th-grade OR 1.87, 95% CI = 1.06, 3.30) and parent/caregivers with acculturation status defined as marginalized as compared to integrated (OR = 2.31, 95% CI = 1.09, 4.86). This study indicates that some USAP parents/caregivers may lack the capacity to acquire health information, utilize health resources, and navigate health decision making. Future efforts to understand and improve health literacy in the USAP should be population specific, thoroughly assess personal and organizational health literacy, and inventory community health care capacity.

Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =- 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review

Assessment of (digital) health literacy in the hospital can raise staff awareness and facilitate tailored communication, leading to improved health outcomes. Assessment tools should ideally address multiple domains of health literacy, fit to the complex hospital context and have a short administration time, to enable routine assessment. This review aims to create an overview of tools for measuring (digital) health literacy in hospitals. A search in Scopus, PubMed, WoS and CINAHL, following PRISMA guidelines, generated 7252 hits; 251 studies were included in which 44 assessment tools were used. Most tools (57%) were self-reported and 27% reported an administration time of <5 min. Almost all tools addressed the domain 'understanding' (98%), followed by 'access' (52%), 'apply' (50%), 'appraise' (32%), 'numeracy' (18%), and 'digital' (18%). Only four tools were frequently used: the Newest Vital Sign (NVS), the Short Test of Functional Health Literacy for Adults ((S)TOFHLA), the Brief Health Literacy Screener (BHLS), and the Health Literacy Questionnaire (HLQ). While the NVS and BHLS have a low administration time, they cover only two domains. HLQ covers the most domains: access, understanding, appraise, and apply. None of these four most frequently used tools measured digital skills. This review can guide health professionals in choosing an instrument that is feasible in their daily practice, and measures the required domains.

Evaluation of Ibuprofen Use on the Immune System Indicators and Force in Disabled Paralympic Powerlifters of Different Sport Levels

Background: Paralympic powerlifting (PP) training is typically intense and causes fatigue and alterations in the immune system. Objective: To analyze whether IBU would affect performance and the immune system after training in PP. Methodology: 10 athletes at the national level (NL) and 10 at the regional level (RL) participated in the study, where force and blood indicators were evaluated after training. The study took place over three weeks: (1) familiarization and (2 and 3) comparison between recovery methods, with ibuprofen or placebo (IBU vs. PLA), 800 mg. In the evaluation of the force, the peak torque (PT), fatigue index (FI), and blood immune system biomarkers were analyzed. The training consisted of five sets of five repetitions with 80% of one maximum repetition (5 × 5, 80% 1RM) on the bench press. Results: The PT at the national level using IBU was higher than with PLA (p = 0.007, η2p = 0.347), and the FI in the NL was lower with IBU than with PLA (p = 0.002, η2p = 0.635), and when comparing the use of IBU, the NL showed less fatigue than the regional level (p = 0.004, η2p = 0.414). Leukocytes, with the use of IBU in the NL group, were greater than in the RL (p = 0.001, η2p = 0.329). Neutrophils, in the NL with IBU, were greater than in the RL with IBU and PLA (p = 0.025, η2p = 0.444). Lymphocytes, in NL with IBU were lower than in RL with IBU and PLA (p = 0.001, η2p = 0.491). Monocytes, in the NL with IBU and PLA, were lower than in the RL with IBU (p = 0.049, η2p = 0.344). For hemoglobin, hematocrit, and erythrocyte, the NL with IBU and PLA were higher than the RL with IBU and PLA (p < 0.05). Ammonia, with the use of IBU in the NL, obtained values higher than in the RL (p = 0.007), and with the use of PLA, the NL was higher than the RL (p = 0.038, η2p = 0.570). Conclusion: The training level tends to influence the immune system and, combined with the use of the IBU, it tends to improve recovery and the immune system.

Pathways linking parental health literacy with health behaviours directed at the child: a scoping review

Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.

Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Health literacy has yet to be described in a non-clinical, racially diverse, community-based cohort.

METHODS

Four questions assessing health literacy were asked during annual phone encounters with Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2016 and 2018 (n = 3629). We used prevalence ratios (PRs) with 95% confidence intervals (CIs) to characterize how demographic and acculturation factors related to limited health literacy. Models adjusted for age, sex, and race/ethnicity, and race/ethnicity-stratified models were also examined.

RESULTS

Limited health literacy was prevalent in 15.4% of the sample. Participants who were older, female, lower-income, or less acculturated were at greater risk for having limited health literacy. Chinese, Hispanic, and Black participants were more likely than White participants to have limited health literacy. Patterns were similar when stratified by race/ethnicity.

DISCUSSION

Within MESA limited health literacy was common, particularly among Chinese and Hispanic participants, with some of the variance explained by differences in acculturation.

Assessment of Factors Associated With Parental Perceptions of Voluntary Decisions About Child Participation in Leukemia Clinical Trials

IMPORTANCE

Obtaining voluntary informed consent prior to enrollment in clinical trials is a fundamental ethical requirement.

OBJECTIVE

To assess whether health literacy, contextual factors, or sociodemographic characteristics are associated with perception of voluntariness among parents who had consented for their child's participation in a leukemia therapeutic clinical trial.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study prospectively enrolled 97 parents of children diagnosed as having leukemia at Rady Children's Hospital San Diego, a large tertiary academic center in California, from 2014 to 2017. Health literacy, contextual factors (acculturation, decisional regret, and satisfaction with informed consent), sociodemographic characteristics, and perception of voluntariness after consenting for a therapeutic clinical trial were measured. Univariable and multivariable regression were used to determine significant associations. The analyses for the present study were conducted from May 2019 to May 2020.

EXPOSURES

Informed consent for a therapeutic leukemia clinical trial.

MAIN OUTCOMES AND MEASURES

The primary outcome of interest was perception of voluntariness and its associations with health literacy and other contextual factors (acculturation, decisional regret, and satisfaction with informed consent) and sociodemographic characteristics, including age, race/ethnicity, parental language, educational level, insurance type, marital status, and socioeconomic status.

RESULTS

Of 97 parents included, the majority were women (65 [67%]), married (71 [73%]), and of self-reported Hispanic ethnicity (50 [52%]). Lower perception of voluntariness was significantly associated with lower health literacy (r = 0.30; 95% CI, 0.11-0.47; P = .004), Spanish language (x̅ = -4.50, P = .05), lower acculturation if of Hispanic ethnicity (r = 0.30; 95% CI, 0.02-0.54; P = .05), greater decisional regret (r = -0.54; 95% CI, -0.67 to -0.38; P < .001), and lower satisfaction with informed consent (r = 0.39; 95% CI, 0.21-0.54; P < .001) in univariable analysis. Lower health literacy remained significantly associated with lower perception of voluntariness in multivariable analysis after adjustment for contextual factors and sociodemographic characteristics (β = 4.06; 95% CI, 1.60-6.53; P = .001). Lower health literacy was significantly associated with Hispanic ethnicity (mean, 4.16; 95% CI, 3.75-4.57; P < .001), Spanish language spoken at home (mean, 3.17; 95% CI, 1.94-4.40; P < .001), high school or less educational level (mean, 3.41; 95% CI, 2.83-3.99; P < .001), public insurance (mean, 4.00; 95% CI, 3.55-4.45; P < .001), and unmarried status (mean, 3.71; 95% CI, 2.91-4.51; P = .03).

CONCLUSIONS AND RELEVANCE

Among parents of children with newly diagnosed leukemia who had consented for their child's participation in a therapeutic clinical trial, lower perception of voluntariness was significantly associated with lower health literacy. These results suggest that parents with low health literacy may perceive external influences in their decision for their child's participation in clinical trials. This finding highlights the potential role of recruitment interventions tailored to the participant's health literacy level to improve voluntary informed consent in underserved populations.

Acculturation and Health Literacy Among Chinese Speakers in the USA with Limited English Proficiency

BACKGROUND

Acculturation is an important factor that is uniquely associated with health literacy among racial/ethnic minorities. We examined the relationship between acculturation and health literacy among Chinese speakers in the USA who have limited English proficiency. Since language proficiency is an important subcomponent of acculturation, we also explored the relationship between English language proficiency and health literacy.

METHODS

Our sample included 405 participants. To evaluate the appropriateness of the acculturation instrument to elicit valid data, we performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We performed linear regressions to investigate the relationship between acculturation and health literacy.

RESULTS

Our acculturation instrument can be divided into three factors: English language proficiency, interactions with family and friends, and interactions with neighbors. The acculturation measurement model exhibited good fit. Higher US acculturation was associated with lower Chinese information appraisal, higher English functional health literacy, and higher English information appraisal. Higher English language proficiency was positively associated with English functional health literacy and English information appraisal. There was no relationship between English language proficiency and Chinese health literacy. Neither acculturation nor English language proficiency was associated with empowerment.

DISCUSSION

English language proficiency might play an important role in English functional health literacy and information appraisal. Developing and implementing English as a second language (ESL) curriculum in health promotion intervention programs can effectively improve English functional health literacy and information appraisal among populations with LEP.

Knowledge, Attitude, and Practice of Paracetamol and Ibuprofen Administration Among Caregivers of the Pediatric Age Group in Jeddah

Background

Fever is one of the most common pediatric conditions usually managed by parents and the cause of nearly all pediatrician visits. However, many parents find the management of childhood fever and febrile diseases challenging owing to a lack of understanding of the nature, effects, and therapies of fever management.

Objectives

This study aimed to assess the knowledge, attitude, and practice of paracetamol and ibuprofen administration among caregivers of the pediatric age group.

Design

Observational cross-sectional survey.

Setting

Jeddah, Saudi Arabia.

Materials and Methods

Data were collected between April 2018 and April 2019 using a pretested interviewer-administered questionnaire consisting of 40 questions.

Sample Size

Overall, 493 caregivers were interviewed.

Results

Paracetamol was reported as the most common antipyretic used by the caregivers (54%) to control fever. Ibuprofen was the least preferred drug (18.5%). The majority of the participants (51.7%) admitted administering antipyretics at a body temperature of 38-38.5°C. A total of 90.7% of the participants measured children’s temperature using a thermometer before administering antipyretics. Dosage was determined according to each child’s age (40.4%), weight (32%), or illness severity (27.6%). However, 36.7% and 51.5% of the participants were unsure of the correct dosage of paracetamol and ibuprofen, respectively. Regarding the maximum frequency of paracetamol use, only 3.7% of the participants answered correctly. Most parents (70.4%) believed that a paracetamol/ibuprofen prescription was not necessary. Overall, 97% of the sample demonstrated inadequate knowledge about antipyretic administration.

Conclusions

Most caregivers had inadequate knowledge regarding factors that influence paracetamol and ibuprofen dosage and frequency of administration. This low level of knowledge increases the risk of improper drug intake, which can result in serious side effects, thereby indicating the need for the development of educational route programs to provide parents with appropriate education and information on fever and fever management.

A discursive paper on the importance of health literacy among foreign domestic workers during outbreaks of communicable diseases

AIM

Using an integrated model of health literacy, we discuss the importance of health literacy among foreign domestic workers in the provision of informal caregiving during outbreaks of communicable diseases. COVID-19 pandemic is used as an example.

BACKGROUND

Adequate health literacy in the population is known to be important for the prevention of communicable diseases. Foreign domestic workers, a group of marginalised caregivers in private households, are generally presumed to have limited health literacy because of numerous socio-cultural disadvantages. To date, there is limited evidence that these informal healthcare providers receive support from community-based nurses.

DESIGN

A discursive paper.

CONCLUSION

Foreign domestic workers, with varying levels of health literacy, may be viewed either as a resource to break the chain of infection or as a potential reservoir of communicable diseases in the community. Meanwhile, restrictions imposed in response to diseases transmissions (e.g. stay-at-home measures for COVID-19) may directly exacerbate the social support received by these foreign domestic works and their ability to access health-related information. There are also concerns about their ability to appraise and evaluate information related to communicable diseases at a time when fake news and misinformation are being disseminated through social media. Language and cultural barriers are important issues that need to be addressed to ensure that foreign domestic workers are in a position to follow public health recommendations.

RELEVANCE TO CLINICAL PRACTICE

Nurses hold an important position in empowering foreign domestic workers with adequate health literacy, by engaging groups of foreign domestic workers in the community and their consulates in planning educational programmes and effectively disseminating information. At a time of global pandemic, an assessment of the health literacy levels of foreign domestic workers in places like Hong Kong is urgently required.

Predicting BMI in Young Children with Developmental Delay and Externalizing Problems: Links with Caregiver Depressive Symptoms and Acculturation

BACKGROUND

Caregiver depression is associated with increased risk for childhood obesity. However, studies assessing the relation between caregiver depression and childhood obesity have focused primarily on typically developing, school-aged children and have not examined the influence of cultural factors.

OBJECTIVES

To evaluate the association between caregiver depressive symptoms and body mass index (BMI) scores in young children with developmental delay (DD) and externalizing behavior problems, as well as the moderating role of acculturation and enculturation on this association.

METHODS

We examined the association between caregiver depressive symptoms and child BMI scores in 147 3-year-old children with DD and elevated levels of externalizing behavior problems. Caregivers of all participating children self-identified as coming from cultural minority backgrounds. We also examined the association between caregiver depressive symptoms and child BMI across levels of caregiver acculturation and enculturation.

RESULTS

Higher levels of caregiver depressive symptoms were associated with higher child BMI scores (b = .189, p = .001). Acculturation significantly moderated the association between caregiver depressive symptoms and child BMI scores (b = .21, p = .01), such that the association was stronger for more acculturated caregivers. Enculturation was not a significant moderator.

CONCLUSIONS

Caregiver depressive symptoms may confer elevated risk for child obesity when caregivers are highly acculturated to the United States, suggesting clinicians should consider levels of acculturation to optimize services for children and families from cultural minority backgrounds.

Feasibility of an Alzheimer's disease knowledge intervention in the Latino community

Background: Latinos experience disparities in Alzheimer's disease (AD) knowledge. The aim of this study was to explore the feasibility of a 45-minute culturally-tailored AD knowledge presentation for professionals serving the Latino community and Latinos served by Latino community organizations. Methods: One-session AD knowledge lunch-and-learn events were conducted with 40 professionals and 37 served Latinos. Participants received a pre-post survey including questions on satisfaction, a subjective AD knowledge question and a 14 item objective AD knowledge questionnaire. Results: Professionals (54.3%) and served Latinos (94.6%) reported the session as being very enjoyable and increased in objective AD knowledge (2.1 and 2.5 units, p < .001) and subjective knowledge (1.1 and 1.7 units; p < .001). Discussion: A brief in-person culturally-tailored session of AD education increases short-term AD knowledge and is perceived as interesting and useful among professionals serving the Latino community and Latinos served by Latino community organizations.

Acculturation and the oral health of a nationally representative sample of Hispanic children in the United States: an analysis of 2011-2012 National Survey of Children's Health data

BACKGROUND

Oral disease is a serious public health issue, and Hispanic children in the United States (US) are more likely than children of other racial/ethnic groups to experience dental caries. Although Hispanic children are a growing segment of the US population there is limited research on the association between acculturation and oral health outcomes in this population. This study examined the associations between household acculturation and pediatric oral health in the Hispanic population using a nationally representative sample of children.

METHODS

Data from the 2011-2012 National Survey of Children's Health were analyzed; analyses included Hispanic children ages 1 to 17. Household acculturation was assessed with a combination of language and parental nativity, while oral health was assessed via parents'/guardians' reports of children's dental caries. Logistic regression was used to examine the association between acculturation and oral health, adjusting for other demographic and social determinants of pediatric oral health. We assessed significance at the p < 0.05 level, and all analyses accounted for the survey's complex sample design.

RESULTS

Analyses included 9143 Hispanic children. In total, 24.9% (95% CI: 22.9-27.0%) experienced dental caries, and there were significant associations between household acculturation and oral health. In unadjusted analyses, 32.0% (95% CI: 28.9-35.4%) of children in low acculturation households, 20.3% (95% CI: 16.0-25.4%) of children in moderate acculturation households, and 16.9% (95% CI: 14.2-20.0%) of children in high acculturation households experienced dental caries (p < 0.001). In adjusted analyses, children in high acculturation households were significantly less likely than those in low acculturation households to experience dental caries (p < 0.001; OR = 0.50; 95% CI: 0.35-0.70). The difference between children in moderate and low acculturation households approached but did not reach statistical significance (p = 0.057; OR = 0.69; 95% CI: 0.48-1.01).

CONCLUSIONS

A dose-response relationship was observed between household acculturation and the oral health of Hispanic children in the US. As acculturation increases, the likelihood of a child experiencing dental caries decreases. These findings suggest that public health and community-based interventions intended to reduce oral health disparities in Hispanic children would likely be most impactful if the acculturation levels of the children's households are considered during program development.

The impact of caregiver health literacy on healthcare outcomes for low income minority children with asthma

Objectives: The aim of this exploratory study was to assess the impact of caregiver health literacy (HL) on health care outcomes for their child with asthma.Methods: Caregiver dyads across two different healthcare delivery systems completed a battery of validated asthma outcome instruments, including the Newest Vital Sign™ as a measure of HL for the caregivers of children ages 7-18 y. Utilization history was obtained through the electronic medical record. Descriptive analysis with bivariate associations was conducted.Results: There was no direct relationship between HL and asthma outcomes in the 34 Hispanic and African American caregiver-child dyads. However, caregiver health literacy was significantly related to language (p = 0.02). African American English-speaking caregivers, seen in an urban emergency department, demonstrated adequate health literacy. Hispanic Spanish-speaking caregivers, seeking care in a mobile asthma van, showed limited health literacy. There was no significant association between caregivers' HL and routine asthma care visits when language and child age were controlled.Conclusions: Assessing patient factors can identify persons at risk who need additional support to negotiate the healthcare system when providing care for a child with asthma.

Associations of Acculturation with English- and Spanish-Language Health Literacy Among Bilingual Latino Adults

Background:

Low health literacy (HL) is associated with poor health status and outcomes. Racial/ethnic minorities in the United States disproportionately experience low HL and HL-related health disparities. Among Latinos, acculturation is associated with health outcomes, but little is known about the relationship between acculturation and HL.

Objective:

We examined associations of sociodemographic and acculturation variables with English- and Spanish-language HL among 142 bilingual Latino adults with adequate HL.

Methods:

HL was assessed in English using the Rapid Estimate of Adult Literacy in Medicine (REALM) and in Spanish with the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). Acculturation was assessed using the four subscales of the Multidimensional Acculturation Scale-II. Associations of sociodemographic data and acculturation with HL were examined using linear regression.

Key Results:

Higher education, higher income, higher English proficiency, and lower Latino cultural identification predicted REALM scores (ps <.05) in univariate models. When these variables were entered into a single model, only education and Latino cultural identification were associated with REALM scores. In univariate analyses, the following characteristics were associated with SAHLSA scores: female gender, being partnered, higher education, higher income, being non-US born, lower English proficiency, and higher Spanish proficiency (ps < .05). Education, being non-US born, English proficiency, and Spanish proficiency were each significant in the multivariate model.

Conclusions:

Results revealed a significant association between acculturation and English- and Spanish-language HL among bilingual Latino adults with adequate HL, suggesting that HL should be assessed in the language in which individuals are most proficient. HL assessed in a nonprimary language may be confounded with language proficiency. [HLRP: Health Literacy Research and Practice. 2019;3(2):e81–e89.]

Plain Language Summary:

The results of this investigation revealed a significant association between acculturation and English- and Spanish-language health literacy among bilingual Latino adults. This suggests that health literacy should be assessed in the language in which individuals are most proficient. Health literacy assessed in a nonprimary language may be influenced by language proficiency.

A Preliminary Study of Health Literacy in an Ethnically Diverse University Sample

There is a considerable body of research on health literacy in adult healthcare settings, mostly among at-risk clinical populations. However, much less is known about health literacy among youth transitioning to adulthood, including college students. Despite the protective effects of higher levels of education, some college students might have other risk factors for low health literacy (i.e., minority status). Hence, the purpose of the present study was to explore health literacy in an ethnically diverse public urban university. Although a majority of the students performed within the adequate range, we observed a subset of Hispanic and foreign students with lower health literacy, particularly in the domain of numeracy. Our preliminary results suggest that, contrary to common belief, there exists a vulnerable subpopulation of college students that have difficulty understanding and using health-related information. Health professionals should be alert to possible low health literacy among college students that may interfere with communication of vital health-related information and decision-making.

Ethnic newspapers and low-income Spanish-speaking adults: influence of news consumption and health motivation on cancer prevention behaviors

OBJECTIVE

Ethnic newspapers have the potential to reach and influence various cultural and ethnic subpopulations traditionally underserved in the United States. The current study sought to explore how ethnic news consumption interacts with health motivation to predict cancer prevention behaviors in a sample of Spanish-speaking adults.

DESIGN

Participants (N = 100) completed a survey in Spanish, with items measuring demographics, acculturation, health literacy, health motivation, ethnic newspaper consumption (for two papers: La Viva and La Raza), and cancer prevention behaviors.

RESULTS

Results indicated consumption of ethnic newspapers correlated positively to acculturation, and cancer screening utilization. In hierarchical regression analyses, the interaction of consumption of an ethnic newspaper (La Raza) and health motivation predicted two of the six prevention behaviors assessed: avoidance of fatty foods and screening behavior.

CONCLUSION

The study provides evidence that consumption of Spanish-language newspapers enhances the likelihood that individuals with high levels of health motivation will engage in healthy behaviors. This finding highlights the utility of utilizing Spanish-language newspapers to reach underserved populations.

The Impact of Maternal Self-Efficacy and Oral Health Beliefs on Early Childhood Caries in Latino Children

OBJECTIVES

Latino children experience one of the highest rates of early childhood caries requiring interventions based on valid conceptual frameworks. The Health Belief Model has relevance as a predictor of compliance with health recommendations based on perceptions of a health condition and behaviors to avoid the condition. The model encompasses four perceptual constructs (susceptibility, severity, benefits, barriers) and, for complex conditions, includes self-efficacy as an extended model. This study evaluated individual (self-efficacy and health beliefs) and cultural (acculturation status) level factors and the inter-relationship to determine if items assessed for the Extended Health Belief Model (EHBM) were valid measures of maternal factors.

METHODS

A cross-sectional study was conducted with 100 mother-child dyads at the Dental Center of Children's Hospital Colorado, Aurora, CO, USA. Participating mothers completed a survey in English or Spanish with items from the Basic Research Factors Questionnaire encompassing sociodemographic characteristics, oral health knowledge and behavior, and psychosocial measures including the EHBM. Language preference was a proxy for maternal acculturation. Children were examined to measure decayed, missing, and filled tooth surfaces. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of the EHBM subscales with oral health-related measures and language preference.

RESULTS

The benefits and self-efficacy scales reflected good reliability. Maternal education was the strongest predictor of health beliefs with significant associations for barriers, benefits, and susceptibility. Perceived benefits increased with each additional year in the household. There was a significant association between maternal oral health knowledge and higher perceived benefits and increased self-efficacy, and the same was found for higher knowledge of dental utilization which was also associated with children perceived as having increased susceptibility to early childhood caries. Less acculturated participants perceived more barriers to behavioral adherence and fewer barriers as knowledge increased. As dental utilization knowledge improved for Spanish-speaking participants, they perceived greater benefits from adherent oral health behavior compared to English-speaking participants.

CONCLUSION

Items assessed for the EHBM were valid as measures of maternal factors influencing children's oral health outcomes in a Latino population.

Does acculturation narrow the health literacy gap between immigrants and non-immigrants-An explorative study

OBJECTIVES

To compare functional health literacy (HL) levels in three immigrant groups to those of the German- and Italian-speaking non-immigrant population in Switzerland. Moreover, to investigate whether language-independent, respectively language-dependent, functional HL and variables of acculturation were associated with self-reported health status among immigrants.

METHODS

Language-independent HL was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) in the respective native languages. Language-dependent HL was measured using Brief Health Literacy Screeners (BHLS) asking about participants' confidence in understanding medical information in the language of the host country. Measures of acculturation included length of stay and age when taking residency in Switzerland.

RESULTS

In particular Albanian- and Portuguese-speaking immigrants had lower levels of functional HL. In unadjusted analysis "age when taking residency in Switzerland" was associated with the BHLS. Adjusted analysis showed that the BHLS were significantly associated with self-reported health among all immigrant groups (p≤0.01).

CONCLUSIONS

Functional HL that is dependent on understanding of medical information in the language of the new host country is a better predictor for self-reported health status among immigrants than language-independent HL.

PRACTICE IMPLICATIONS

In the clinical setting limited functional HL might be a significant obstacle to successful disease treatment and prevention in immigrants.

Assessing the Nutrition Literacy of Parents and Its Relationship With Child Diet Quality

OBJECTIVE

To estimate the reliability and validity of the Nutrition Literacy Assessment Instrument for Parents (NLit-P) and to investigate relationships among parental nutrition literacy, parental and child body mass index, and child diet quality (Healthy Eating Index).

METHODS

Cross-sectional study of 101 parent-child dyads that collected measures of socioeconomic status, nutrition literacy, 2 24-hour child diet recalls, and body mass index. Reliability of NLit-P was assessed by confirmatory factor analysis. Pearson correlation and multiple linear regression were used.

RESULTS

Fair to substantial reliability was seen across 5 NLit-P domains, whereas Pearson correlations support concurrent validity for the NLit-P related to child diet quality and parental income, age, and educational attainment (P < .001). For every 1% increase in NLit-P, there was a 0.51 increase in child Healthy Eating Index (multivariate coefficient, 0.174; P < .001).

CONCLUSIONS AND IMPLICATIONS

The NLit-P demonstrates potential for measuring parental nutrition literacy, which may be an important educational target for improving child diet quality.

Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study

BACKGROUND

It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations.

METHODS

This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits.

RESULTS

Despite the high (70%; 99% confidence interval [CI], 57%-82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, 20%-45%) of the children received 0 to 1 dose of analgesia. Overall, 21% children (99% CI, 11%-35%) received 4 or less total doses of pain medication over the entire week after surgery. Of the total analgesic doses administered to children in the week after surgery, only 44% (99% CI, 40%-47%) were in accepted ranges.

CONCLUSIONS

Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home.

Addressing issues of vaccination literacy and psychological empowerment in the measles-mumps-rubella (MMR) vaccination decision-making: a qualitative study

Background

Whether or not to vaccinate one’s child is one of the first health-related decisions parents have to make after their child’s birth. For the past 20 years, the share of parents choosing not to immunize their children has increased in many countries, for various reasons. Among these, rumors affirming that vaccinations contain dangerous chemicals or might trigger severe chronic diseases have negatively affected parental attitudes towards pediatric immunizations, particularly the vaccination against measles, mumps and rubella (MMR), raising a number of public health concerns. The primary aim of this qualitative study is to understand what drives parents’ decision, giving special attention to vaccination literacy and psychological empowerment in such a context.

Methods

Twenty individual semi-structured interviews were conducted in the Canton of Ticino (Switzerland) between January and June 2014. Participants were either mothers or fathers of children less than 1 year old living in Switzerland. An inductive thematic analysis was performed to identify the main themes with regard to vaccination literacy and psychological empowerment in the MMR vaccination decision-making.

Results

Parents’ reports yielded four main themes: (a) the paradox of the free choice, referring to the misinterpretation of current vaccination policies; (b) giving up the power, pointing at the outcomes of a low perceived competence; (c) a far-reaching decision, reflecting the importance attributed to the MMR choice and the different levels of impact the decision can have; (d) the demand for shared-decision making, referring to the parental needs in relation to the child’s healthcare provider.

Conclusion

Understanding what drives parents’ management of their children’s immunization schedule in terms of vaccination literacy and psychological empowerment can help health professionals to communicate more effectively with parents in order to facilitate an informed decision, and stakeholders to design tailored health education programs and materials. This can ultimately help increase the coverage of the MMR vaccination.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2200-9) contains supplementary material, which is available to authorized users.

The relationship between acculturation and infant feeding styles in a Latino population

OBJECTIVE

To assess the relationship between parental acculturation and infant feeding style in a sample of Latino parents.

METHODS

A post hoc analysis was performed using data from an ongoing four-site randomized controlled trial to promote early childhood obesity prevention. Cross-sectional data of parent-child dyads at the 12-month well-child visit who self-reported their Latino ethnicity were analyzed. The Short Acculturation Scale for Hispanics (SASH) and a subset of the Infant Feeding Style Questionnaire (IFSQ) that assessed four primary feeding styles were administered. SASH level (low vs. high) with each feeding style was compared by analyses.

RESULTS

Complete SASH data were available for 398 of 431 Latino dyads. Median SASH score was 1.8 (IQR 1.4-2.7); 82% of participants had low acculturation (score < 3). Of the nine outcome variables, four were significantly associated with SASH: "Laissez-Faire/attention" (AOR: 2.3; 95% CI: 1.06-5.13; P = 0.004), "Laissez-Faire/diet quality" (AOR: 3.9; 95% CI: 1.7-8.75; P = 0.005), "Pressuring as soothing" (AOR: 3.6; 95% CI:1.63-8.05; P = 0.007), and "Restrictive/diet quality" (AOR: 0.4; 95% CI: 0.19-0.94; P = 0.031).

CONCLUSIONS

Latino parents with lower acculturation were more likely than those with higher acculturation to endorse feeding styles that are associated with child obesity. Further research is needed to determine why acculturation and feeding style relate.

Moderating Effects of Health Literacy on Change in Physical Activity Among Latinas in a Randomized Trial

INTRODUCTION

Latinas report low rates of physical activity (PA) and are at risk for poor health outcomes. Language and literacy barriers impede access and utilization of PA-related resources. This study examined health literacy as a moderator on changes in moderate-to-vigorous physical activity (MVPA) in 196 Latinas enrolled in Seamos Saludables, a randomized-controlled trial of a 6-month culturally and linguistically adapted PA print intervention

METHODS

Secondary analyses were conducted on demographics, acculturation and generation status, and health literacy (Newest Vital Sign). MVPA was determined by 7 day physical activity recall, assessed at baseline and 6 months. General linear models examined interaction effects between health literacy (HL), experimental condition (treatment vs. control), and generation status.

RESULTS

Health literacy moderated change in MVPA from baseline to 6 months. The intervention effect was greater among first-generation Latinas with limited health literacy.

DISCUSSION

Differences in health literacy level appear to influence MVPA outcomes. Formative research is recommended to ensure that materials are appropriate when developing print-based PA interventions, particularly among first-generation Latinas who are more likely to have limited health literacy.

Strategic roles for health communication in combination HIV prevention and care programs

This special issue of JAIDS: Journal of Acquired Immune Deficiency Syndromes is devoted to health communication and its role in and impact on HIV prevention and care. The authors in this special issue have tackled a wide swath of topics, seeking to introduce a wider biomedical audience to core health communication principles, strategies, and evidence of effectiveness. Better awareness of health communication strategies and concepts can enable the broader biomedical community to partner with health communication experts in reducing the risk of HIV, sexually transmitted infections, and tuberculosis and maximize linkage and adherence to care. Interventions can be strengthened when biomedical and health communication approaches are combined in strategic and evidence-based ways. Several of the articles in this special issue present the current evidence for health communication's impact. These articles show how far we have come and yet how much further we have to go to document impact convincingly. Examples of the biomedical approaches to HIV control include treatment as prevention, voluntary medical male circumcision, preexposure prophylaxis, sterile needle exchange, opiate substitution therapy, and prevention of mother-to-child transmission. None will succeed without behavior change, which can be facilitated by effective health communication.

Health literacy and injury prevention behaviors among caregivers of infants

BACKGROUND

Unintentional injury is a leading cause of infant mortality.

PURPOSE

To examine the role of caregiver health literacy in infant injury prevention behaviors.

METHODS

A cross-sectional analysis of data collected in 2010-2012 from a randomized trial at four pediatric clinics was performed in 2012-2013. Caregiver health literacy was assessed with the Short Test of Functional Health Literacy in Adults. Caregiver-reported adherence to American Academy of Pediatrics-recommended injury prevention behaviors was assessed across seven domains: (1) car seat position; (2) car seat use; (3) sleeping safety; (4) fire safety; (5) hot water safety; (6) fall prevention; and (7) firearm safety.

RESULTS

Data were analyzed from 844 English- and Spanish-speaking caregivers of 2-month-old children. Many caregivers were non-adherent with injury prevention guidelines, regardless of health literacy. Notably, 42.6% inappropriately placed their children in the prone position to sleep, and 88.6% did not have their hot water heater set <120°F. Eleven percent of caregivers were categorized as having low health literacy. Low caregiver health literacy, compared to adequate health literacy, was significantly associated with increased odds of caregiver non-adherence with recommended behaviors for car seat position (AOR=3.4, 95% CI=1.6, 7.1) and fire safety (AOR=2.0, 95% CI=1.02, 4.1) recommendations. Caregivers with low health literacy were less likely to be non-adherent to fall prevention recommendations (AOR=0.5, 95% CI=0.2, 0.9).

CONCLUSIONS

Non-adherence to injury prevention guidelines was common. Low caregiver health literacy was significantly associated with some injury prevention behaviors. Future interventions should consider the role of health literacy in promoting injury prevention.

A health literate approach to the prevention of childhood overweight and obesity

OBJECTIVE

To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population.

METHODS

Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population.

RESULTS

12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63 ± 0.76, and Fry graph 6.0 ± 0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change.

CONCLUSION

The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity.

PRACTICE IMPLICATIONS

Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.

The impact of limited English proficiency on asthma action plan use

OBJECTIVE

The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers.

METHODS

A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than "very well". Data were analyzed using Fisher's exact test and odds ratios (OR).

RESULTS

One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p = .01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3-6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7-7.0]), age of child >7 years (OR 1.0 [95% CI 0.5-2.4]), caregiver education  ≥  associate degree (OR 1.4 [95% CI 0.6-3.0]), private insurance (OR 0.7 [95% CI 0.3-1.8]), White race (OR 0.7 [95% CI 0.2-2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2-1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3-2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child's asthma as mild/well controlled.

CONCLUSION

Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.