Health Literacy Interventions in Cancer: a Systematic Review

Health literacy & Chagas disease knowledge: A cross-sectional study in Southern Loja Province, Ecuador

Objective

Health literacy is associated with many patient outcomes. This study sought to determine the association between a person's level of health literacy and their knowledge about Chagas disease.

Methods

A cross-sectional survey was conducted with people living in two counties in rural Loja Province, Ecuador who attended a mobile health clinic. The communities in which the study was conducted are at high risk of Chagas disease and have limited access to both health care and educational resources. The Spanish version of Short Assessment for Health Literacy measured health literacy. The Chagas Disease Knowledge questionnaire measured knowledge of Chagas disease. T-tests and correlational analysis were used to assess associations.

Results

Overall 85 people participated in this study. A majority of the respondents were female (64.1%), and a plurality were married (40.7%) and had education less than secondary (40.7%). The average age of the sample was 44.31 ± 18.85. Health literacy levels and Chagas disease knowledge in the communities were low. About half of people had inadequate health literacy. No association between health literacy and Chagas knowledge was found.

Conclusion

Health literacy levels and Chagas disease knowledge were not found to be correlated. Explanations for the lack of association may include common causes of inadequate investment in Chagas disease education as well as neglect of health systems in rural Ecuador. Efforts to improve both health literacy and Chagas disease knowledge in poorer, rural areas of Ecuador are needed.

Innovation

This is the first study to assess relationships between health literacy and knowledge of Chagas disease in an uninfected population. For novel conditions, relationships between health literacy and disease knowledge should be investigated before communication campaigns are adapted.

Personal and organisational health literacy in the non-specific symptom pathway for cancer: An ethnographic study

INTRODUCTION

People being investigated for cancer face a wealth of complex information. Non-specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner 'gut feeling', who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways.

METHODS

This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowing and clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy.

RESULTS

Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge.

CONCLUSION

We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help-seeking post-discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtesting or inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors.

PATIENT OR PUBLIC CONTRIBUTION

Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.-A. M.) was involved in data analysis and writing the manuscript.

Cancer: A model topic for misinformation researchers

Although cancer might seem like a niche subject, we argue that it is a model topic for misinformation researchers, and an ideal area of application given its importance for society. We first discuss the prevalence of cancer misinformation online and how it has the potential to cause harm. We next examine the financial incentives for those who profit from disinformation dissemination, how people with cancer are a uniquely vulnerable population, and why trust in science and medical professionals is particularly relevant to this topic. We finally discuss how belief in cancer misinformation has clear objective consequences and can be measured with treatment adherence and health outcomes such as mortality. In sum, cancer misinformation could assist the characterization of misinformation beliefs and be used to develop tools to combat misinformation in general.

Associations of social vulnerability with truncal and extremity melanomas in the United States

BACKGROUND

Prior studies in social determinants (SDoH) of truncal-extremity melanomas (TEM) have analyzed race, income, and environmental factors relative to their effect on health disparities. However, they are limited by the narrow scopes of SDoH and study population, while lacking analyses of interrelational contribution of SDoH on TEM disparities.

METHODS

This retrospective cohort study of adult TEM patients (1975-2017) assessed linear regression trends in months of survival, as well as logistic regression trends in advanced presenting stage, surgery, and chemotherapy receipt across TEM subtypes with increasing overall social vulnerability and vulnerability in 15 SDoH variables grouped into socioeconomic status (SES), minority-language status (ML), household composition (HH), and housing-transportation (HT) themes measured by the SVI. SVI measures are ranked/compared across all US counties for relative vulnerability in a specific SDH and their total composite while accounting for sociodemographic-regional differences.

RESULTS

Across 325 760 TEM patients, increasing overall social vulnerability demonstrated significant decreases in the survival period for 7/13 TEM histology types (p < 0.001), with relative decreases in the survival period as high as 44.0% (67.0-37.5 months) for epithelioid cell. SES and HH were the highest-magnitude contributors to these overall trends. For many patients with TEM, increased odds of advanced presenting stage (highest with acral-lentiginous: odds ratio [OR], -1.18; 95% confidence interval [CI], 1.02-1.36), decreased odds of indicated surgery receipt (lowest with amelanotic, 0.79; 0.71-0.87), and increased odds of indicated chemotherapy (highest with melanoma in giant nevi: 1.50; 1.01-2.44) were observed; SES and ML followed by HH and HT contributed to these trends.

CONCLUSIONS

There were detriments in TEM care & prognosis in the United States with increasing social vulnerability. Identifying which SDH quantifiably are associated more with disparities in interrelational, real-world contexts is important to provide nuance to inform future research and initiatives to address TEM disparity.

Health literacy interventions for informal caregivers: systematic review

AIM

The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.

METHODS

MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool.

RESULTS

Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL.

DISCUSSION

Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.

Interventions to improve oncofertility knowledge and decision-making in patients with low health literacy: A systematic review

OBJECTIVE

To conduct a systematic review of interventions that improve knowledge, health and decision-related outcomes in cancer, fertility or the intersection of both among low health literacy (LHL) patients.

METHODS

Articles published from 2000 to March 2022 in English were identified through searching MEDLINE, PsycInfo, and Embase databases on 29/03/2022. Studies were independently screened against eligibility criteria and appraised for quality. A narrative synthesis of data was presented.

RESULTS

Of 235 citations, 11 studies (2585 participants) investigating three categories were included: decision-support tools (n = 8), mobile health applications (n = 2) and communication tools (n = 1). No eligible study was identified for fertility or oncofertility. All interventions integrated multimedia or interactivity to supplement plain-language text. Decision aids and mobile health applications improved knowledge, reduced decisional conflict and increased clarity around cancer-related choices. Overall, findings favoured the use of online interventions tailored for LHL patients.

CONCLUSION

There is a lack of data on LHL interventions in fertility and oncofertility. In cancer, LHL interventions improved knowledge and decision-making outcomes. The ideal intervention remains inconclusive.

PRACTICE IMPLICATIONS

Lack of engagement with LHL needs in oncofertility and fertility settings have implications for informed treatment decision-making. In cancer, further research is required to ascertain most effective intervention format.

Disparities in Cancer Incidence across Income Levels in South Korea

BACKGROUND

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea.

METHODS

This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis.

RESULTS

The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q.

CONCLUSIONS

Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.

Health literacy and breast cancer screening adherence: results from the population of Tuscany, Italy

Mammographic screening can reduce breast cancer (BC) mortality in women. In Italy, although attendance rates increased recently, they are still far from the recommended levels internationally. Inadequate health literacy (HL) may be a reason for poor awareness and/or knowledge about the importance of completing cancer screening. This study examined the relationship between HL, other sociodemographic determinants, and their influence on participation in both opportunistic and organized BC screenings among women aged 50-69 in Tuscany. The study analyzed 2017-2019 data from the Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia). HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Among the 2250 interviewees, 75.3% underwent the organized BC screening and 9.4% on voluntary basis. Although to a different extent, HL was significantly associated to compliance rates with both opportunistic and organized screenings. Among sociodemographic factors, only occupational status was associated with opportunistic screening attendance rates. As expected, being invited by letter resulted to be strongly associated with participation to organized screening programs and the medical advice predicts for participating to both opportunistic and organized screening. This study highlights the relevant role that HL plays in BC, opportunistic and organized, screening adherence in a universal healthcare system. To increase BC screening participation rates, healthcare systems would benefit by implementing interventions for improved HL at population level or within healthcare organizations.

Patients' Individualized Care Perceptions and Health Literacy Using an Interactive App During Breast and Prostate Cancer Treatment: Two Parallel Randomized Controlled Trials

The use of symptom management mobile apps can reduce patients' symptom burden during cancer treatment, but the evidence is lacking about their effect on care. Moreover, if patients' health literacy can be improved, it needs to be more rigorously tested. This study aimed to evaluate patients' perceptions of individualized care and health literacy using an interactive app in two randomized trials. Patients undergoing neoadjuvant chemotherapy for breast cancer (N = 149) and radiotherapy for prostate cancer (N = 150) were consecutively included and randomized into one intervention or control group. Outcome measures were Individualized Care Scale, Swedish Functional Health Literacy Scale, and Swedish Communicative and Critical Health Literacy Scale. In the breast cancer trial, no group differences were observed regarding individualized care or health literacy. Most patients had sufficient health literacy levels. In the prostate cancer trial, intervention group patients rated higher perceived individualized care regarding decision control at follow-up than the control group. Less than half had sufficient health literacy levels and intervention group patients significantly improved their ability to seek, understand, and communicate health information. Education level explained significant variance in health literacy in both trials. Using an interactive app can positively affect individualization in care and health literacy skills among patients treated for prostate cancer, although further research is warranted.

Biomarker testing communication, familiarity, and informational needs among people living with breast, colorectal, and lung cancer

OBJECTIVES

This study aims to characterize patient experiences with biomarker testing, including history of biomarker testing, related communication and education, self-perceived familiarity and informational needs.

METHODS

436 U.S. adults diagnosed with lung (38%), colorectal (35%) or breast cancer (27%) from 2018 to 2022 completed a survey. Two logistic regressions were conducted to predict patients' familiarity with biomarker testing and informational needs.

RESULTS

Despite high biomarker testing rates (85%), half of respondents reported low familiarity with biomarker testing and three-quarters reported outstanding informational needs. Regression models indicate those patients who have greater health literacy and report having conversations with their oncologists about biomarker testing have more familiarity with biomarker testing and less informational needs, even after controlling for important sociodemographic factors.

CONCLUSIONS

There is an opportunity to improve patients' familiarity with biomarker testing and decrease outstanding informational needs by focusing on factors such as health literacy and patient-provider communication, which could further cultivate patients' understanding of the importance of biomarker testing in cancer care.

PRACTICE IMPLICATIONS

These findings underscore the importance of patient-provider relationships and the need for additional tools that assist providers in assessing patients' health literacy and facilitating conversations with patients, especially those focused on complex topics such as biomarker testing.

Health literacy interventions among patients with chronic diseases: A meta-analysis of randomized controlled trials

OBJECTIVES

This study was conducted to determine the effectiveness and impact of health literacy interventions for patients with chronic diseases.

METHODS

We searched PubMed, Web of Science, Embase, Scopus, and EBSCO CINAHL from inception through March 2022. Eligible chronic diseases include diabetes, heart disease, cancer, and chronic obstructive pulmonary disease. RCTs were included in eligible studies to assess health literacy and other relevant health outcomes. Two investigators selected studies, extracted data, and assessed the methodological quality of included studies independently.

RESULTS

A total of 18 studies involving 5384 participants were included in the final analysis. The implementation of health literacy interventions exhibited a significant improvement in the health literacy level of individuals diagnosed with chronic diseases (SMD = 0.75, 95% CI = 0.40-1.10). Analysis of heterogeneity sources indicated statistically significant variations in the effects of interventions across different diseases and age groups (P < 0.05). However, no significant impact was observed on patients with chronic obstructive pulmonary disease (COPD), interventions with a follow-up duration exceeding three months, or application-based interventions on the health literacy level of individuals with chronic diseases. Remarkably, our findings revealed that health literacy interventions exerted a positive influence on health status (SMD = 0.74, 95% CI = 0.13-1.34), depression and anxiety (SMD = 0.90, 95% CI = 0.17-1.63), as well as self-efficacy (SMD = 0.28, 95% CI = 0.15-0.41) among patients diagnosed with chronic diseases. Furthermore, a specific analysis was conducted to evaluate the effects of these interventions on hypertension and diabetes control. The results demonstrated that health literacy interventions were more effective in enhancing hypertension control compared to diabetes control.

CONCLUSION

Health literacy interventions have demonstrated effectiveness in improving the health of patients with chronic diseases. The importance of emphasizing the quality of these interventions cannot be overstated, as factors such as appropriate intervention tools, extended intervention duration, and reliable primary care services play crucial roles in their efficacy.

From Awareness to Action: A Review of Efforts to Reduce Disparities in Breast Cancer Screening

Breast cancer is a significant public health concern, and addressing disparities in breast cancer screening is crucial for improving early detection and reducing mortality rates. This review article examines efforts to bridge the gap between awareness and action in reducing disparities in breast cancer screening. A systematic approach was employed to gather relevant literature using various databases. The selected studies encompassed a range of interventions, including policy changes, community-based programs, culturally competent interventions, technological advancements, and patient navigation. The review highlights the importance of policies and legislation in improving access to screening services and the impact of community-based initiatives in addressing disparities. Culturally competent interventions, tailored messaging, and language support were found to be effective in improving screening rates among diverse populations. Technological advancements, such as telemedicine and mobile health applications, were identified as promising approaches to increase access to screening services. Patient navigation programs effectively addressed barriers to screening and improved screening rates. The review also discusses evaluating efforts, limitations, and the need for continuous improvement. Future directions and recommendations include addressing gaps in the existing literature, proposing research directions, and providing recommendations for policymakers, healthcare providers, and researchers. By implementing these recommendations and working collaboratively, we can strive for equitable access to breast cancer screening for all populations, ultimately leading to improved outcomes and reduced disparities.

Cancer literacy among Jordanian colorectal cancer survivors and informal carers: Qualitative explorations

Introduction

Cancer patients face a variety of challenges in understanding their diagnosis and treatment options. Making informed decisions requires health literacy. There is scant research on how colorectal cancer (CRC) survivors and their caregivers engage with healthcare systems and obtain cancer-related knowledge to maintain proper health literacy, which is crucial for enhancing their outcomes.

Materials and methods

In-depth semi-structured interviews (IDIs) with CRC survivors (n = 15) and online focus groups (FG) with informal caregivers (ICs) were held in Amman between Jan-June 2020. In-depth interviews were conducted using semi-structured interview protocol that addressed the healthcare experience of CRC cancer survivors. FGs evaluated ICs' perspectives of e-health for cancer care support. IDIs and FGs were done in the local Jordanian Arabic dialect, which was then translated into English. Transcribed audio-recordings were thematically coded and framework analysis was used.

Results

The findings are organized around a central concept of “exploring the level of literacy and its impact.” From the overarching theme, three themes and subthemes emerged, including: (1) The current state of counseling and information provision, (2) The impact of lack of information, awareness, and literacy and (3) The health system's influence on literacy.

Conclusions

Poor cancer literacy hinders patients throughout their cancer journey. Empowering cancer patients is crucial for a more timely and positive patient experience. Increased cancer literacy together with the creation of health-literate organizations and systems have the potential to improve patients' treatment throughout the continuum of care.

Brain Tumor at Diagnosis: From Cognition and Behavior to Quality of Life

BACKGROUND

The present narrative review aims to discuss cognitive-emotional-behavioral symptoms in adults with brain tumors at the time of diagnosis.

METHODS

The PubMed database was searched considering glioma, pituitary adenoma, and meningioma in adulthood as pathologies, together with cognitive, neuropsychological, or behavioral aspects.

RESULTS

Although a significant number of studies describe cognitive impairment after surgery or treatment in adults with brain tumors, only few focus on cognitive-emotional-behavioral symptoms at diagnosis. Furthermore, the importance of an effective communication and its impact on patients' quality of life and compliance with treatment are seldom discussed.

CONCLUSIONS

Adults with brain tumors have needs in terms of cognitive-emotional-behavioral features that are detectable at the time of diagnosis; more research is needed to identify effective communication protocols in order to allow a higher perceived quality of life in these patients.

Development of Japanese Cancer Intelligence Quotient to Measure Cancer Literacy and Knowledge among Japanese Laypersons

INTRODUCTION

Health literacy has been identified an essential factor in leading a healthy lifestyle. Because some cancer prevention and screening methods have been established, we believe that identifying disadvantaged populations with low literacy regarding cancer is crucial. Thus, in this study, we aim to create a self-administered cancer-specific health literacy scale to be administered to Japanese laypersons.

METHODS

Using definitions from previous studies, we constructed a scale named the Japanese Cancer Intelligence Quotient (JCIQ) for both literacy (JCIQ-L) and knowledge (JCIQ-K) aspects. We generated potential items for both aspects, extracted appropriate ones using two-step online surveys, and compared the JCIQ and cancer-preventive behaviors and cancer-screening intentions, both of which we set as alternative indicators of the right attitude and practice toward cancer by performing a multiple regression analysis from another web survey.

RESULTS

Between April and May 2020, we conducted three-step surveys online. After conducting the two-step surveys for thousands of people, we extracted 12 literacy questions and 22 knowledge questions using factor analysis and the correct answer ratio of every item. In the final investigation of 3,094 people, a multiple regression analysis found that the JCIQ-L and JCIQ-K were significant factors in terms of predicting both behaviors (JCIQ-L:β = 0.07, p < 0.001, JCIQ-K:β = 0.05, p < 0.01) and willingness (JCIQ-L:β = 0.04, p < 0.05, JCIQ-K:β = 0.17, p < 0.001) after adjusting for participant characteristics (e.g., gender, age, income level, employment status).

CONCLUSIONS

We developed the first reliable scale for measuring cancer literacy and knowledge of Japanese laypersons.

A Study of Self-Care Practice in Routine Radiotherapy Care: Identifying Differences Between Practitioners and Non-Practitioners in Sociodemographic, Clinical, Functional, and Quality-of-Life-Related Characteristics

Objectives:

The objective of this study was to describe self-care practice during radiotherapy for cancer and to identify potential differences between practitioners and non-practitioners of self-care regarding sociodemographic, clinical, functional, and quality-of-life-related characteristics.

Methods:

In this descriptive study, 439 patients (87% response rate) undergoing radiotherapy responded to a study questionnaire regarding self-care, sociodemographic, clinical (eg, experienced symptoms), functional, and quality-of-life-related characteristics.

Results:

Of the 439 patients, 189 (43%) practiced at least one self-care strategy, while 250 (57%) did not. In total, the patients described 332 self-care practices, resulting in 14 different categories of self-care strategies. The 5 most common indicators of practicing self-care were fatigue, general wellbeing, psychological symptoms, nausea, vomiting and improving physical condition. The 5 most common self-care strategies were physical activity, increased recovery, healthy eating, distraction, and skincare. Patients who were married, were older than 69, patients with less education than university education, patients undergoing a combination of internal and external radiotherapy, patients experiencing fewer than 8 symptoms, and better quality of life, practiced self-care to a lower extent than did other patients. Functional capacity did not differ between self-care practitioners and non-practitioners.

Conclusion and Implications for Practice:

Of the patients undergoing radiotherapy, slightly less than half practiced self-care during an ordinary week of radiotherapy. Because older and less-educated patients were less likely to practice self-care, cancer care practitioners should consider paying particular attention to helping such patients with their self-care practice.

Leveraging Stories to Promote Health and Prevent Cancer

Many challenges are associated with communicating health messages to promote healthy behaviors and prevent cancer including limited health literacy levels, varied life experiences, and different learning styles. In this issue of Cancer Prevention Research, Chen and colleagues codeveloped personal, audiovisual digital stories using community-engaged, Digital Storytelling. Their goal was to improve the attitudes of and vaccination intention for human papillomavirus among Vietnamese American mothers of unvaccinated children ages 11-14. This spotlight discusses the implications of their results and further the broader use of stories as tools to promote health and prevent cancer-particularly in underserved minority and immigrant populations. See related article, p. 465.

Online Medical Misinformation in Cancer: Distinguishing Fact From Fiction

It is without question that the Internet has democratized access to medical information, with estimates that 70% of the American population use it as a resource, particularly for cancer-related information. Such unfettered access to information has led to an increase in health misinformation. Fortunately, the data indicate that health care professionals remain among the most trusted information resources. Therefore, understanding how the Internet has changed engagement with health information and facilitated the spread of misinformation is an important task and challenge for cancer clinicians. In this review, we perform a meta-synthesis of qualitative data and point toward empirical evidence that characterizes misinformation in medicine, specifically in oncology. We present this as a call to action for all clinicians to become more active in ongoing efforts to combat misinformation in oncology.

Health literacy among cancer survivors: Results from the 2016 behavioral risk factor surveillance system survey

Health literacy is a set of knowledge and skills that enables individuals to obtain, communicate, process and understand information, and services to make appropriate health decisions and to successfully navigate the health care system. Health literacy is important to quality of cancer survivorship care and patient self-management of their disease.We examined health literacy among cancer survivors, using data from the 2016 Behavioral Risk Factor Surveillance System. We compared health literacy across various demographic and socioeconomic groups and estimated the adjusted odds in favor of low health literacy for these characteristics.We found that about 16% of the cancer survivors had low health literacy. The prevalence was higher among Hispanic and Black individuals, and among those with poor health status, low income and educational attainment.A sizeable percentage of cancer survivors have low health literacy which is likely to complicate their ability to self-manage their disease and navigate the health care system for optimal care. In order to ensure the quality and appropriateness of cancer survivorship care, effective interventions are needed to address low health literacy in these populations.

Dissemination of validated health literacy videos: A tailored approach

BACKGROUND

Previously, we showed that chemotherapy terminology is difficult for patients to understand. Therefore, we developed short videos explaining key terminology and though proven effective, they will only be helpful if appropriately disseminated. Therefore, we aimed to determine the best dissemination method at three different healthcare settings.

METHODS

With consent, we interviewed healthcare workers from (1) an academic cancer center, Winship Cancer Institute (Winship) serving higher SES patients, (2) an inner-city, safety-net hospital Grady Memorial (GMH), (3) clinics serving rural Georgia, from the Winship Community Network (Network). All interviews were transcribed and analyzed using a semantic content analysis method. Suggested dissemination plans were then implemented.

RESULTS

Twenty-two Winship, 11 GMH, and 4 Network healthcare workers were interviewed. Seventy-two percent (n = 8) of the GMH and 100% (n = 4) of Network healthcare workers felt that the best place for patients to view the videos was in the clinic, compared to 27% (n = 6) of the Winship clinicians. 68% (n = 15) of the Winship clinicians stated an app would be the most useful format, compared to 27% (n = 3) at GMH, and 0% at Network sites. Video viewing increased after dissemination plans were implemented.

CONCLUSION

Educational materials explaining oncology treatment terminology enhance patient understanding, yet without proper dissemination, these tools may never reach the intended patient population. Our study shows that dissemination plans need to be tailored to each individual patient population, with rural and lower SES patients needing to view the videos during clinic visits, and patients of more means viewing them using technology at home.

A Framework of AI-Based Approaches to Improving eHealth Literacy and Combating Infodemic

The global COVID-19 pandemic has put everyone in an urgent need of accessing and comprehending health information online. Meanwhile, there has been vast amount of information/misinformation/disinformation generated over the Internet, particularly social media platforms, resulting in an infodemic. This public health crisis of COVID-19 pandemic has put each individual and the entire society in a test: what is the level of eHealth literacy is needed to seek accurate health information from online resources and to combat infodemic during a pandemic? This article aims to summarize the significances and challenges of improving eHealth literacy in both communicable (e.g., COVID-19) and non-communicable diseases [e.g., cancer, Alzheimer's disease, and cardiovascular diseases (CVDs)]. Also, this article will make our recommendations of a general framework of AI-based approaches to improving eHealth literacy and combating infodemic, including AI-augmented lifelong learning, AI-assisted translation, simplification, and summarization, and AI-based content filtering. This general framework of AI-based approaches to improving eHealth literacy and combating infodemic has the general advantage of matching the right online health information to the right people.