The Many Health Literacies: Advancing Research or Fragmentation?

Associations between health literacy proficiencies and health-related quality of life and GP visits among young people in Norway: a population-based cross-sectional study

OBJECTIVES

Despite globally increased attention from policymakers and being recognised as a critical determinant of health, health literacy (HL) research in young people (YP) remains limited. This study aims to describe HL in YP across person factors and explore the associations between HL and health-related quality of life (HRQoL) and the number of visits to general practitioners (GP visits).

DESIGN

Cross-sectional study.

SETTING

Population-based data collection applying country representative strata in Norway.

PARTICIPANTS

890 participants aged 16-25 years.

PRIMARY AND SECONDARY MEASURES

Rasch modelling and Wright's method were used to identify statistically distinct levels of HL proficiency. Multiple linear regression and negative binomial regression models were applied to explore the associations between HL and HRQoL, and between HL and GP visits, respectively.

RESULTS

Among YP, HL was statistically significantly associated with HRQoL and the number of GP visits, when adjusting for age, gender, education, self-perceived social status and financial deprivation. For every logit increase in HL, the number of GP visits decreased by 22%. Four statistically distinct levels of HL proficiency were identified for the 12-item HLS19-YP12 scale, started from a cut-point of 23, 30, 37 and 44 out of 48. Relatedly, 70% of respondents were observed at or below level 2 (30-36 points), indicating a varying lack of central skills. The span from lowest (1) to highest (4) HL level was associated with a decrease of 2.1 GP visits per year and an increase of .12 on the EQ-5D index.

CONCLUSIONS

This study provides new empirical insights into the impact of HL in YP. Identified cut-points for the HLS19-YP12 may contribute to simplifying the process of adapting information and communication for various HL skills. The study also suggests the need for more efforts in HL policy and structural intervention development to enhance YP health and well-being.

Alignment of Patient Information Leaflets with the Health Literacy Skills of Future End-Users: Are We on the Same Page?

Effective health communication will not be possible if the messages directed to patients do not adapt to their health literacy skills. In this sense, if the Patient Information Leaflets (PILs) are not understood properly, they will not fulfill their purpose. Secondary education aims to develop students' fundamental skills, including reading comprehension, which should align with future patients. This study assesses reading comprehension of commonly used PILs among secondary education students. An observational cross-sectional study involved 590 Spanish secondary school students from March to June 2022. They read 3 original PILs and completed a questionnaire about medication use information. The European health literacy survey questionnaire (short version) and sociodemographic data were collected. The average correct answer rate was only 51%, with just 14.58% understanding when to take ibuprofen, results that fell significantly below the minimum 80% threshold required by the European Union. Age, gender, and cultural background didn't significantly impact comprehension. In conclusion, health literacy skills acquired in secondary education are insufficient for understanding current PILs. Educational reform is necessary to improve students' ability to comprehend medication instructions and enhance PILs for effective communication. At the same time, our work highlights that current PILs need to be redesigned to reduce the cognitive burden imposed on patients.

Interventions for improving health literacy in migrants

BACKGROUND

Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health.

OBJECTIVES

To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions.

SEARCH METHODS

We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier).

SELECTION CRITERIA

We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information).

DATA COLLECTION AND ANALYSIS

We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis.

MAIN RESULTS

We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence.

AUTHORS' CONCLUSIONS

Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.

Behavior Guidance during the Covid-19 Pandemic: Health Literacy as a Weapon against the Virus

Portugal was hit by COVID-19 on the 2^nd of March 2020. For almost two months, the country was confined due to the declaration of the emergency state. The confinement was always conveyed by the media, who clearly guided citizens toward preventive behaviors and so became a means of fighting this pandemic by helping the country stay home. Several authors recognize the importance of health communication and health literacy in fighting COVID-19. In a public health crisis like this, media are important actors in the promotion of health and prevention of disease, and they can have a central role in behavior change. To further understand how the media guided citizens toward preventive behaviors we applied a questionnaire survey to Portuguese journalists. More than 90% assumed citizens' behavior guidance. Journalists' perceptions about their work reflect a true concern with the promotion of health literacy, and their assumption of a public service mission was crucial in people's adherence to confinement. Health literacy achieved its maximum during this confinement period, not only because these were extraordinary times but also because Portuguese journalists had an exemplar behavior.

Intergenerational Online Health Information Searching and Brokering: Framing Health Literacy as a Family Asset

Latino populations are disproportionately impacted by health disparities and face both connectivity and health literacy challenges. As evidenced by the current global pandemic, access to reliable online health-related information and the ability to apply that information is critical to achieving health equity. Through a qualitative study on how Latino families collaborate to access online health resources, this work frames health literacy as a family-level mechanism. Interviews with parent-child dyads combined with online search tasks reveal how families integrate their individual skillsets to obtain, process, and understand online information about illnesses, symptoms, and even medical diagnoses. As they engage in intergenerational online health information searching and brokering, families creatively navigate information and communication technologies (ICTs) to address a range of health needs. Bilingual children help immigrant parents obtain urgent and non-urgent health information needed to care for other family members. When children are tasked with addressing a health need critical to their parent's wellbeing, they collaborate with their parents to obtain, interpret, and apply online health information. Intergenerational online health information searching and brokering thus reveals family-level strengths that can be leveraged to promote both health and digital literacy among marginalized populations.

General versus disease-specific health literacy in patients with breast cancer: a cross-sectional study

Health literacy is recognized as a critical factor affecting communication across the continuum of cancer care and plays a key role in patients' ability to meaningfully discuss their condition with healthcare providers. However, there is no consensus on the best approach to measure health literacy in clinical practice. The aims of this study were to compare general and disease-specific measurements of health literacy in patients with breast cancer as well as examine their relationships with patient-provider communication. During office visits, patients with HER-2 + breast cancer who received care at oncology clinics with value-based models of care completed a survey including the 6-item cancer health literacy tool (CHLT-6), 6-item newest vital sign (NVS), 2 items measuring difficulty of patient-provider communication, and 11 demographic/clinical items. The mean age of 146 participants was 57.1 ± 10.8 years. Most participants had adequate general health literacy as measured by the NVS (79%) and a high probability of adequate cancer health literacy (≥ 0.7) as measured by the CHLT-6 (92%). Most patients easily communicated with healthcare providers (90.2%) and understood information they provided (83.5%). However, there was no significant relationship between patient-provider communication and health literacy. Both the CHLT-6 and NVS may be useful tools to assess the health literacy of patients with cancer in clinical practice. Study findings of adequate health literacy and ease of communication might have been influenced by the value-based care models adopted by participating clinics. Further research in more diverse samples of patients with cancer and different types of oncology practice settings is warranted.

Social insurance literacy: a scoping review on how to define and measure it

PURPOSE

Sickness insurance and workers' compensation systems decide on peoples' eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients' dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system.

METHODS

The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop.

RESULTS

Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy.

CONCLUSIONS

Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.Implications for rehabilitationSocial insurance literacy is a new concept that is based on theories in sociology, social medicine and public health.It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples' contacts with social insurance systems.The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process.The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.

COVID-19 and Health Information Seeking Behavior: Digital Health Literacy Survey amongst University Students in Pakistan

Amid the COVID-19 pandemic, digital health literacy (DHL) has become a significant public health concern. This research aims to assess information seeking behavior, as well as the ability to find relevant information and deal with DHL among university students in Pakistan. An online-based cross-sectional survey, using a web-based interviewing technique, was conducted to collect data on DHL. Simple bivariate and multivariate linear regression was performed to assess the association of key characteristics with DHL. The results show a high DHL related to COVID-19 in 54.3% of students. Most of the Pakistani students demonstrated ~50% DHL in all dimensions, except for reliability. Multivariate findings showed that gender, sense of coherence and importance of information were found to be significantly associated with DHL. However, a negative association was observed with students' satisfaction with information. This led to the conclusion that critical operational and navigations skills are essential to achieve COVID-19 DHL and cope with stress, particularly to promote both personal and community health. Focused interventions and strategies should be designed to enhance DHL amongst university students to combat the pandemic.

Health Knowledge and Adherence as Predictors of Viral Burden and CD4+ T-Cell Count in Youth and Young Adults Living With HIV

Health literacy influences HIV treatment for youth and, thus, is a research priority. We explored health knowledge and self-reported adherence, as indicators of health literacy, among youth living with HIV (YLWH) and the association between health literacy and health outcomes. A total of 102 YLWH ages 13-25 years participated in the study. Participants completed the Brief Estimate of Health Knowledge and Action-HIV Version; CD4 T-cell counts and viral loads were extracted from participant medical records. Participants had a moderate amount of HIV knowledge, and most reported taking their medications under most conditions. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. Health literacy is an important factor that should be addressed by practitioners working with YLWH. More research is needed to determine the best way to measure and improve health literacy.

Development, validation and performance of a newly designed tool to evaluate functional medication literacy in Slovenia

Background Medication literacy refers to the ability of individuals to safely and appropriately access, understand and act on basic medication information. It is vital for correctly and safely using medications. General health literacy measures do not adequately address specific skills for medication literacy, and there are no general, self-administered, performance-based instruments for assessing patients' medication literacy. Objective The aim was to develop and validate a self-administered performance-based questionnaire measuring functional medication literacy and to evaluate functional medication literacy among the Slovenian general population. Setting A random sample of adult Slovenian residents received the questionnaires at their home addresses. Method The initial content was derived from medication counselling literature. Thirteen patients and 14 healthcare professionals provided feedback about its comprehensibility, comprehensiveness, and difficulty thus supporting content and face validity. The developed questionnaire, comprising 30 items divided into 5 categories (dosage, adverse effects, interactions, precautions, and other information), was sent to a random sample of 1500 adult Slovenian residents. The overall validity of the questionnaire was assessed via reliability, criterion and discriminant validity using the Kuder-Richardson Formula 20, multiple linear regression and Mann-Whitney test. Descriptive statistics were used to evaluate medication literacy. Main outcome measure The psychometric properties of the questionnaire (reliability, content, face, criterion, and discriminant validity); level of functional medication literacy. Results A total of 402 residents returned eligible questionnaires (26.8% response rate). The Kuder-Richardson Formula 20 reliability coefficient for the whole questionnaire was 0.823. One item that did not demonstrate discriminant validity was deleted. Criterion validity was supported by a significant association between age and medication literacy (β = - 0.303). Income (β = 0.243) and current self-perceived health (β = 0.187) also were associated with medication literacy. The median of medication literacy score was 24 out of 29 points. Dosage-related items requiring understanding of long text instructions and the use of numeracy skills received the most incorrect answers. Conclusion A performance-based questionnaire measuring functional medication literacy among a general population with supported validity was developed. Slovenian residents encountered difficulties when dealing with items requiring prose literacy and numeracy skills, especially related to dosing. Special attention should be paid to low-income elderly with poor self-perceived health.

Which literacy for health promotion: health, food, nutrition or media?

Education and literacy are important aspects of health promotion. The potential for health literacy to promote healthier choices has been widely examined, with studies variously incorporating food literacy, nutrition literacy and/or media literacy as components of health literacy, rather than treating each as unique concepts for health promotion. This study examines similarities and differences across health literacy, food literacy, nutrition literacy and health-promoting media literacy to highlight how each literacy type theorizes the relationship between education and health. A meta-review of existing scoping and systematic reviews examining literacy conceptualizations was conducted to examine the four literacies. Representative concept definitions were extracted and key competencies (or skills) and desired consequences were identified and grouped into subcategories for analysis. This study located 378 articles, of which 17 scoping/systematic reviews were included (10 for health literacy, 3 for food, 1 for nutrition and 3 for media). Representative concept definitions of the four literacy types revealed three skill categories (information acquisition, information analysis, and the application of information) and three categories of desired consequences (knowledge, attitudes and behaviors), with each of the four literacy types emphasizing varied collections of skills and desired consequences. Despite perceived similarities in content, health, food, nutrition and media literacy conceptualize the relationship between education and health differently, emphasizing the distinct types of knowledge to promote health-related outcomes. A better understanding of the differences between these four literacies will lead to informed decision making for researchers, educators and health practitioners in intervention design and implementation.

Gender-Specific Aspects of Health Literacy: Perceptions of Interactions with Migrants among Health Care Providers in Germany

Health literacy can be described as a complex process shaped by individual resources and preferences and by the nature and quality of health-related information people encounter. The main objective of this study was to explore the views of health care professionals on how gender as a personal determinant of health literacy affected their interactions with migrant patients. The interrelated challenges, needs and applied solutions were analyzed from a health literacy perspective. Five focus group discussions with health care professionals working with migrants (n = 31) were conducted in Cologne, Germany, audio recorded, transcribed and analyzed by qualitative content analysis. Gender-specific aspects, such as the gender of health care providers as a factor, were portrayed above all in relation to patients from Turkey and Arab countries regarding access to and understanding of health-related information. These statements exclusively represent the possibly biased or assumptions-based perspectives of health care professionals on their migrant patients and were made against the background of a systemic lack of time and the challenge of overcoming language barriers. Especially in this context, reducing time pressure and improving communication in the treatment setting may be to the benefit of all actors within healthcare.

Health Literacy and Perceptions of Stigma

Calls for progress in health literacy argue that efforts across society are promising for increasing capacities at a broader level. However, it is unknown how the general public perceives people who struggle with health information. While it may be ideal to establish interventions beyond the individual, stigma held by others could limit this work. This study explores whether one's personal health literacy skills are associated with stigma enacted toward others who struggle with health literacy. Adults (N = 5,151) responded to a survey consisting of health literacy assessments and a vignette in which a patient made a health-related mistake. Differences were observed regarding the number of participants who self-reported (n = 251) versus objectively scored as having low health literacy (n = 794). Participants who self-reported (M_lowHL = 5.67, M_highHL = 5.99, p < .01) or had low objective health literacy (M_lowHL = 5.75, M_highHL = 6.01, p < .001) exhibited less pity for the person in the vignette than health literate participants. Participants were more demanding of a young person featured in the vignette (33-year old), indicating greater personal responsibility (M₇₂ = 5.12, M₃₃ = 5.67), anger (M₇₂ = 4.54, M₃₃ = 5.57), and less pity (M₇₂ = 6.18, M₃₃ = 5.75) compared to an older person (72-year old). Results from the present study suggest contradictory perceptions among patients who are likely to feel stigma themselves.

Exploring the Association Between Health Literacy and Psychological Well-Being Among Industry Managers in Germany

OBJECTIVE

Industry managers are typically exposed to high work demands but have received limited attention by research, particularly concerning the issue of health literacy and how this relates to their psychological well-being. The aim of this study was to explore the association between health literacy and psychological well-being among managers in Germany.

METHODS

An online survey of a sample of 126 commercial industry managers was conducted. Effects of health literacy on psychological well-being (WHO-5 index) were investigated using path analysis.

RESULTS

The findings show a quarter of managers were classified as having poor well-being. Health literacy, namely the facets self-regulation (β = 0.40, P < 0.001), self-perception (β = 0.26, P < 0.001), self-control (β = 0.25, P < 0.01), and proactive approach to health (β = 0.09, P < 0.05), were positively associated with psychological well-being.

CONCLUSION

The study indicates that higher health literacy is associated with decreased risk of poor well-being.

Child and Youth Health Literacy: A Conceptual Analysis and Proposed Target-Group-Centred Definition

(1) Background: This article adopts an interdisciplinary perspective to analyse, examine, and reflect upon prominent health literacy (HL) understandings in childhood and youth. (2) Method: The conceptual analysis combined Rodgers’ and Jabareen’s approaches to conceptual analysis in eight phases. (3) Results: First, we present exploratory entry points for developing a child-specific HL understanding based on the six dimensions of a ‘health-literacy 6D model’. Second, we describe and reflect upon five meta-level dimensions covering the HL definitions and models for children and youth found in the conceptual analysis. Third, we integrate our findings into a target-group-centred HL definition for children and youth. (4) Discussion/Conclusion: This article raises awareness for the heterogeneity of the current conceptual HL debate. It offers a multidisciplinary approach for advancing the existing understanding of HL. Four recommendations for future actions are deduced from the following four principles, which are inherent to the proposed target-group-centred HL definition: (a) to characterize HL from an asset-based perspective, (b) to consider HL as socially embedded and distributed, (c) to recognize that HL develops both in phases and in flexible ways, and (d) to consider the multimodal nature of health-related information. Further research is necessary to test the feasibility and applicability of the proposed definition and conceptual understanding in both research and practice.

"I was Right about Vaccination": Confirmation Bias and Health Literacy in Online Health Information Seeking

When looking for health information, many people turn to the Internet. Searching for online health information (OHI), however, also involves the risk of confirmation bias by means of selective exposure to information that confirms one's existing beliefs and a biased evaluation of this information. This study tests whether biased selection and biased evaluation of OHI occur in the context of early-childhood vaccination and whether people's health literacy (HL) level either prevents or facilitates these processes. Vaccination beliefs were measured for 480 parents of young children (aged 0-4 years) using an online survey, after which they were exposed to a list of ten vaccine-related message headers. People were asked to select those headers that interested them most. They also had to evaluate two texts which discussed vaccination positively and negatively for credibility, usefulness, and convincingness. The results showed that people select more belief-consistent information compared to belief-inconsistent information and perceived belief-confirming information as being more credible, useful, and convincing. Biased selection and biased perceptions of message convincingness were more prevalent among people with higher HL, and health communication professionals should be aware of this finding in their practice.

Health Literacy in Web-Based Health Information Environments: Systematic Review of Concepts, Definitions, and Operationalization for Measurement

Background

Health literacy research seems to lack a consensus on what aspects to include into literacy in the context of health and on how to operationalize these concepts for measurement purposes. In addition to health literacy, several other concepts, such as electronic health (eHealth) literacy and mental health literacy, have been developed across disciplines. This study examines how these different concepts are used when studying health-related competencies in Web contexts.

Objective

This study systematically reviews health literacy concepts and definitions and their operationalization in studies focused on Web-based health information environments.

Methods

A systematic literature search was conducted in April 2016 in 6 electronic databases with a limitation to articles in English published between January 2011 and April 2016. Altogether, 1289 unique records were identified and screened according to the predefined inclusion criteria: (1) original, peer-reviewed research articles written in English; (2) the topic of the article concerned literacy in the context of health; (3) informants of the study were lay people, not health professionals or students of the field; and (4) the focus of the study was placed on an Web-based information environment. In total, 180 full texts were screened, of which 68 were included in the review. The studies were analyzed with an emphasis on the used health literacy concepts and measures.

Results

On the basis of the included studies, several concepts are in use when studying health-related literacy in Web environments, eHealth literacy and health literacy being the most common ones. The reviewed studies represent a variety of disciplines, but mostly medical sciences. Typically, quantitative research methods are used. On the basis of the definitions for health literacy, 3 thematic categories were identified: general and skill-based, multidimensional, and domain-specific health literacy. Most studies adopted a domain-specific concept, followed by the ones that used a general and skill-based concept. Multidimensional concepts occurred least frequently. The general health literacy concepts were usually operationalized with reading comprehension measures, the domain-specific concepts with self-efficacy measures, and multidimensional concepts with several types of measures. However, inconsistencies in operationalization were identified.

Conclusions

The results show that in studies conducted in Web-based information environments, several different health literacy concepts are in use, and there is no clear consensus on the definitions for these concepts. Future studies should place emphasis on the conceptual development of health literacy in Web contexts to gain better results on operationalization for measurement. Researchers are encouraged to provide clear operational definitions for the concepts they use to ensure transparency in reporting.

Development of an LGB-specific health literacy scale

No studies to date have examined health literacy among lesbian, gay, and bisexual (LGB) individuals, nor considered whether LGB-specific health literacy might be a contributing factor to well-documented health disparities in LGB populations. This pilot study gathered online survey data from a national convenience sample of 232 LGB adults age 40 and older. A scale developed specifically for this study had 10 items related to general health literacy and 10 items related to LGB-specific health information and skills. Factor analysis revealed that the two subscales were distinct and internally consistent, and accounted for 66% of the variance. Higher LGB health literacy was associated with greater likelihood of coming out to the healthcare provider, reporting better overall health, and having healthcare providers who were knowledgeable about LGBT issues. Greater age was associated with lower general health literacy, but was not associated with LGB literacy. Respondents who had worked in healthcare settings had higher levels of both LGB and general health literacy. Potential differences by gender on sociodemographic and health variables were identified that need to be examined in larger, more diverse samples.

A theory-based self-report measure of health literacy: The Calgary Charter on Health Literacy scale

We set out to test a theory-based measure of health literacy. To do so, we included the newly developed Calgary Charter on Health Literacy scale in Pre- and Post-evaluation of the Life Enhancement Program at multiple sites. The program focusing on health literacy and the prevention of chronic disease is conducted with health-care provider organization partners across the United States. In testing the reliability and validity of the new measure of health literacy, Cronbach’s alpha is very acceptable level at 0.80. There are numerous statistically significant correlations between the change in health literacy and participants’ changes in knowledge, attitudes, beliefs, behaviors, and health status. Data and analysis indicate that the Calgary Charter on Health Literacy Scale is a valid and reliable measurement tool in the contexts and with the populations they were tested within. More testing is necessary and warranted in a wider variety of contexts and populations—ideally to include large representative random samples and comparison groups. We recommend that policymakers increase focus on advancing health literacy as an evidence-based approach to reach the goals of improved individual and public health at a lower cost.

Health Literacy in Adult Education Centers: Exploring Educator and Staff Needs

Objective. Incorporating health content into adult education courses is promising for increasing health literacy skills among "hard-to-reach" populations. The purpose of this study was to gain previously untapped knowledge of adult education personnel (i.e., educators, staff) about the strategies and programs that would be beneficial for helping students learn about health. Method. Personnel (N = 53) from three literacy coalitions completed an online survey that assessed interest and preferences for developing a health literacy curriculum. Results. Personnel indicated general concepts such as health services and insurance as those of greatest priority. Additionally, tools designed for general use (completion of forms) were favored. Personnel preferred programs that focused on general skills over those designed to address specific health topics, χ²(1) = 11.52, p = .001. Conclusions. Adult education personnel find greatest value in health literacy programs aimed at increasing general skills rather than disease-/topic-specific content. There were several mismatches in topics noted as a "priority" and those for which personnel felt comfortable teaching. A focus on fostering general health skills will help all students-not just those with specific health concerns such as diabetes and asthma. Teaching health literacy through general skill development could make health programs exciting, engaging, and accessible for students.

Do adolescents understand the items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) - German version? Findings from cognitive interviews of the project "Measurement of Health Literacy Among Adolescents" (MOHLAA) in Germany

Background

In Germany, there are no measurement tools to assess the general health literacy of adolescents. The aim of the study "Measurement of Health Literacy Among Adolescents" (MOHLAA) is to develop such a tool for use among adolescents aged 14-17. The German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47-GER) served as a blueprint for the development of the tool. The present study examined the extent to which the HLS-EU-Q47-GER can be applied to the measurement of general health literacy in adolescents.

Methods

The applicability of the HLS-EU-Q47-GER for adolescents was tested qualitatively using cognitive interviewing (CI). Purposive sampling was used to achieve an equal distribution of participants regarding age groups, educational backgrounds and gender. CI was standardized on the basis of an interview guide. Verbal probing and the retrospective think-aloud technique were applied. The interviews were audio-recorded, transcribed and analyzed using the criteria of theory-based analysis, which were derived from the model of cognitive processes. The analysis focused on identifying terms and questions that were difficult to understand and on scrutinizing the extent to which the content of the items is appropriate for assessing adolescents' health literacy.

Results

Adolescent respondents were unfamiliar with some terms of the HLS-EU-Q47-GER or provided heterogeneous interpretations of the terms. They had limited or no experience regarding some health-related tasks in health care and disease prevention that are addressed by HLS-EU-Q-items. A few items seemed to be too "difficult" to answer due to a high abstraction level or because they lacked any reference to the everyday lives of youth. Despite comprehension problems with some of the HLS-EU items, the respondents assessed the covered health-related tasks as "very easy" or "fairly easy". CI stressed the importance of interpersonal agents, especially parents, in helping adolescents understand and judge the reliability of health information.

Conclusions

The results of CI indicated that the applicability of the HLS-EU-Q47-GER to the measurement of general health literacy among adolescents aged 14-17 is limited. In order to prevent biased data, some items of the questionnaire should be adjusted to adolescents' state of development and experiences with health care and disease prevention.

The Use of the Newest Vital Sign Health Literacy Instrument in Adolescents With Sickle Cell Disease

The purpose of this article is to discuss the use of the Newest Vital Sign (NVS) health literacy instrument in adolescents with sickle cell disease. The NVS evaluates both literacy and numeracy (the ability to understand and work with numbers) as well as the ability to locate and apply information. It is important to validate the NVS for use in adolescents, as the only currently validated instrument, the Rapid Estimate of Adolescent Literacy in Medicine–Teen (REALM-Teen), does not measure numeracy or the ability to locate or apply information. This cross-sectional, descriptive, exploratory correlational study included appraisal of data from completion of the REALM-Teen and NVS instruments by a convenience sample of 75 adolescents with sickle cell disease. The mean age of this study sample was 14.7 years ( SD = 2.2). The mean grade level of participants was 8.7 ( SD = 2.2). Internal consistency for the NVS in this population was acceptable (α = .63). Criterion validity was based on correlations between raw scores on the NVS and raw scores on the REALM-Teen. There was a significant moderate, positive correlation between NVS and REALM-Teen scores ( r = .38, p < .01), demonstrating good criterion validity. Preliminary evidence for reliability and validity of the NVS in this population was established.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Health literacy in childhood and youth: a systematic review of definitions and models

BACKGROUND

Children and young people constitute a core target group for health literacy research and practice: during childhood and youth, fundamental cognitive, physical and emotional development processes take place and health-related behaviours and skills develop. However, there is limited knowledge and academic consensus regarding the abilities and knowledge a child or young person should possess for making sound health decisions. The research presented in this review addresses this gap by providing an overview and synthesis of current understandings of health literacy in childhood and youth. Furthermore, the authors aim to understand to what extent available models capture the unique needs and characteristics of children and young people.

METHOD

Six databases were systematically searched with relevant search terms in English and German. Of the n = 1492 publications identified, N = 1021 entered the abstract screening and N = 340 full-texts were screened for eligibility. A total of 30 articles, which defined or conceptualized generic health literacy for a target population of 18 years or younger, were selected for a four-step inductive content analysis.

RESULTS

The systematic review of the literature identified 12 definitions and 21 models that have been specifically developed for children and young people. In the literature, health literacy in children and young people is described as comprising variable sets of key dimensions, each appearing as a cluster of related abilities, skills, commitments, and knowledge that enable a person to approach health information competently and effectively and to derive at health-promoting decisions and actions.

DISCUSSION

Identified definitions and models are very heterogeneous, depicting health literacy as multidimensional, complex construct. Moreover, health literacy is conceptualized as an action competence, with a strong focus on personal attributes, while also recognising its interrelatedness with social and contextual determinants. Life phase specificities are mainly considered from a cognitive and developmental perspective, leaving children's and young people's specific needs, vulnerabilities, and social structures poorly incorporated within most models. While a critical number of definitions and models were identified for youth or secondary school students, similar findings are lacking for children under the age of ten or within a primary school context.

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide

Background

Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing.

Objective

The purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts.

Methods

Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items.

Results

Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03).

Conclusions

Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

Gestational Weight Gain Through a Health Literacy Lens: A Scoping Review

Few women gain the recommended amount of weight during pregnancy, which has health implications for mothers and their newborns. Work in this area focuses on factors that are difficult to change. The purpose of this project was to review literature on a more patient-centered concept-health literacy. A scoping review was conducted to determine whether aspects of health literacy are included in gestational weight gain (GWG) research. Thirty articles were selected for review. Although these studies included health literacy aspects indirectly, only 2 directly measured health literacy using existing measures. Work that incorporates health literacy in a GWG context is needed. Health literacy may be a critical, yet understudied, factor in understanding why GWG falls outside of the recommendations.

Why We Need the Concept of "Mental Health Literacy"

In this issue, Mackert and colleagues argue for the benefits of a general health literacy focus, which can be applied across health domains. Using the concept of mental health literacy as an example, this article argues that there are also major advantages of a domain-specific approach. The concept of mental health literacy has had policy impacts and led to the development of interventions, which might not have otherwise occurred. It has also led to the development of assessments specifically targeted at intervention goals. It is concluded that while a general concept of health literacy might be appropriate for some purposes, it does not meet the specific needs of the mental health area.