Effects of health literacy to self-efficacy and preventive care utilization among older adults

Association between the utilization of senior centers and participation in health check-ups

The global older adult population is increasing. Early detection and intervention through health check-ups are crucial for successful aging, as they play a significant role in identifying and addressing diseases. This study explored the relationship between the utilization of senior centers and the promotion of health check-ups. It utilized data from 10,097 individuals aged 65 years and above, sourced from the 2020 Elderly Survey in South Korea. The primary variable of interest was classified into two groups: those who utilized senior centers and those who did not. Subgroups were further categorized based on the frequency of usage and the presence of family members among senior centers users. Logistic regression analyses were conducted to assess the association between the utilization of senior centers and participation in health check-ups. Both men and women utilizing senior centers demonstrated a higher likelihood of participating in health check-ups compared with those who did not use senior centers. Participants visiting senior centers in a week exhibited a progressively higher likelihood of engaging in health check-ups compared with those who visited such senior centers zero times a week. Senior centers can serve as effective intervention methods to enhance health check-ups among older adults. Furthermore, this can contribute to fostering successful aging among older adults.

Assessment of health literacy in a French emergency department

BACKGROUND

Health literacy (HL) has become a subject of major interest in public health worldwide. It is known to be linked to self-efficacy in care use and to global health status, and a non-negligible frequency of problematic or inadequate levels of HL in populations worldwide is reported. As this has yet to be evaluated in France, the present study aimed to evaluate the HL level of patients in a French emergency department (ED).

METHODS

We conducted a descriptive, cross-sectional observational, single center study in the ED of the Lyon Sud hospital (Hospices civils de Lyon, Lyon, France). The primary endpoint was the HL level of the patients determined according to the score obtained using the 16-item European Health Literacy Survey Questionnaire. The secondary endpoint was the identification of sociodemographic factors associated with the HL level.

RESULTS

A total of 189 patients were included for analysis. 10% (95% CI [3%; 17%]) of the patients had an inadequate HL, 38% (95% CI [31%; 45%]) had a problematic HL, and 53% (95% CI [46%; 61%] had an adequate HL. In multivariate analysis, age and perceived health status were independent predictors of the HL level; OR =0.82 (95% CI [0.69; 0.97]; p=0.026) for a 10-year increase in age, and OR =1.84 (95% CI [1.22; 2.82]; p=0.004]).

CONCLUSIONS

The HL level of the patients in the ED studied herein was similar to that found in the population of France and other European countries and was influenced by age and perceived health status, which are both associated with care needs. It may be therefore interesting to explore in future studies how taking into consideration HL in the general population may lead to a better self-efficacy in care and optimize the use of the healthcare system.

Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis

Objective: The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Methods: Drawing a sample (n = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results: Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Discussions: Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care.

Factors associated with poor health literacy in older adults: A systematic review

OBJECTIVES

To identify factors associated with poor health literacy in older adults.

METHODS

A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy".

PROSPERO - CRD

42022350140.

RESULTS

Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others).

CONCLUSIONS

The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

COVID-19 vaccine refusal associated with health literacy: findings from a population-based survey in Korea

BACKGROUND

Poor health literacy is associated with lower utilization of preventable services. However, the relationship between health literacy and COVID-19 vaccine hesitancy remains controvertible.

METHODS

This study used data from 229,242 individuals who completed the Community Health Survey in Korea from August 16 to October 31 in 2021. To operationalize COVID-19 vaccine hesitancy, we measured vaccine refusal, which is defined as not having been vaccinated and not intending to get vaccinated against COVID-19. Health literacy is operationalized in two dimensions; the ability to understand spoken directions from health professionals and the ability to understand written information regarding health. Covariates include sex, age, educational level, marital status, employment status, basic living security pension status, and subjective health status. Two multivariable logistic regression models were run to determine factors associated with COVID-19 vaccine refusal. Model 1 included sociodemographic characteristics and subjective health status. Model 2 added two health literacy variables. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

Only 3.9% of the Korean adult population were estimated to refuse COVID-19 vaccine. The most commonly cited reasons for COVID-19 vaccine refusal were concerns about vaccine adverse events (47.6%), followed by the assessment of one's own health status (29.5%). Individuals who found spoken directions very difficult to understand were more likely to refuse COVID-19 vaccine than those who found spoken directions very easy (OR = 1.55, 95% CI: 1.28-1.87, p < 0.001). People who did not pay attention to written information were more likely to refuse COVID-19 vaccine than those who reported it to be very easy to understand (OR = 1.28, 95% CI: 1.13-1.45, p < 0.001). People in all other categories of the literacy spectrum for either spoken or written information did not have an increased risk of COVID-19 vaccine refusal.

CONCLUSION

Health literacy was significantly associated with COVID-19 vaccine refusal. Health literacy programs could be beneficial to reduce vaccine refusal, particularly for the people who find spoken directions from health professionals very difficult to understand and those who do not pay attention to written information.

Definitions and measurement of health literacy in health and medicine research: a systematic review

OBJECTIVES

The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments.

DESIGN

Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019.

ELIGIBILITY CRITERIA

We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years.

DATA EXTRACTION AND SYNTHESIS

Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam's descriptions of the different health literacy levels.

RESULTS

120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1).

CONCLUSION

Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies.

PROSPERO REGISTRATION NUMBER

CRD42020179699.

Health literacy and healthcare service utilisation in the 12-months prior to entry into residential alcohol and other drug treatment

INTRODUCTION

Health literacy refers to an individual's capacity to gather, process and understand health information, make appropriate health decisions, and engage adequately with healthcare services. Inadequate health literacy has been linked to an increase in acute healthcare utilisation. Research suggests that people living with substance use disorders also access acute healthcare services at high rates. The study investigates whether overall health literacy is related to this population's use of general healthcare services.

METHODS

A total of 568 participants were recruited from residential substance use treatment services located in NSW, Australia, as part of a randomised controlled trial; the Continuing Care Project. All participants completed a face-to face baseline questionnaire, which included the Health Literacy Questionnaire; a measure of multidimensional health literacy. Latent profile analysis was used to examine health literacy profiles, with multinominal regression analysis examining if healthcare service utilisation was related to these profiles.

RESULTS

Three profiles of health literacy were identified and termed lowest (n = 86, 15.1%), moderate (n = 338, 59.5%) and highest health literacy (n = 144, 25.4%). The sample accessed both primary and acute healthcare services at high rates. When controlling for demographic variables, there were no significant differences identified between health literacy profiles and service use.

DISCUSSION/CONCLUSIONS

This study was the first to use a multidimensional health literacy tool to examine health literacy and general healthcare service utilisation for people attending residential substance use disorder treatment. This population access high levels of healthcare services, however the role that health literacy may play in helping reduce acute healthcare use requires further investigation.

Simple scoring algorithm to identify community-dwelling older adults with limited health literacy: a cross-sectional study in Taiwan

OBJECTIVE

Health literacy (HL) is the degree of individuals' capacity to access, understand, appraise and apply health information and services required to make appropriate health decisions. This study aimed to establish a predictive algorithm for identifying community-dwelling older adults with a high risk of limited HL.

DESIGN

A cross-sectional study.

SETTING

Four communities in northern, central and southern Taiwan.

PARTICIPANTS

A total of 648 older adults were included. Moreover, 85% of the core data set was used to generate the prediction model for the scoring algorithm, and 15% was used to test the fitness of the model.

PRIMARY AND SECONDARY OUTCOME MEASURES

Pearson's χ² test and multiple logistic regression were used to identify the significant factors associated with the HL level. An optimal cut-off point for the scoring algorithm was identified on the basis of the maximum sensitivity and specificity.

RESULTS

A total of 350 (54.6%) patients were classified as having limited HL. We identified 24 variables that could significantly differentiate between sufficient and limited HL. Eight factors that could significantly predict limited HL were identified as follows: a socioenvironmental determinant (ie, dominant spoken dialect), a health service use factor (ie, having family doctors), a health cost factor (ie, self-paid vaccination), a heath behaviour factor (ie, searching online health information), two health outcomes (ie, difficulty in performing activities of daily living and requiring assistance while visiting doctors), a participation factor (ie, attending health classes) and an empowerment factor (ie, self-management during illness). The scoring algorithm yielded an area under the curve of 0.71, and an optimal cut-off value of 5 represented moderate sensitivity (62.0%) and satisfactory specificity (76.2%).

CONCLUSION

This simple scoring algorithm can efficiently and effectively identify community-dwelling older adults with a high risk of limited HL.

How does health literacy affect the utilization of basic public health services in Chinese migrants?

Previous studies have focused on the determinants of basic public health services utilization, such as socioeconomic status and mobility characteristics, rather than on health literacy. Thus, this study aimed to estimate the effect of health literacy on the utilization of basic public health services among Chinese migrants. Based on the 2016 China Migrants Dynamic Survey data (N = 2335), this study used propensity score matching approach to estimate the effect of health literacy on the utilization of basic public health services, including the establishment of health records and receipt of health education, and to explore heterogeneity in this effect based on educational attainment and urban-rural status. The findings show that high levels of health literacy increased the probability of establishing health records and receiving more health education. Also, high levels of health literacy had a positive effect on the utilization of basic public health services among Chinese migrants, especially those with less education or living in urban areas. Policy makers should more carefully consider the actual situation and needs of migrants who are living in urban areas or have less education, constructing more targeted service programs.

Health Literacy Mediates the Association Between Socioeconomic Status and Productive Aging Among Elderly Chinese Adults in a Newly Urbanized Community

Productive aging, or older adults engaging in paid or unpaid activities that produce socially valued goods or services, has been suggested to have the beneficial impact on older adults' health and well-being. We performed a cross-sectional study to examine the influence of health literacy on the relationship between socioeconomic status (SES) and productive aging among older Chinese adults in a newly urbanized community. Data was collected from 995 older adults from a newly urbanized community between June and August 2013 in Chengdu, China. We used structural equation modeling (SEM) to test the hypothesized relationship among SES, health literacy and productive aging. Results showed that education attainment and income had a direct positive effect on health literacy (β = 0.47and β = 0.15, respectively). Education had a partial indirect effect on productive aging through health literacy (β = 0.27). And health literacy was an important factor in improving the productive aging of the elderly. Interventions targeting health education and health promotion should be taken to improve health literacy of older adults under the background of urbanization, especially for those with lower SES.

Assessment of the Readability of Online Patient Education Material from Major Geriatric Associations

BACKGROUND/OBJECTIVES

An increasing number of patients are using the internet to supplement information provided by medical professionals. Online geriatric patient education materials (PEMs) should be written at or below a 6th grade reading level (GRL) that takes into account barriers unique to the geriatric population. The objectives of the study are to assess PEMs of geriatric associations' websites and determine whether they are above the GRL recommended by the Centers for Disease Control and National Institutes of Health.

DESIGN

Descriptive and correlational methodology. PEMs from 10 major geriatric associations were assessed for their GRL using 10 scales. Eight of the scales provide a numerical GRL while two of the scales provide a visual representation of the GRLs. Analysis was conducted using Readability Studio 2019.3.

SETTING

Analysis was conducted February 2020.

PARTICIPANTS

Identified 10 geriatric associations and 884 PEMs.

MEASUREMENTS

GRLs were measured by 10 validated readability indices: the Degrees of Reading Power and Grade Equivalent test, Flesch-Kincaid grade level, Simple Measure of Gobbledygook test, Coleman-Liau Index, Gunning Fog Index, New Fog Count, New Dale-Chall readability formula, Ford, Caylor, Sticht scale, Raygor readability estimate graph, and Fry readability graph.

RESULTS

The mean of all PEMs using the numerical scales was 11.1 ± 2.4. Ninety-nine percent of PEMs are above the 6th GRL. PEMs ranged from a grade 3.0 to 19.0 reading level. Analysis of variance demonstrated a significant difference between associations (P < .0001), and multiple comparison analysis identified the National Institute on Aging as the content easiest to read (9.5 ± 1.6).

CONCLUSION

PEMs from geriatric association websites are written above the recommended 6th GRL. As patients increasingly look toward online supplementary health information during COVID-19, there is an opportunity for improving PEMs to enable greater comprehension by the target population.

The Health Literacy Questionnaire: Initial Validity Testing in a Norwegian Sample

BACKGROUND

The Health Literacy Questionnaire (HLQ) is a multidimensional generic questionnaire developed to capture a wide range of health literacy needs. There is a need for validation evidence for the Norwegian version of the HLQ (N-HLQ).

OBJECTIVE

The present study tested an initial version of the Norwegian HLQ by exploring its utility and construct validity among a group of nursing students.

METHODS

A pre-test survey was performed in participants (N = 18) who were asked to consider every item in the N-HLQ (44 items across nine scales). The N-HLQ was then administered to 368 respondents. Scale consistency was identified and extracted in a series of factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution performed on randomly drawn 50% of the samples obtained by bootstrapping. Correlations between the nine factors obtained in the 13-factor PCA and the scale scores computed by the scale scoring syntaxes provided by the authors of the original HLQ were estimated.

KEY RESULTS

The pre-test survey did not result in the need to rephrase items. The internal consistency of the nine HLQ scales was high, ranging from 0.81 to 0.72. The best fit for reproduction of the scales from the original HLQ was found for these dimensions: "1. feeling understood and supported by health care providers," "2. having sufficient information to manage my health," and "3. actively managing my health." For the dimensions "7. navigating in the healthcare system" and "8. ability to find good health information," a rather high degree of overlap was found, as indicated by relatively low differences between mean highest correlations and mean next-highest correlations.

CONCLUSIONS

Despite some possible overlap between dimensions 7 and 8, the N-HLQ appeared relatively robust. Thus, this study's results contribute to the evidence validation base for the N-HLQ in Norwegian populations. [HLRP: Health Literacy Research and Practice. 2020;4(4):e190-e199.] PLAIN LANGUAGE SUMMARY: This study tested the Norwegian version of the Health Literacy Questionnaire. The questionnaire (44 items across nine scales) was completed by 368 nursing students. Despite some overlap between scale 7 ("navigating in the health care system") and scale 8 ("ability to find good health information"), the questionnaire appears to serve as a good measurement for health literacy in the Norwegian population.

Health Literacy and Outcomes of a Community-Based Self-Help Intervention: A Case of Korean Americans With Type 2 Diabetes

BACKGROUND

Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy's effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research.

OBJECTIVE

The aim of this study was to empirically examine underlying mechanisms of health literacy's role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus.

METHODS

Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012-2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling.

RESULTS

A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy.

DISCUSSION

Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.

Are college students health literate?

Objective: To examine the health literacy of college students. Participants: A convenience sample of 245 graduate and undergraduate college students. Methods: During February-April of 2018 participants completed the Short Test of Functional Health Literacy which assessed literacy on two passages describing a thyroid scan, and basic healthcare insurance information. Results: Most college students displayed adequate health literacy (99.2%). The ANOVA analyses revealed college classification was the most significant predictor, followed by ethnicity, sex, and primary language. Age was significantly related to health literacy, when holding college classification constant. Interestingly, college major, healthcare work experience, or having health care credentials were not predictors of health literacy. Conclusion: This group of college students had adequate health literacy skills. However, the results of this study revealed demographic disparities that suggest further study.

Mediating and regulating effects of self-efficacy on health literacy and quality of life in patients with gastric cancer undergoing chemotherapy

BACKGROUND

Quality of life and health literacy are the main factors influencing the quality of life of gastric cancer (GC) patients. The purpose of this study was to investigate the mediating and regulating effects of self-efficacy on health literacy and quality of life in patients with GC.

AIM

To investigate the mediating and regulating effects of self-efficacy on health literacy and quality of life in patients with GC undergoing chemotherapy.

METHODS

One hundred and thirty-six GC patients hospitalized at Yiwu Central Hospital of Zhejiang Province from January 2018 to November 2019 were selected as the study subjects. The Chinese version of general self-efficacy scale, health literacy scale, and quality of life index of patients with chronic diseases were used for questionnaire survey and statistical analysis.

RESULTS

Self-efficacy score was 22.95 ± 4.65, health literacy score was 85.94 ± 7.56, and quality of life score was 4.84 ± 0.52. Pearson correlation analysis showed that the self-efficacy of GC patients undergoing chemotherapy was positively correlated with health literacy and quality of life (P < 0.05). The mediating effect was analyzed by stratified regression method and three regression equations were established. The results showed that the quality of life and health literacy as well as self-efficacy and health literacy were statistically significant in step 1 and step 2 (P < 0.05). In step 3, self-efficacy was introduced and the influence of health literacy on quality of life was reduced (P < 0.05), indicating that self-efficacy had a partial mediating effect between health literacy and quality of life. The regulating effect analysis was carried out through multiple regression, and the health literacy and self-efficacy were centralized to generate the interaction terms of "health literacy × self-efficacy". The quality of life was taken as the dependent variable, and the health literacy, self-efficacy, and interaction terms were taken as the independent variables for the regression analysis. The results showed that the regression coefficient of "health literacy × self-efficacy" was statistically significant (β' = 0.018, t = 2.725; P < 0.01), and the regulating effect was significant (△R² = 0.018, P < 0.01).

CONCLUSION

Self-efficacy has mediating and regulating effects on health literacy and quality of life in patients with GC undergoing chemotherapy.

Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive survey-based overview

OBJECTIVE

Monitoring inequality in healthcare utilisation is essential to reduce persistent inequalities in health in lower-middle income countries. This study aimed to assess socioeconomic inequalities in the utilisation of primary care, secondary care and preventive care in Indonesia.

METHODS

A cross-sectional study was conducted using data from the 2014 Indonesia Family Life Survey with a total of 42 083 adult participants. Socioeconomic status (SES) was measured by educational level and income. Healthcare utilisation was measured in: (1) primary care, (2) outpatient in secondary care, (3) inpatient care and (4) cardiovascular-related preventive care. The magnitude of inequalities was measured using the relative index of inequality (RII).

RESULTS

Small educational inequalities were found for primary care utilisation (RII 1.13, 95% CI 1.01 to 1.26). Larger educational inequalities were found for outpatient secondary care (RII 10.35, 95% CI 8.11 to 13.22) and inpatient care (RII 2.78, 95% CI 2.32 to 3.32). The largest educational inequalities were found for preventive care, particularly regarding blood glucose tests (RII 30.31, 95% CI 26.13 to 35.15) and electrocardiography tests (RII 30.90, 95% CI 24.97 to 38.23). Compared with educational inequalities, income inequalities were larger for primary care (RII 1.68, 95% CI 1.52 to 1.85) and inpatient care (RII 3.11, 95% CI 2.63 to 3.66), but not for outpatient secondary care and preventive care.

CONCLUSIONS

Socioeconomic inequalities in healthcare utilisation in Indonesia are particularly large in secondary and preventive care. Therefore, it is recommended to prioritise policies focused on improving timely, geographical and financial access to secondary and preventive care for lower SES groups.

Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults

BACKGROUND

Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes.

PURPOSE

This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities.

METHODS

This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment.

RESULTS

Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities.

CONCLUSION

The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

Relationship between self-care behaviors and health literacy among elderly women in Iran, 2015

Background and aim

Self-care is a basic concept in health promotion, regarding the importance of health literacy as a key factor in self-care. This study aimed to identify the relationship between self-care behaviors and health literacy among elderly women in Iran.

Methods

This descriptive and analytic study was performed between October and December 2015. A total of 360 participants were selected from elderly women referred to health centers. Data was collected by test of functional health literacy in adults (S-TOFHLA) and a checklist for assessment of self-care behaviors, and health information seeking. Data were analyzed by SPSS software (version 22) with One-Way Analysis of Variance, and the Pearson correlation coefficient, t-test and regression test.

Results

The mean score of functional health literacy was 41.30±6.29. Of the participants, 73.6% had inadequate health literacy, 20.8% borderline health literacy, and 5.6% enough health literacy. The mean score of health information seeking was 1.791. Also, 31.9% of elderly women had poor self-care behaviors, 56.9% moderate, and 11.1% high. A significant difference was observed in mean score of health literacy between different levels of self-care (F=30.087, p<0.001). Based on regression analysis, health literacy and health information seeking predicted 19.9% of the variance of self-care behaviors.

Conclusion

This study highlights the necessity of promoting health literacy and attention to its influencing factors to improve self-care ability of elderly women. In conclusion, Planning interventions to improve health literacy is essential for health promotion among elderly women.

The Association of Health Literacy and Electronic Health Literacy With Self-Efficacy, Coping, and Caregiving Perceptions Among Carers of People With Dementia: Research Protocol for a Descriptive Correlational Study

Background

In the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers’ needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored.

Objective

The aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions.

Methods

A sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer’s associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures.

Results

As a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017.

Conclusions

Carers’ eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers’ perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers’ eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research.

Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis

Background

Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people’s ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context.

Objective

We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking.

Methods

Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one’s general practitioner (GP). Path analysis was employed for data analysis.

Results

We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared.

Conclusions

The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary.

Health Literacy and Its Link to Healthcare Service Utilization Among Older Adults in Korea

Existing studies report a negative association between health literacy and hospital/emergency room use. Despite substantial research on this topic among older Americans, little is known about the link between health literacy and healthcare services use among older Koreans. This study investigates this link, using a sample of 596 adults, 65 and older, from Korea's three largest cities. Andersen's behavior model guided the study. Findings revealed that participants with higher health literacy were significantly less likely to use emergent health services. Enhanced health literacy will likely promote better health outcomes for older Koreans and reduce Korea's healthcare costs.

Health Literacy Impact on National Healthcare Utilization and Expenditure

BACKGROUND

Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure.

METHODS

Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software.

RESULTS

The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about $172 billion.

CONCLUSION

Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs.

Gender Differences in Health Literacy Among Korean Adults: Do Women Have a Higher Level of Health Literacy Than Men?

The role of gender in determining the level of health literacy in Korean adults is unclear. This study aimed to investigate the level of health literacy in Korean adults and identify factors associated with health literacy by gender. This study employed a cross-sectional survey design with a convenient sample of 585 community-dwelling Korean adults age19 years and older. Health literacy was measured by using eight items selected from Chew et al.'s 16-question self-reported health literacy measure. In accordance with Andersen's health behavior model, predisposing, enabling, and need factors were included in the multiple regression model. Women indicated a higher level of health literacy than men in understanding medical forms, directions on medication bottles, and written information offered by health care providers. Additionally, for Korean women, a higher level of health literacy was associated with attaining a higher education level and having a consistent place to receive care. Unmarried men and men who had higher self-rated health reported a higher level of health literacy compared with their counterparts. Lower level of depression and higher monthly income were significantly linked to a higher level of health literacy in both men and women. This study has established the importance of gender differences in health literacy and suggests gender-specific intervention may be warranted to reduce the existing gap in health literacy in both Korean men and women. Future research should replicate this study to confirm whether or not our finding is an international phenomenon.

The OPtimising HEalth LIterAcy (Ophelia) process: study protocol for using health literacy profiling and community engagement to create and implement health reform

BACKGROUND

Health literacy is a multi-dimensional concept comprising a range of cognitive, affective, social, and personal skills and attributes. This paper describes the research and development protocol for a large communities-based collaborative project in Victoria, Australia that aims to identify and respond to health literacy issues for people with chronic conditions. The project, called Ophelia (OPtimising HEalth LIterAcy) Victoria, is a partnership between two universities, eight service organisations and the Victorian Government. Based on the identified issues, it will develop and pilot health literacy interventions across eight disparate health services to inform the creation of a health literacy response framework to improve health outcomes and reduce health inequalities.

METHODS/DESIGN

The protocol draws on many inputs including the experience of the partners in previous co-creation and roll-out of large-scale health-promotion initiatives. Three key conceptual models/discourses inform the protocol: intervention mapping; quality improvement collaboratives, and realist synthesis. The protocol is outcomes-oriented and focuses on two key questions: 'What are the health literacy strengths and weaknesses of clients of participating sites?', and 'How do sites interpret and respond to these in order to achieve positive health and equity outcomes for their clients?'. The process has six steps in three main phases. The first phase is a needs assessment that uses the Health Literacy Questionnaire (HLQ), a multi-dimensional measure of health literacy, to identify common health literacy needs among clients. The second phase involves front-line staff and management within each service organisation in co-creating intervention plans to strategically respond to the identified local needs. The third phase will trial the interventions within each site to determine if the site can improve identified limitations to service access and/or health outcomes.

DISCUSSION

There have been few attempts to assist agencies to identify, and respond, in a planned way, to the varied health literacy needs of their clients. This project will assess the potential for targeted, locally-developed health literacy interventions to improve access, equity and outcomes.