The Relationship between Health Literacy and Health Disparities: A Systematic Review

Health literacy disparities in South Korea: insights from a latent profile analysis

BACKGROUND

Health literacy has been empirically linked to overall health outcomes. Existing interventions generally employ a variable-centred approach, often neglecting the cumulative impact of various factors and the ways different groups interact with health information. We aimed to explore health literacy in the general population of South Korea by identifying and characterising distinct health literacy profiles using latent profile analysis.

METHODS

A cross-sectional design was utilised, analysing health literacy data from the second wave of the Korea Health Panel Survey (collected between March and July 2021) with responses from 9,509 adults. Health literacy was assessed in the domains of health management, disease prevention, and health promotion using the 16-item European Health Literacy Survey Questionnaire. Latent profile analysis was used to identify health literacy profiles, and multinomial logistic regression analysis was used to examine sociodemographic and health-related factors associated with profile membership.

RESULTS

Latent profile analysis revealed three distinct health literacy groups: low (27.91%), moderate (63.51%), and high (8.58%). A social gradient was observed, with disparities in age, education, income, and residence observed across the groups. Membership in the low health literacy group was associated with being older, disability, and chronic disease-populations with heightened healthcare needs.

CONCLUSIONS

The findings underscore the need for targeted interventions to address the unique challenges faced by populations with low health literacy in a universal health coverage system such as that of South Korea. By identifying those at highest risk for low HLit and targeting policy measures accordingly, healthcare systems can allocate resources more effectively and make health information genuinely accessible for all. In doing so, such strategies can ultimately help mitigate the disparities highlighted in this study. These insights provide a foundation for policies aimed at promoting health equity through focused health literacy initiatives.

Evaluating the Association Between Health Literacy and Patient-Reported Outcome Measures After Distal Radius Fracture

PURPOSE

Patient-reported outcome measures (PROMs) are used to assess patients' outcomes during the treatment of distal radius fractures (DRFs). Limited health literacy is linked to poorer health outcomes. We asked whether limited health literacy is associated with PROM scores in patients with a DRF.

METHODS

This cross-sectional study enrolled adults ≥18 years of age with an isolated DRF from two urban hospitals within 6 weeks of injury or surgery. Participants completed a demographics survey, brief health literacy screen, and three PROMs: Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 Short Form-7a (PROMIS-UE); and Numeric Rating Scale (NRS). Associations between social determinants of health (SDOH) factors (health literacy, income, education, and preferred language) and PROMs were assessed using multivariable linear regressions. Propensity score analyses to control for confounding and postmatching regressions were conducted.

RESULTS

Sixty-five patients participated in this study. In this sample, the mean age was 54 years, 65% were women, 26% had limited health literacy, 46% had public insurance, 18% completed at most a high school education, and 23% preferred a language other than English (PLOE). In multivariable analyses, limited health literacy and PLOE were associated with worse PROMIS-UE, and low income was associated with worse QuickDASH and NRS; associations between health literacy and QuickDASH and NRS were not statistically significant. Propensity score analyses indicated that all SDOH variables had confounding effects on associations between health literacy and PROMs. The postmatching regression analysis demonstrated that PLOE was associated with worse PROMIS-UE, and low income and PLOE with worse QuickDASH and NRS scores; limited health literacy was not significantly associated with any PROMs.

CONCLUSIONS

Low income and PLOE were significant predictors of worse PROM scores. After adjusting for other SDOH variables, limited health literacy was not significantly associated with PROM scores. These findings underscore the importance of recognizing and addressing the multiple interconnected SDOH aspects associated with PROM scores.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognosis IV.

Risk perceptions, knowledge and protection practices related to COVID-19 in Dessie City Administration, Northeast Ethiopia: a community-based study

Background

COVID-19 is a global concern due to its high transmission and mortality rates. Despite governments' efforts worldwide to control its spread, many people were hesitant to adopt preventive measures. The effectiveness of these measures largely depends on public willingness, which is influenced by their knowledge and perception of risk. Therefore, this study aimed to examine the knowledge, risk perceptions, protection practices, and related factors concerning COVID-19 in the Dessie City Administration, Northeast Ethiopia.

Methodology

This study employed a cross-sectional design. We selected seven hundred ninety participants using a systematic sampling technique. Data was collected face-to-face using an interviewer-administered questionnaire. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to summarise the sample characteristics. Multivariable logistic regression analysis was conducted using SPSS (version 23), and the results were presented in the form of text, tables, and graphs.

Results

Of the study participants, 498 (63%) had good knowledge of the pandemic, while 457 (58%) had a low-risk perception. Only 305 (39%) demonstrated good protection practices. The most trusted sources of information were healthcare personnel (686 participants, 86.8%), followed by the Ministry of Health websites (654 participants, 82.8%). Monthly income (>10,000 ETB), knowledge, and risk perceptions with AORs of 3.05 (CI: 1.51-6.14), 4.45 (CI: 2.81-7.04), 2.06 (CI: 1.38-3.08) were significantly associated with protection practices against the COVID-19 pandemic.

Conclusion

More than two-thirds of the participants demonstrated good knowledge about COVID-19. However, over half perceived themselves to be at low risk and engaged in poor preventive practices. Control efforts will be challenging, especially among younger and less educated groups who consider themselves at low risk, requiring focused attention. Understanding people's risk perceptions and beliefs about the effectiveness of COVID-19 prevention measures is essential for improving protective behaviours. Health education and active community engagement are key strategies in combating the spread of the virus.

Neighborhood characteristics and health literacy: Evidence from the survey of racism and public health

OBJECTIVES

Limited research exists on the relationship between neighborhood characteristics and health literacy. We investigated the potential impacts of neighborhood characteristics on health literacy and explored whether these associations varied across racial/ethnic groups.

STUDY DESIGN

The study was a web-based cross-sectional study of adults (18+ years old) residing in areas within the US Health and Human Services Regions 1, 2, or 3.

METHODS

The 2023 Survey of Racism and Public Health dataset was linked with the 2017-2021 American Community Survey dataset using the respondents' zip codes to obtain measures of residential segregation, neighborhood deprivation, racial and economic polarization, and racial and educational isolation. The Brief Health Literacy Screen was used to assess participants' health literacy. Unadjusted and adjusted models were employed to explore the associations between neighborhood characteristics and limited health literacy.

RESULTS

Of 4948 participants, the mean age was 47 (SD = 17) years, 48 % were White, and 42 % had college degrees or higher. Greater neighborhood deprivation was associated with an increased likelihood of limited health literacy (aOR = 1.12, 95 % CI: 1.01, 1.24). Higher racial and economic polarization was associated with decreased odds of limited health literacy (aOR = 0.83, 95 % CI: 0.73, 0.93). Increased racial isolation is associated with increased odds of limited health literacy (aOR = 1.31, 95 % CI:1.14,1.50). These associations did not significantly vary by racialized/ethnic groups.

CONCLUSIONS

Incorporating neighborhood characteristics in health literacy research helps reveal a possible critical key risk factor; higher neighborhood deprivation increases the likelihood of limited health literacy with no variation across the racial/ethnic groups within the same neighborhood. The findings point policymakers toward the direction for intervention in policy changes that will reduce the maldistribution of health-and economic-promoting resources and risky life-course exposures in communities to improve public health literacy.

Addressing Health Communication Gaps: Improving Patient Experiences and Outcomes Through Human-Centered Design

Communication gaps within healthcare systems significantly compromise patient outcomes. This article explores systemic challenges through the dual lens of personal experience as a cancer survivor and professional insights as a human-centered design leader. Drawing on an IRB-approved study and literature review, it examines how ineffective communication creates barriers to patient understanding and safety, with disproportionate impacts on marginalized populations. The article introduces an innovative application of human-centered design methodology to transform healthcare communication by prioritizing patient needs and experiences. Seven evidence-based strategies provide actionable frameworks for healthcare stakeholders to enhance communication clarity, accessibility, and effectiveness, creating a more equitable, patient-centered healthcare system that serves all populations effectively.

Mental health literacy among basic healthcare providers and community health volunteers of Lalitpur Metropolitan City, Nepal

BACKGROUND

Mental health literacy (MHL) is particularly essential for primary healthcare providers for the early recognition and management of mental disorders. In Nepal, mid-level healthcare workers and Female Community Health Volunteers (FCHVs) play a vital role in community-based mental health services, yet their MHL remains insufficiently studied. This study assesses MHL among basic healthcare providers and health volunteers in Lalitpur Metropolitan City, Nepal and identifies factors associated with it.

METHODS

A cross-sectional study was conducted among 233 healthcare workers, including mid-level healthcare providers, FCHVs, and other community health volunteers. Participants were selected through simple random sampling. MHL was measured using the Mental Health Literacy Assessment Scale (MHLAS), with scores dichotomized at the median (≥ 75 = high MHL, < 75 = low MHL). Descriptive statistics summarized key variables, while Pearson's chi-square test and odds ratios (OR) with 95% confidence intervals (CI) were used to identify associations.

RESULTS

The MHLAS score ranged between 45 and 98, with a mean score of 76 ± 9.27 and a median of 75 (IQR: 11). Out of 233 participants, 129 (55%; 95% CI: 49-62%) were classified as having high MHL. Higher education levels (OR = 9.77, p < 0.001) and mid-level healthcare provider status (OR = 2.44, p = 0.020) were significantly associated with higher MHL. Participants with 5-10 years of experience (OR = 4.50, p = 0.029) and those who received mental health training during academic courses (OR = 1.99, p = 0.022) or on the job (OR = 1.90, p = 0.036) had significantly higher MHL. However, factors such as gender, marital status, and work experience beyond 10 years were not significantly associated with MHL.

CONCLUSION

Despite their critical role in community mental health, nearly half of the primary healthcare providers in Nepal had low MHL. This study highlights the urgent need to integrate MHL training into academic curricula and ensure continuous professional development among basic health care providers.

A health literate evaluation of a reproductive health education program for young men with sickle cell disease

BACKGROUND

Health literacy (HL) is known to be low among those with sickle cell disease (SCD). Reproductive health knowledge gaps exist among those with SCD, which drove the research team to create an education tool for adolescent males entitled, 'Fertility edUcaTion to Understand ReproductivE health in Sickle cell disease' (FUTURES) in 2023. This study sought to evaluate and revise FUTURES using HL tools and a community-advised review to improve clarity, understandability, actionability, and relatability.

METHODS

Four evaluators conducted a HL assessment of the original and revised FUTURES programs using the Patient Education Assessment Tool for Audio/Visual Materials (PEMAT-AV) and the modified Centers for Disease Control and Prevention Clear Communication Index (CDC-CCI-modified). Paired samples t-tests were used to compare PEMAT-AV and CDC-CCI-modified scores between the original and revised versions of FUTURES. Community advisory board feedback identified opportunities to improve program design.

RESULTS

HL assessment revealed high HL demand of the original FUTURES program. The revised program had significantly higher understandability and clarity scores and was re-designed to be more engaging and representative of the intended audience. However, the CDC-CCI-modified score fell below the recommended threshold and actionability remained unchanged.

CONCLUSIONS

This study outlined an approach that prioritized HL and community voices when revising an education tool, which could be used in future efforts to design accessible and relatable patient education materials for this population and others. More work is needed to evaluate the impact of the HL revision process on patient knowledge and outcomes for this and other at-risk patient populations.

Immigrants' self-perceived barriers to healthcare: A systematic review of quantitative evidence in European countries

BACKGROUND

with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing.

METHODS

we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential).

RESULTS

linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned.

DISCUSSION

policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants' needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results' robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.

Health Communication on the Internet: Promoting Public Health and Exploring Disparities in the Generative AI Era

Health communication and promotion on the internet have evolved over time, driven by the development of new technologies, including generative artificial intelligence (GenAI). These technological tools offer new opportunities for both the public and professionals. However, these advancements also pose risks of exacerbating health disparities. Limited research has focused on combining these health communication mediums, particularly those enabled by new technologies like GenAI, and their applications for health promotion and health disparities. Therefore, this viewpoint, adopting a conceptual approach, provides an updated overview of health communication mediums and their role in understanding health promotion and disparities in the GenAI era. Additionally, health promotion and health disparities associated with GenAI are briefly discussed through the lens of the Technology Acceptance Model 2, the uses and gratifications theory, and the knowledge gap hypothesis. This viewpoint discusses the limitations and barriers of previous internet-based communication mediums regarding real-time responses, personalized advice, and follow-up inquiries, highlighting the potential of new technology for public health promotion. It also discusses the health disparities caused by the limitations of GenAI, such as individuals' inability to evaluate information, restricted access to services, and the lack of skill development. Overall, this study lays the groundwork for future research on how GenAI could be leveraged for public health promotion and how its challenges and barriers may exacerbate health inequities. It underscores the need for more empirical studies, as well as the importance of enhancing digital literacy and increasing access to technology for socially disadvantaged populations.

Which AI doctor would you like to see? Emulating healthcare provider-patient communication models with GPT-4: proof-of-concept and ethical exploration

Large language models (LLMs) have demonstrated potential in enhancing various aspects of healthcare, including health provider-patient communication. However, some have raised the concern that such communication may adopt implicit communication norms that deviate from what patients want or need from talking with their healthcare provider. This paper explores the possibility of using LLMs to enable patients to choose their preferred communication style when discussing their medical cases. By providing a proof-of-concept demonstration using ChatGPT-4, we suggest LLMs can emulate different healthcare provider-patient communication approaches (building on Emanuel and Emanuel's four models: paternalistic, informative, interpretive and deliberative). This allows patients to engage in a communication style that aligns with their individual needs and preferences. We also highlight potential risks associated with using LLMs in healthcare communication, such as reinforcing patients' biases and the persuasive capabilities of LLMs that may lead to unintended manipulation.

Awareness of environmental risk factors contributing to asthma exacerbations among asthmatic patients in the Jazan region, Saudi Arabia

Bronchial asthma is a common chronic airway disease marked by reversible obstruction and bronchial hyperresponsiveness. Effective management relies on patient understanding of the condition and available treatments. This study aimed to assess awareness of asthma risk factors, exacerbations, and disease severity among the population in the Jazan region of Saudi Arabia. A cross-sectional observational study was conducted through social media platforms, targeting individuals from various cities in the Jazan region. A total of 633 participants completed structured questionnaires designed to assess their knowledge of asthma and its environmental risk factors. Data were analyzed using Statistical Package for the Social Sciences software. Out of the 633 participants, 506 (79.9%) demonstrated good awareness of the relationship between environmental risk factors and asthma exacerbations, while 127 (20.1%) exhibited poor awareness. Nearly all participants (99.2%) had prior knowledge of asthma, and 437 (69%) were aware of the link between environmental factors and exacerbations, making efforts to reduce exposure. House dust mites were identified as the most frequently reported cause of asthma exacerbations (69.5%), followed by respiratory infections (67.1%). A significant association was found between educational level and awareness of asthma's environmental triggers (P = .020), with participants holding bachelor's and diploma degrees showing higher levels of awareness compared to other educational groups. The overall level of awareness regarding environmental risk factors associated with asthma exacerbations was satisfactory, though gaps remain in understanding specific triggers such as respiratory infections, cold weather, and exercise. Educational attainment and a formal asthma diagnosis were significantly associated with greater awareness. Targeted educational interventions may help bridge these knowledge gaps, enhancing asthma management, and reducing exacerbations in the region.

Health disparities and health literacy challenges experienced by individuals with hearing loss: A scoping review

OBJECTIVE

The purpose of this scoping review is to explore health disparities and health literacy challenges encountered by U.S. adults with hearing loss when trying to seek specialized care and access to medical devices such as hearing aids.

METHODS

The Arksey and O'Malley (2005) York methodology was used for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results.

RESULTS

A total of 52 articles were retained for analysis. Significant associations were reported between health literacy and health disparities when assessing the relationship between health literacy and poor health outcomes, social support surrounding health, communication with health professionals, accessibility of health information, immediacy of care, income, healthcare costs, age, and gender.

CONCLUSION

Findings will inform evidence-based strategies to increase equitable access to affordable and quality care among patients with hearing loss.

Readability of Patient Education Materials in Plastic Surgery: Assessing 14 Years of Progress

Background

Current recommendations suggest that patient education materials (PEMs) be written at or below the sixth-grade reading level. In a 2010 study, the average readability of PEMs on the American Society of Plastic Surgeons (ASPS) and The Aesthetic Society (AS) websites was found to be at the 11th-grade level or higher. We sought to assess progress made toward providing accessible PEMs.

Methods

PEMs were obtained from the ASPS and AS websites. The PEMs were entered into an online scoring tool. PEMs were scored on 3 common readability indices: Flesch-Kincaid, Simple Measure of Gobbledygook, and Flesch Reading Ease (FRE).

Results

The average grade level of ASPS PEMs calculated using the Flesch-Kincaid, Simple Measure of Gobbledygook, and FRE readability models were 9.7 ± 1.1, 12.6 ± 0.7, and 47.6 ± 6.2, respectively. This FRE score corresponds to approximately grade 13-16 reading levels. The average of AS PEMs were 9.3 ± 0.5, 12.3 ± 0.3, and 51.3 ± 3.9, respectively; this FRE corresponds to grade 10-12 reading levels. There were no PEMs written at or below the recommended sixth-grade reading level found on ASPS and AS websites.

Conclusions

Despite increasing awareness of the need for equitable access to healthcare, PEMs continue to be written at a reading level well above the recommendation. Over the past 14 years, we have seen only modest improvement in readability indices. In addition to advocating for more accessible PEMs, we must gather a deeper understanding of how patients seek information about plastic surgery.

Electronic Health Literacy among Older Adults: Development and Psychometric Validation of the Hebrew Version of the Electronic Health Literacy Questionnaire

INTRODUCTION

In the digital age, electronic health literacy (eHealth literacy) has become crucial for maintaining and improving health outcomes. As the population ages, developing and validating tools that accurately measure eHealth literacy levels among older adults in different cultures is essential.

OBJECTIVES

This study aimed to validate the Hebrew version of the electronic Health Literacy scale among Israelis aged 65 and older by assessing its psychometric properties, including content validity, construct validity, age-based convergent validity, internal consistency reliability, and test-retest reliability.

METHODS

A sample of 628 Israelis aged 65 and older was recruited using convenience sampling. Participants completed an online survey consisting of the HeHEALS, demographic questions, items related to participants' use of online health information sources, and measures of self-rated health, satisfaction with health, and perceived health compared to others. Psychometric properties were assessed using various statistical analyses.

RESULTS

The HeHEALS demonstrated good content validity, construct validity, age-based convergent validity, internal consistency reliability, and test-retest reliability. Exploratory factor analysis supported a unidimensional structure of the HeHEALS. Significant positive correlations were found between HeHEALS and education, income, and subjective health measures. Users of online health information sources had significantly higher electronic health literacy scores than non-users.

CONCLUSIONS

The HeHEALS is a valid and reliable tool for assessing eHealth literacy among older adults in Israel, with potential applications in research and practice to promote digital health equity.

Socioeconomic Status and Breast Cancer Treatment in the United States: Results From a Systematic Literature Review

BackgroundIn 2024, breast cancer is the second most common cancer globally, affecting 2.3 million women. In the United States (US), 310 720 new female breast cancer cases were estimated in 2024. Existing research has identified substantial disparities in breast cancer treatment and survival based on socioeconomic status (SES). This systematic review examines the association between the key SES indicators income, education, and occupation on breast cancer outcomes among the US breast cancer patients.MethodsAn electronic search was conducted using Medline®, Embase®, and Web of Science, from inception to December 2023. Observational studies examining the influence of SES indicators on breast cancer outcomes, including treatment receipt, adherence, and survival, were included. Data were summarized qualitatively due to heterogeneity in SES measures and outcome definitions.ResultsOf 2600 studies retrieved from the searches, 23 studies met the inclusion criteria (19 cohort, 4 cross-sectional). Women with lower SES were less likely to receive or experience delay in receiving the recommended treatment than women with higher SES. In addition, women with low household income (<$25,000) were more likely to report discontinuations in therapy as compared to women with an income of $50,000 or more. Education level influenced treatment adherence and timely care, with higher educational attainment linked to improved survival rates. Occupational status impacted treatment continuity, with low-wage jobs and inflexible work schedules contributing to delays and discontinuation of care.ConclusionSES significantly influences breast cancer care and survival, with lower SES associated with delayed treatment, poorer adherence, and worse outcomes. Healthcare interventions and policies focusing on equitable access to quality care tailored to all women, regardless of their socioeconomic background, may improve breast cancer outcomes for the patients with various demographic characteristics in the US.

Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement

Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.

Adolescent health literacy: sociodemographic determinants and its relationship with substance use avoidance

Adolescence is a critical period for health literacy (HL) development and for decision-making regarding substance use behaviors. Little is known about which sociodemographic factors are related to the three major components of HL (i.e. functional, interactive, critical HL) and the extent to which these components of HL moderate the relationship between sociodemographic determinants of substance use avoidance and avoidance for adolescents. This study aimed to identify sociodemographic determinants of functional, interactive, critical and composite HL among adolescents, and to assess HL's role as a determinant and moderator of substance use avoidance. Data were collected from 675 adolescents (mean age = 15.5 years, ~53% girls, ~32% Hispanic/Latine) through Qualtrics survey panels and in school settings. Participants completed surveys on social and demographic factors, HL, and substance use. Binary and multinomial logistic regressions were used to address the study aims. In adjusted analyses, adolescents who were girls, Hispanic/Latine (vs. White), food secure, English proficient, had private communications with health providers, and those without impaired decision-making had higher odds of having high HL. Having higher functional, interactive and composite HL increased the odds of substance use avoidance and moderated the effect of age, with younger adolescents with higher HL (vs. low HL) having greater odds of substance use avoidance. Our findings suggest that HL may act as a protective factor against the initiation of substance use in younger adolescents. Thus, HL may be a good intervention strategy to delay substance use initiation for younger adolescents.

Health literacy and mental well-being among university students in the United States

Objective: Exploration of the relationship between mental health constructs and physical health constructs can help practitioners better understand the mental health of vulnerable populations, such as college students in the United States. The purpose of this exploratory study was to investigate the connection between mental well-being and health literacy of US college students. Participants: The sample included 410 undergraduate students (63% white; 71% female) attending universities across the United States. Methods: Participants completed the All Aspects of Health Literacy Scale and the Warwick-Edinburgh Mental Well-being Scale. Univariate and bivariate statistics were observed for all study variables, and three linear regression models were run to see whether functional, communicative, and/or critical health literacy scores predicted mental well-being. Conclusions: Findings suggest that health literacy was associated with improved mental well-being among US college students, which has implications for health programming at US universities, such as the coordination of physical and mental healthcare.

Spatial associations of daily PM2.5 concentration with cardiovascular and pulmonary morbidity in Korea

Air pollution, particularly fine particulate matter less than 2.5 μm in diameter (PM2.5), contributes to respiratory and cardiovascular diseases and poses significant public health risks worldwide. This study evaluated the short-term effects of PM2.5 on hospital admissions for cardiovascular and respiratory diseases, with additional analyses to identify vulnerable populations based on regional characteristics. The present study analyzed data from 249 Korean communities between 2006 and 2021. Data on daily hospital admissions for cardiovascular and respiratory diseases were obtained from the National Health Insurance Service. Data on PM2.5 concentrations were sourced from air quality modeling. Additional data on regional characteristics, including the regional deprivation index, proportion of elderly residents, education levels, and greenness levels, were also collected. We used case time series analysis to assess the associations between PM2.5 concentrations and hospital admissions for cardiovascular and respiratory diseases and explored effect modification by regional characteristics with stratified analyses. The mean numbers of daily cardiovascular admissions and respiratory admissions were 5.68 ± 5.46 and 6.46 ± 8.03, respectively. The mean PM2.5 concentrations were 23.58 ± 13.66 μg/m3. A10 μg/m³ increment in daily PM2.5 concentration was associated with increase of cardiovascular and respiratory hospitalization by 0.94% (95% CI: 0.84%, 1.04%) and 1.43% (95% CI: 1.34%, 1.52%), respectively. Regional characteristics analysis showed significant disparities, with higher risks for hospital admissions in areas with lower deprivation and low greenness. This study highlights the significant short-term health impacts of PM2.5 on respiratory and cardiovascular hospital admissions in Korean communities. The findings underscore the critical role of regional and demographic factors in modulating these effects, identifying socio-economic areas, age structure of the population, lower education levels, and low greenness as key vulnerability factors.

Neighborhood socioeconomic factors and characteristics correlated with avoidable emergency department visits: A spatial analysis of a Canadian academic hospital

INTRODUCTION

The influence of neighborhood characteristics and socioeconomic status (SES) factors on avoidable emergency department (ED) utilization is not well understood in a universal healthcare system. We examined correlations between these factors and avoidable ED visits at a Canadian academic hospital.

MATERIALS AND METHODS

We conducted a retrospective cohort study using administrative ED data from a hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023, and neighborhood data from the Statistics Canada Census of Population 2021. Avoidable visits were classified using the Emergency Department Avoidability Classification (EDAC), and mapped to neighborhoods using Canadian postal codes. SES was defined primarily based on education attained, household income, employment and housing security. The top 20 postal codes with the highest avoidable ED visits were categorized into quartiles and analyzed for trends using chi-squared tests of spatial association and Spearman rank correlations.

RESULTS

A consistent ordinal trend across quartiles was observed throughout the study period, with quartile 1 representing the lowest avoidable ED visits and quartile 4 the highest. The quartiles were unevenly distributed spatially, though there was a significant association between close proximity to the ED and avoidable visits (X2 = 7.07, p <0.05). The quartile with the highest avoidable ED visits (quartile 4) had the greatest proportion of one-person households (35.5%) and one-parent families (37.8%), and showed statistically significant positive correlations with male sex, living alone and having an indigenous identity. Quartile 4 had the highest rates of individuals not completing high school (18.6%, p < 0.05), unemployment (13.7%), households spending greater than 30% of their income on shelter (26.5%), and households earning less than $30,000 annually (16.6%, compared to 8.7% in quartile 1 with the lowest avoidable ED visits).

DISCUSSION

In a universal healthcare setting, lower SES neighborhoods were correlated with higher rates of avoidable ED visits. Targeted interventions that address social determinants of health disparities in neighborhoods with lower SES could reduce the burden of avoidable ED visits, and promote more equitable healthcare utilization.

Factors Associated with Health-Seeking Behavior in Indonesia: Evidence from the Indonesian Family Life Survey 2014

Background and Objectives: Health-seeking behavior is a critical determinant of health outcomes, particularly in countries like Indonesia. Given the increasing burden of noncommunicable diseases, understanding the factors that influence health-seeking behavior in this context is essential for developing more accessible and effective public health strategies. This study aimed to identify various factors associated with health-seeking behavior among patients with chronic diseases across Indonesia, especially in formal facilities. Materials and Methods: This study used a cross-sectional research design, utilizing Indonesian Family Life Survey (IFLS)-5 data. The inclusion criteria included respondents aged 20-74 years old with at least one chronic disease based on self-reported data. Respondents who did not receive treatment, practiced self-medication, or provided incomplete data were excluded. We used multivariate logistic regression to identify factors associated with health-seeking behavior in formal facilities. Results: The results revealed that 80.7% (n = 1993) of the 2471 respondents sought treatment in formal facilities, whereas 19.3% (n = 478) opted for informal facilities. Respondents who were Bugis (OR 9.187, 95% CI 2.182-38.683; p = 0.002), retired (OR 2.966, 95% CI 1.233-7.135; p = 0.015), did not smoke (OR 1.604, 95% CI 1.126-2.285; p = 0.009), made less than IDR 1,500,000 a month (OR 1.466, 95% CI 1.174-1.831; p = 0.000), had to travel more than 3 km to reach a treatment facility (OR 1.847, 95% CI 1.41-2.42; p = 0.000), or had more than one comorbidity (OR 1.396, 95% CI; p = 0.01) were more likely to seek treatment at formal facilities. Conclusions: These findings are expected to provide recommendations for policymakers, healthcare providers, and researchers to contribute to the development of targeted interventions that can improve healthcare access and utilization, ultimately enhancing health outcomes and equity in Indonesia.

Experiences of Low-Income Indonesian Pregnant Women Regarding the Challenges of Receiving Health Services: A Qualitative Content Analysis

Background

The information needs of low-income pregnant women are multisectoral, encompassing both pregnancy-related and non-pregnancy-related information. Barriers to receiving information for low-income pregnant women are specific and complex. This study aimed to explore the experiences of low-income Indonesian pregnant women regarding the challenges of receiving health information.

Methods

A qualitative study was conducted using content analysis according to Graneheim and Lundman's approach between January and June 2022. A total of 17 women were selected for this study using purposive sampling. In-depth interviews were done following semi-structured interview guidelines, concluding when saturation was reached. Nvivo software version March 2020 was used for organizing data and analysis.

Results

Three themes emerged concerning receiving health information among low-income women, including encountering barriers to accessing information and care, access to ineffective information sources, and difficulties in applying pregnancy health information.

Conclusion

This study shows that barriers to receiving information are specific to low-income pregnant women. Therefore, solution approaches must also be specific. Efforts to improve receiving health information can be achieved through developing educational materials that are easy to access and understand, improving e-health literacy, refining counseling skills among village midwives, holding culturally tailored educational programs, improving mothers' health literacy by family and husbands, integrating counseling with a focus on critical literacy, and formulating policies to alleviate the midwife's workload.

The Digital Health Revolution: Exploring the Impact of Online Cancer Information on Self-Reported Preventive Behaviors

Cancer, one of the leading causes of death worldwide, is a disease characterized by uncontrolled cell growth within the body. While there have been many improvements in the treatment of cancer clinically, there is now an urgent need to improve cancer-related communication. This study explores the impact of online health information, specifically cancer-related information and prevention, among members of the general public. Through a randomized survey, we examined what information leads people to take action to minimize their cancer risk and communicate with their providers. Through evaluation of the various modes of communication, we were able to provide insight into which are more effective and better received by members of the general public. Through this, ways of bettering these avenues of communication and strengthening the bond between them will be highlighted and more easily elaborated on by future studies. The results of our study indicated that 60% of participants asserted that they are motivated by online preventive information to take steps to limit their cancer risk, while only roughly 44% of participants overall agreed that their doctor has communicated with them about when proper cancer screenings should be scheduled for the future. Although patients may be turning to the Internet now more than ever due to various reasons, when comparing self-reported rates of comprehension among the study participants, 35% agreed that the cancer-related information they can access online is confusing, while fewer than 22% of participants agreed that the cancer-related information they receive directly from their doctor is confusing. This is indicative of the limitations the Internet may have when undertaking the role of being a medical resource, especially when acting as a replacement for in-person medical appointments where patients can communicate directly with their physicians. Ultimately, these results provide a unique perspective into how people receive, evaluate, and implement cancer-preventive steps and general health-related information in a post-COVID-19 world, where the Internet is now strongly embedded in healthcare.

Factors associated with knowledge and practices of COVID-19 prevention among mothers of under-2 children in Bangladesh

The COVID-19 pandemic extensively impacted maternal, neonatal, and child health (MNCH) in Bangladesh. Misconceptions arising from a lack of knowledge related to the virus contributed to reduced uptake of MNCH services, which eventually helped increase maternal and neonatal mortality rates during the pandemic. In this study, we assessed the knowledge and practices related to COVID-19 prevention among the mothers of under-2 children in Bangladesh. The study was conducted in May 2021 as part of a broader research project related to COVID-19 response on MNCH service utilization. We collected data from 2207 mothers in six districts of Bangladesh using a multi-stage cluster sampling technique. We constructed weighted and unweighted composite knowledge and practice scores and identified different socio-demographic characteristics associated with the scores using multilevel generalized mixed-effect linear regression models. In general, the mothers revealed poor knowledge and practices related to COVID-19. On a weighted scale of 100, the mean composite knowledge and practice scores were 32.6 (SD = 16.4) and 53.1 (SD = 13.9), respectively. The mothers presented inadequate knowledge about COVID-19 transmission, symptoms, and the recommended preventive measures. At the same time, maintaining a safe physical distance was the least practiced preventative measure (10.3%). Level of education, access to television, and the internet were significantly positively associated with their knowledge and practices related to COVID-19. Knowledge score was also positively associated with the practice score (OR = 1.26; p-value <0.001). Mothers living in islands or wetlands scored poorly compared to those living in inland. The results indicate significant gaps in knowledge and practices related to COVID-19 prevention among mothers of under-2 children. Addressing these gaps, particularly by targeting mothers with lower levels of education and residing in hard-to-reach geographic locations, could consequently help enhance MNCH service uptake during pandemics like COVID-19.

Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population

BACKGROUND

Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to validate a novel three-item question set for predicting health literacy.

METHODS

This cross-sectional study utilized an in-person questionnaire alongside the S-TOFHLA. The sample included 2027 English- and Spanish-speaking adults (≥18 years) recruited from primary care practices serving a low-income eastern Pennsylvania community. Most patients (57.7%) identified as Hispanic. Diagnostic accuracy of each question and aggregated scores were assessed against the validated survey by calculating the area under the receiver operating characteristic (AUROC) curve.

RESULTS

Questions in the 'Problems Learning' and 'Help Reading' domains (AUROC 0.66 for each) performed better than the 'Confident Forms' question (AUROC 0.64). Summing all three scores resulted in an even higher AUROC curve (0.71). Cronbach's alpha of the combined items was 0.696.

CONCLUSIONS

Study results suggest that any of the three questions are viable options for screening health literacy levels of diverse patients in primary care clinical settings. However, they perform better as a summed score than when used individually.

Improving Health Literacy of Elective Procedures in Pediatric Otolaryngology

OBJECTIVE

To identify if the addition of supplementary material, such as video or written resources, to the consent process, can improve a patient's or guardian's health literacy in pediatric otolaryngology.

STUDY DESIGN

Prospective randomized crossover design.

SETTING

Tertiary Academic Center.

METHODS

From April 18, 2022 to August 29, 2023, 151 children scheduled to undergo 1 of 6 procedures by the same provider were queried and completed a 6-question baseline test based on the information. They each watched a 2-minute video and read a written summary about the procedure; the order of resources was randomized. They answered the same 6-questions after viewing each resource. All tests were scored based on accuracy using an ordinal scale of 1 to 6. Resource preference was collected. Wilcoxon signed-rank tests were run to analyze differences in scores after the addition of supplementary resources and logistic regression modeling was run to analyze demographic effects on postresource score differences.

RESULTS

Of 151 participants, 74.2% were guardians, with 78.8% having completed a high school or greater education. The Wilcoxon signed-rank test indicated that postresource scores were statistically significantly higher (P < .001) than pretest scores. Logistic regression modeling showed that participants were less likely to show score improved if they were younger than 18 and were of white race. A majority (87.4%) preferred the addition of a video to the consent process.

CONCLUSION

The addition of video or written resources significantly improves understanding of elective procedures. The development of procedure-specific resources can supplement the consent process and ensure decision-makers have adequate health literacy for informed decision-making.

Readability of Patient Education Materials in Head and Neck Cancer: A Systematic Review

Importance

Patient education materials (PEMs) can promote patient engagement, satisfaction, and treatment adherence. The American Medical Association recommends that PEMs be developed for a sixth-grade or lower reading level. Health literacy (HL) refers to an individual's ability to seek, understand, and use health information to make appropriate decisions regarding their health. Patients with suboptimal HL may not be able to understand or act on health information and are at risk for adverse health outcomes.

Objective

To assess the readability of PEMs on head and neck cancer (HNC) and to evaluate HL among patients with HNC.

Evidence Review

A systematic review of the literature was performed by searching Cochrane, PubMed, and Scopus for peer-reviewed studies published from 1995 to 2024 using the keywords head and neck cancer, readability, health literacy, and related synonyms. Full-text studies in English that evaluated readability and/or HL measures were included. Readability assessments included the Flesch-Kincaid Grade Level (FKGL grade, 0-20, with higher grades indicating greater reading difficulty) and Flesch Reading Ease (FRE score, 1-100, with higher scores indicating easier readability), among others. Reviews, conference materials, opinion letters, and guidelines were excluded. Study quality was assessed using the Appraisal Tool for Cross-Sectional Studies.

Findings

Of the 3235 studies identified, 17 studies assessing the readability of 1124 HNC PEMs produced by professional societies, hospitals, and others were included. The mean FKGL grade ranged from 8.8 to 14.8; none of the studies reported a mean FKGL of grade 6 or lower. Eight studies assessed HL and found inadequate HL prevalence ranging from 11.9% to 47.0%.

Conclusions and Relevance

These findings indicate that more than one-third of patients with HNC demonstrate inadequate HL, yet none of the PEMs assessed were developed for a sixth grade or lower reading level, as recommended by the American Medical Association. This incongruence highlights the need to address the readability of HNC PEMs to improve patient understanding of the disease and to mitigate potential barriers to shared decision-making for patients with HNC. It is crucial to acknowledge the responsibility of health care professionals to produce and promote more effective PEMs to dismantle the potentially preventable literacy barriers.

Assessing the readability and quality of online patient information for laser tattooremoval

Just as tattoos continue to increase in popularity, many people with tattoos also seek removal, often due to career concerns. Prospective clients interested in laser tattoo removal may do research about the procedure online, as the internet increasingly becomes a resource to get preliminary health information. However, it is important that the online health information on the topic be of high quality and be accessible to all patients. We analyzed 77 websites from a Google search query using the terms "Laser tattoo removal patient Information" and "Laser tattoo removal patient Instructions" to assess this. The websites were evaluated for their readability using multiple validated indices and comprehensiveness. We found that websites had a broad readability range, from elementary to college, though most were above the recommended eighth-grade reading level. Less than half of the websites adequately discussed the increased risk of pigmentary complications in the skin of color clients or emphasized the importance of consulting with a board-certified dermatologist/plastic surgeon before the procedure. Over 90% of the websites noted that multiple laser treatments are likely needed for complete clearance of tattoos. The findings from our study underscore a significant gap in the accessibility and quality of online information for patients considering laser tattoo removal, particularly in addressing specific risks for patients with darker skin tones and emphasizing the need for consulting a board-certified physician before undergoing the procedure. It is important that online resources for laser tattoo removal be appropriately written to allow better decision-making, expectations, and future satisfaction for potential clients interested in the procedure.

The impact of digital economy development on public health: evidence from Chinese cities

Introduction

The swift advancement of the digital economy not only plays a crucial role in stimulating a country's economic growth but also exerts a significant influence on national health and well-being.

Methods

Adopts the data of 285 prefecture-level cities in China from 2010 to 2022, and employs the panel data fixed-effects model, spatial Durbin model, and mediated effects model to study the impact of digital economic development on the level of urban public health.

Results

It is found that digital economic development significantly improves the level of urban public health, and the effect has a spatial spillover effect. The impact of digital economic development on urban public health is mainly concentrated in cities with higher levels of economic development, higher levels of digital economic development, and lower levels of urban public health. Among them, technological innovation and information dissemination are the main dissemination channels through which digital economic development affects the level of urban public health.

Discussion

The advancement of the digital economy significantly impacts urban public health. It is advisable to bolster policies guiding digital economy development, enhance cross-sector collaboration between the digital economy and public health, reinforce public health education and awareness campaigns, improve the digital health literacy of the population, continue to enhance the fairness and accessibility of basic medical services, and address and bridge the "digital divide" between regions, as well as urban and rural areas.

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study

BACKGROUND

India is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population.

METHODS

A community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person.

RESULTS

The prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02-1.09). Physical inactivity (AOR 1.68, 95% CI 1.027-2.77) and lack of social support (AOR 1.57, 95% CI 1.01-2.45) also increased the likelihood of multimorbidity.

CONCLUSION

There is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Health literacy strengths and needs among migrant communities from Portuguese-speaking African countries in Portugal: a cross-sectional study

Introduction

Health literacy among migrants is a matter of public health and social justice. Migrants from diverse backgrounds encounter challenges such as linguistic barriers, cultural disparities, restricted access to health services, and heterogeneous migration statuses. Addressing these challenges requires careful consideration of their unique experiences and needs to promote equitable health outcomes. This can hinder their ability to navigate the healthcare system, understand health information, and engage in health-promoting behaviours. However, there is still a significant gap in our understanding of health literacy within migrant communities. This study has a dual aim: to identify health literacy strengths and needs among migrants from Portuguese-speaking African Countries (PALOP) countries in the Lisbon Metropolitan Area and to examine associations between demographic, socioeconomic, migration and health condition characteristics and the health literacy domains.

Methods

A cross-sectional survey was conducted. Data were collected from 506 PALOP migrants using the Health Literacy Questionnaire (HLQ). We also collected demographic, socioeconomic, migration, and health condition data. We employed multiple linear regression to understand the relationship between the HLQ nine domains and these characteristics.

Results

The HLQ scores revealed distinct patterns of health literacy between the groups. Health literacy needs were particularly evident in the domains related to feeling understood and supported by healthcare providers and navigating the healthcare system. Conversely, higher scores and potential strengths were observed in actively managing one's health and understanding enough health information to make informed decisions. However, in these, the average scores suggest that a high proportion of people recognised difficulties. 'The results also indicated that a higher educational level was associated with increased health literacy. In contrast, low self-perceived health status, living alone, shorter duration of residence in Portugal, and being either undocumented or in the process of obtaining legal status were associated with lower health literacy.

Conclusion

Our study highlights the importance of migration-related variables and self-reported health status in understanding health literacy among migrant communities. Factors such as length of stay and low self-perceived health status are associated with potentially disadvantageous levels of health literacy, which could exacerbate health inequalities. Assessing these variables is critical to identify gaps in health literacy and develop tailored interventions to reduce health inequalities.

Racial Composition of Past and Current Social Environments and Health Literacy

BACKGROUND

Research is needed to understand the impact of social determinants of health on health literacy throughout the life course. This study examined how racial composition of multiple past and current social environments was related to adults' health literacy.

METHODS

In this study, 546 adult patients at a primary care clinic in St. Louis, Missouri, completed a self-administered written questionnaire that assessed demographic characteristics and a verbally administered component that assessed health literacy with the Rapid Estimate of Adult Literacy in Medicine - Revised (REALM-R) and Newest Vital Sign (NVS), and self-reported racial composition of six past and four current social environments. Multilevel logistic regression models were built to examine the relationships between racial composition of past and current social environments and health literacy.

RESULTS

Most participants identified as Black or multiracial (61%), had a high school diploma or less (54%), and household income <$20,000 (72%). About 56% had adequate health literacy based on REALM-R and 38% based on NVS. In regression models, participants with multiple past white environments (e.g., locations/conditions in which most of the people who live, go to school, work, and have leisure time are White) and (vs. 0 or 1) were more likely to have adequate health literacy based on REALM-R (adjusted odds ratio [aOR] = 1.79; 95% confidence interval [CI]: 1.04-3.07). Similarly, participants who had multiple past white social environments were more likely (aOR = 1.94, 95% CI: 1.15-3.27) to have adequate health literacy based on NVS than those who had not. The racial composition of current social environments was not significantly associated with health literacy in either model.

CONCLUSIONS

Racial composition of past, but not current, educational and residential social environments was significantly associated with adult health literacy. The results highlight the importance of examining the impact of social determinants over the life course on health literacy. The findings suggest that policies ensuring equitable access to educational resources in school and community contexts is critical to improving equitable health literacy. [HLRP: Health Literacy Research and Practice. 2024;8(3):e130-e139.].

Initiating and Maintaining a Lifestyle Program Directed at Persons Living with Severe Mental Illness in a Municipality Care Setting

Lifestyle programs are effective in improving the health of persons living with severe mental illness. However, the implementation of these programs and making them a sustainable part of daily care remain challenging. This qualitative descriptive study aimed to describe how staff worked with and experienced a lifestyle program in a municipality mental health care setting over time. The program intended to support persons living with severe mental illness to overcome health challenges. Data was collected at three time points spanning 7 years. The staff motivated the participants with SMI with severe mental illness to take part in the program, prepared them, and gave them individualized lifestyle support. A key factor of the program's implementation was the staff's interest and engagement in lifestyle questions. According to the staff it was apparent that small efforts such as running the present program could give synergic health effects such as improved mental- and social health. This study shows that it is feasible to conduct this lifestyle program in ordinary care without considerable resources. However, support from management is crucial, as well as the development of guidelines and routines of the work with lifestyle questions.

Health literacy in cancer care: A systematic review

PURPOSE

Health literacy (HL) is a set of knowledge and skills that enables individuals to interpret and act upon health information, which is essential for health equity. There is a growing body of evidence in the field of HL in cancer care but there is, to our knowledge, no systematic review that explores the association between sociodemographic factors and HL among patients with cancer. The aim of this study was therefore to conduct a systematic review of the existing literature that assesses HL levels and the relationship between HL and sociodemographic factors in an adult cancer population.

METHODS

This is a systematic review and its protocol was registered in PROSPERO (ID: CRD42021164071). The study was conducted in accordance with the PRISMA statement. The literature search, from December 2009 to September 2023, was made in six databases, AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science Core Collection.

RESULTS

Fifteen studies were included in the review. The included studies used nine different measurement tools for assessing HL. In the included studies between 11.9 % and 86 % had limited HL. We identified a relationship between limited HL and annual income, education level, ethnicity, living in rural areas and multiple comorbidities.

CONCLUSION

The results indicate that limited HL is prevalent in the cancer population and should be acknowledge in everyday practice to meet health equity. Our awareness about sociodemographic factors and its association with HL, may enhance adherence to cancer treatment and quality of life, and lower physical and emotional distress.

Exploring Racial and Ethnic Differences in Parent-Reported Strengths in Children with Autism Spectrum Disorder

BACKGROUND

Several studies have demonstrated racial/ethnic differences in parental concerns in children with autism spectrum disorder (ASD). However, no studies have investigated racial/ethnic differences in parent-reported strengths. The purpose of this study was to explore racial/ethnic differences in parent-reported strengths in children with ASD.

DESIGN AND METHODS

This was a retrospective cross-sectional study investigating the relationship between parent-reported strengths and race/ethnicity at the time of an ASD diagnosis. Parent-reported strengths were qualitatively clustered into themes, and theme frequencies were quantitatively examined for relationships to race/ethnicity.

RESULTS

Parents of Caucasian children reported a mean of 5.00 (SD = 2.17) total strengths compared to 3.75 (SD = 2.32) among Hispanic/Latinx children, 3.36 (SD = 1.43) among Asian/PI children, and 3.91 (SD = 2.05) among children from other races/ethnicities. Bivariate linear regression analyses indicated that Asian/PI, Hispanic, and other child race/ethnicity, compared to Caucasian child race/ethnicity, were associated with significantly fewer parent-reported total strengths. Asian/PI and Hispanic child race/ethnicity were associated with significantly fewer personality strengths, while maternal education was associated with a greater number of personality strengths.

CONCLUSION

This study found racial and ethnic differences in parent-reported strengths in children with ASD. Further, higher levels of maternal education influenced total, personality, and behavioral strengths. Receipt of a greater number of child services was also associated with a greater number of behavioral strengths.

A mobile app for chronic disease self-management for individuals with low health literacy: A multisite randomized controlled clinical trial

The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in patients 40 years and older with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. A randomized controlled trial was completed at two sites. Individuals aged 40 years and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. The mobile app may have been effective in increasing participants' levels of several psychosocial variables, but this interpretation can only be advanced tentatively in light of lack of control-experimental group differences. Reading difficulty level was not significantly related to outcomes.

Health literacy and asthma: An update

The US Department of Health and Human Services has defined health literacy (HL) as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Structural and social determinants of health lead to low HL in approximately 36% of adults in the United States, where this condition is most prevalent in racial and ethnic minorities, economically disadvantaged communities, and immigrants with limited English proficiency. In turn, low HL can worsen asthma outcomes through direct effects (eg, nonadherence to or incorrect use of medications) and indirect effects (eg, an unhealthy diet leading to obesity, a risk factor for asthma morbidity). The purpose of this update is to examine evidence from studies on low HL and health and asthma outcomes published in the last 12 years, identify approaches to improve HL and reduce health disparities in asthma, and discuss future directions for research in this area under the conceptual framework of a socioecological model that illustrates the multifactorial and interconnected complexity of this public health issue at different levels.

Does health literacy mediate the relationship between socioeconomic status and health related outcomes in the Belgian adult population?

BACKGROUND

Health literacy (HL) has been put forward as a potential mediator through which socioeconomic status (SES) affects health. This study explores whether HL mediates the relation between SES and a selection of health or health-related outcomes.

METHODS

Data from the participants of the Belgian health interview survey 2018 aged 18 years or older were individually linked with data from the Belgian compulsory health insurance (n = 8080). HL was assessed with the HLS-EU-Q6. Mediation analyses were performed with health behaviour (physical activity, diet, alcohol and tobacco consumption), health status (perceived health status, mental health status), use of medicine (purchase of antibiotics), and use of preventive care (preventive dental care, influenza vaccination, breast cancer screening) as dependent outcome variables, educational attainment and income as independent variables of interest, age and sex as potential confounders and HL as mediating variable.

RESULTS

The study showed that unhealthy behaviours (except alcohol consumption), poorer health status, higher use of medicine and lower use of preventive care (except flu vaccination) were associated with low SES (i.e., low education and low income) and with insufficient HL. HL partially mediated the relationship between education and health behaviour, perceived health status and mental health status, accounting for 3.8-16.0% of the total effect. HL also constituted a pathway by which income influences health behaviour, perceived health status, mental health status and preventive dental care, with the mediation effects accounting for 2.1-10.8% of the total effect.

CONCLUSIONS

Although the influence of HL in the pathway is limited, our findings suggest that strategies for improving various health-related outcomes among low SES groups should include initiatives to enhance HL in these population groups. Further research is needed to confirm our results and to better explore the mediating effects of HL.

Health literacy and its association with mental and spiritual well-being among women experiencing homelessness

Low health literacy (HL) has been linked to low self-rated health, reduced efficacy of behaviour change, and challenges in preventing, treating, or managing health conditions. People experiencing homelessness are at risk of poor HL; however, few studies have investigated HL in relation to mental and spiritual well-being among people experiencing homelessness in general, or women experiencing homelessness specifically. This cross-sectional study of 46 women experiencing homelessness in Stockholm, Sweden, recruited during the period October 2019-December 2020, aimed to examine how HL was associated with mental and spiritual well-being among women experiencing homelessness. Participants answered questions about socio-demographic characteristics (age, length of homelessness, education) and digital technology (mobile phone/the Internet) use, in addition to Swedish language versions of three questionnaires administered through structured, face-to-face interviews: the Communicative and Critical Health Literacy Scale, the General Health Questionnaire 12 and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. Data were analysed using linear regression, which revealed statistically significant associations between HL and mental well-being (p = .009), and between HL and spiritual well-being (p = .022). However, neither socio-demographic characteristics nor digital technology use were significantly associated with HL. In conclusion, promoting HL may improve mental and spiritual well-being in this vulnerable population. An advisory board of women with lived experiences of homelessness (n = 5) supported the interpretation of the findings and emphasised the need to consider HL in relation to basic needs such as 'housing first'. Moreover, health information and services should be accessible to people with different degrees of HL.

Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis

BACKGROUND

Although sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality.

METHODS

We performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression.

RESULTS

Among the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors.

CONCLUSIONS

Age was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.

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

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

Mining the health disparities and minority health bibliome: A computational scoping review and gap analysis of 200,000+ articles

Without comprehensive examination of available literature on health disparities and minority health (HDMH), the field is left vulnerable to disproportionately focus on specific populations or conditions, curtailing our ability to fully advance health equity. Using scalable open-source methods, we conducted a computational scoping review of more than 200,000 articles to investigate major populations, conditions, and themes as well as notable gaps. We also compared trends in studied conditions to their relative prevalence using insurance claims (42 million Americans). HDMH publications represent 1% of articles in Medical Literature Analysis and Retrieval System Online (MEDLINE). Most studies are observational in nature, although randomized trial reporting has increased fivefold in the past 20 years. Half of HDMH articles concentrate on only three disease groups (cancer, mental health, and endocrine/metabolic disorders), while hearing, vision, and skin-related conditions are among the least well represented despite substantial prevalence. To support further investigation, we present HDMH Monitor, an interactive dashboard and repository generated from the HDMH bibliome.

Cancer Health Literacy and Its Correlated Factors in the United Arab Emirates-A Cross Sectional Study

INTRODUCTION

Cancer Health literacy (CHL) is the health literacy related to cancer knowledge, prevention, treatment, screening, and access to services. It is an important indicator of people's adherence to screening and preventive measures, which helps to reduce the incidence and prevalence of cancer. The study assessed the CHL level and its association with relevant socio-demographic characteristics and sources of information among primary health care patients and visitors in the United Arab Emirates (UAE).

METHODS

A cross-sectional study recruited survey participants who consented to respond to an interviewer-administered questionnaire. The assessment of CHL was done by using 15 questions. CHL level was measured as a median score and also categorized as poor/inadequate, moderate, good/excellent. Nominal logistic regression was used to analyze the relationship between CHL categories and participants' sociodemographic characteristics and CHL sources of information.

RESULTS

Of the total 492 participants, 45.5% were young adults (30-39 years old), 32.9% were males, and 70.8% were UAE nationals. The overall median CHL score was 8.0 (IQR = 5.0-10). 33.7% of the participants had a poor/inadequate level of CHL, 49.6% had a moderate level and 16.7% had a good to excellent level of CHL. 76.9% of the participants knew the importance of early cancer screening tests, 72.7% acknowledged the metastatic capacity of cancer, and the protective factors of cancer, especially, in colon cancer (71.7%). A high proportion of participants received health information about cancer via the internet (50.7%), television (45.3%), social media (40.2%), and doctors (43.6%). Nationality other than UAE (aOR = 1.62, 95% CI = 1.03-2.56, P = .038), having university education (aOR = 2.20, 95% CI = 1.21-3.99, P = .010) compared to those with lower than high school, and having a family history of cancer (aOR = 2.42, 95% CI = 1.33-4.41, P = .004) were positively associated with CHL. Older age (aOR = .36, 95% CI = .17-.75, P = .007 for 50-59 years, and aOR = .29, 95% CI = .11-.82, P = .019) for 60-69 years, higher-income (aOR = .57, 95% CI = .33-.99, P = .047 for 10,000-19,999 AED; aOR = .53, 95% CI = .33-.88, P = .013 for ≥20,000) compared with those earning <10,000 AED were negatively associated with CHL.

CONCLUSIONS

CHL among the resident UAE population was moderately adequate, therefore implementation of awareness campaigns seems to be warranted. Moreover, evaluation research targeting the CHL impact on cancer prevention practices and screening is also advocated.

A mixed-method systematic literature review of health literacy interventions for people with disabilities

AIMS

To identify the components and characteristics of health literacy interventions for people with disabilities and to explore the outcomes in terms of health literacy competencies.

DESIGN

A mixed-method systematic literature review.

REVIEW METHODS

The search results were reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The quality appraisal was guided by the Mixed Methods Appraisal Tool. The contents of each intervention were mapped to the health literacy intervention model and the outcomes were annotated using the integrated model of health literacy.

DATA SOURCES

The literature search was conducted using several electronic databases, including PubMed, EMBASE, CINAHL, Cochrane library and PsycINFO in December 2022.

RESULTS

Ten studies were selected for this systematic literature review. Seven studies were quantitative, two were qualitative and one was a mixed-methods study. The four components of the health literacy interventions included empowering individuals with low-health literacy (n = 10), strengthening individuals' social support system (n = 3), improving communication with health professionals (n = 1) and reducing barriers to access health systems (n = 3). No intervention addressed improving health professionals' health literacy competencies. Health literacy competencies identified as outcomes in the studies included access (n = 1), understand (n = 7), appraise (n = 1) and apply (n = 9) the health information.

CONCLUSIONS

The significant findings of this systematic literature review provide baseline data and evidence for developing health literacy interventions for people with disabilities. However, this review demonstrates that only a handful of intervention studies have addressed the low-health literacy of people with disabilities. Further and more rigorous interventions addressing health literacy for people with diverse disabilities are warranted.

IMPACT

This review provides insights into how health literacy interventions can be tailored to the type of disability. Further, efforts should be expanded to comprehensively promote all the four core competencies of health literacy to reduce health disparities for individuals living with disabilities.

NO PATIENT OR PUBLIC CONTRIBUTION

Systematic literature review.

Using self-reported health as a social determinants of health outcome: a scoping review of reviews

Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure.

Emergency department performance assessment using administrative data: A managerial framework

Administrative data play an important role in performance monitoring of healthcare providers. Nonetheless, little attention has been given so far to the emergency department (ED) evaluation. In addition, most of existing research focuses on a single core ED function, such as treatment or triage, thus providing a limited picture of performance. The goal of this study is to harness the value of routinely produced records proposing a framework for multidimensional performance evaluation of EDs able to support internal decision stakeholders in managing operations. Starting with the overview of administrative data, and the definition of the desired framework's characteristics from the perspective of decision stakeholders, a review of the academic literature on ED performance measures and indicators is conducted. A performance measurement framework is designed using 224 ED performance metrics (measures and indicators) satisfying established selection criteria. Real-world feedback on the framework is obtained through expert interviews. Metrics in the proposed ED performance measurement framework are arranged along three dimensions: performance (quality of care, time-efficiency, throughput), analysis unit (physician, disease etc.), and time-period (quarter, year, etc.). The framework has been judged as "clear and intuitive", "useful for planning", able to "reveal inefficiencies in care process" and "transform existing data into decision support information" by the key ED decision stakeholders of a teaching hospital. Administrative data can be a new cornerstone for health care operation management. A framework of ED-specific indicators based on administrative data enables multi-dimensional performance assessment in a timely and cost-effective manner, an essential requirement for nowadays resource-constrained hospitals. Moreover, such a framework can support different stakeholders' decision making as it allows the creation of a customized metrics sets for performance analysis with the desired granularity.

Relationship between health literacy and attitudes toward acupuncture: A web-based cross-sectional survey with a panel of Japanese residents

The relationship between health literacy of Japanese people, their attitudes toward acupuncture, and their behavior in choosing this therapy is currently unclear. Therefore, for this study, we conducted a web-based survey to address this unknown relationship. A questionnaire comprising four categories (health status, health literacy, previous acupuncture experience, and attitudes toward acupuncture) was administered to 1,600 Japanese participants. For this study, we performed cross-tabulation and path analysis to examine the relationship between each questionnaire item. The mean score of participants' health literacy was 3.41 (SD = 0.74), and older, educated, female participants tended to have higher health literacy. The respondents perceived acupuncture to be effective for chronic low back pain, tension-type headache, and knee pain due to osteoarthritis (40.0%, 38.7%, and 21.8%, respectively). Contrastingly, acupuncture was perceived as far less effective for postoperative nausea/vomiting and prostatitis symptoms (8.3% and 8.7%, respectively). Of the total study respondents, 34.4% reported that they would try acupuncture only if recommended by clinical practice guidelines, and 35.6% agreed that acupuncture is safe. The path analysis showed that attitudes toward acupuncture were significantly influenced by the participants' health literacy, number of information sources, and previous acupuncture experience. However, it was also found that experience with acupuncture was not directly associated with health literacy. Although the Japanese population with higher health literacy is more likely to perceive acupuncture positively, they do not necessarily have sufficient relevant knowledge of the clinical evidence. Therefore, their decision to receive acupuncture may be more dependent on personal narratives rather than clinical evidence. Thus, future challenges lie in individual education of the population on how to choose a reliable health information source, and organizational efforts to provide more reliable health information.

Mining the Health Disparities and Minority Health Bibliome: A Computational Scoping Review and Gap Analysis of 200,000+ Articles

Without comprehensive examination of available literature on health disparities and minority health (HDMH), the field is left vulnerable to disproportionately focus on specific populations or conditions, curtailing our ability to fully advance health equity. Using scalable open-source methods, we conducted a computational scoping review of more than 200,000 articles to investigate major populations, conditions, and themes in the literature as well as notable gaps. We also compared trends in studied conditions to their relative prevalence in the general population using insurance claims (42MM Americans). HDMH publications represent 1% of articles in MEDLINE. Most studies are observational in nature, though randomized trial reporting has increased five-fold in the last twenty years. Half of all HDMH articles concentrate on only three disease groups (cancer, mental health, endocrine/metabolic disorders), while hearing, vision, and skin-related conditions are among the least well represented despite substantial prevalence. To support further investigation, we also present HDMH Monitor, an interactive dashboard and repository generated from the HDMH bibliome.

Letting people flourish: defining and suggesting skills for maintaining and improving positive health

Background

The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health.

Subsections

Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers.

Discussion and conclusion

The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.

Health literacy: association with socioeconomic determinants and the use of health services in Spain

Background

Health literacy (HL) is the set of social and cognitive skills that determine person's level of motivation and the ability to access, understand and use information to promote and maintain good health. The aim of this study is to assess the level of health literacy, and to analyze its relationship with sociodemographic variables, state of health, and use of health services in the population aged 15 and over in the Valencian Community (Spain).

Methods

Cross-sectional study based on a sample of 5,485 subjects participating in the Health Survey of the Valencia Community. The HLS-EU-Q16 was used. As outcome variables we considered HL categorized into 2 levels: Inadequate or Problematic HL and Sufficient HL and the standardized literacy index. Prevalence rates and HL means were estimated and OR were calculated to analyze the association between variables.

Results

A total of 12.8% of the subjects surveyed presented an inadequate or problematic degree of HL. This percentage was higher in people >85 years (63.1%), with a low level of education (46.5%), in retired people (27.4%) or in other work situations (25.0%), in foreigners (18.1%), in low-income people (16.2%), with a perception of poor health status (26.9%), chronic disease (18.5%) or with activity limitations (56.4% severe, 19.7% not severe). Significant differences were found. With the exception of chronic disease, all the variables analyzed were associated with HL. Low HL was associated with a lower consumption of medicines, a greater use of health services, general medical consultations, poorer knowledge of new health technologies and fewer preventive health visits.

Conclusion

The percentage of inadequate or problematic HL was globally not very high, but certain population subgroups notably presented a high degree of inadequate or problematic HL. Raising the HL level of such groups should be regarded as a priority. HL was shown to be associated with the service use and new health technology use. Enhancing the population's HL should lead to the following: a greater probability of adopting preventive practices; improving the use of the health system; and boosting people's abilities to manage and to improve their own health.