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Self-Identification of Mental Health Problems Among Young Adults Experiencing Homelessness. Community Ment Health J 2023; 59:844-854. [PMID: 36681751 PMCID: PMC9867546 DOI: 10.1007/s10597-022-01068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023]
Abstract
Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify.
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Summanen AM, Rautopuro J, Kannas L, Paakkari L. Measuring Health Literacy in Basic Education in Finland: The Development of a Curriculum- and Performance-Based Measurement Instrument. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15170. [PMID: 36429888 PMCID: PMC9690733 DOI: 10.3390/ijerph192215170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
This paper describes the development of an objective curriculum- and performance-based health literacy (HL) measurement instrument to assess Finnish 9th graders' learning outcomes in the school subject termed Health Education (HE). There were four phases: (i) construction of the theoretical framework for the measurement, (ii) item generation, (iii) the field test (n = 252), and (iv) item analysis and item selection for the main study, in which 3652 ninth grade pupils (aged 15-16) participated. Initially, 303 HL test items were formulated, of which 107 were tested in two different field test versions. Both versions exhibited high reliability as measured by Cronbach's alpha coefficient. The main study contained 55 items. Testing and item analysis enabled the development of a comprehensive competence- and curriculum-based HL measurement instrument for school-aged children. Measurement of HL in schools provides information for national policies, and for developing HE as a school subject.
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Affiliation(s)
- Anna-Mari Summanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylän yliopisto, Finland
| | - Juhani Rautopuro
- Finnish Institute for Educational Research, University of Jyväskylä, 40014 Jyväskylän yliopisto, Finland
| | - Lasse Kannas
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylän yliopisto, Finland
| | - Leena Paakkari
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylän yliopisto, Finland
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Fleary SA, Freund KM, Nigg CR. Development and validation of assessments of adolescent health literacy: a Rasch measurement model approach. BMC Public Health 2022; 22:585. [PMID: 35331182 PMCID: PMC8953064 DOI: 10.1186/s12889-022-12924-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Health literacy (HL) is implicated in improved health decision-making and health promotion, and reduced racial, ethnic, and socioeconomic health disparities. Three major areas of HL include functional, interactive, and critical HL. HL skills develop throughout the lifespan as individuals' psychosocial and cognitive capacities develop and as they accumulate experiences with navigating health systems. Though adolescence is marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. Both the adult and adolescent HL literature are also limited by the paucity of validated test-based measures for assessing HL. The existing test-based validated HL measures for adolescents were originally designed for adults. However, adolescents are at an earlier phase of developing their HL skills (e.g., fewer experiences navigating the health system) compared to adults and measures originally designed for adults may assume prior knowledge that adolescents may lack therein underestimating adolescents' HL. This study developed and validated test-based assessments of adolescents' functional, interactive, and critical HL. METHODS Items were generated in an iterative process: focus groups with adolescents informed item content, cognitive interviews with adolescents and expert consultation established content and face validity of the initial items, and items were revised or removed where indicated. High school students (n = 355) completed a measurement battery including the revised HL items. The items were evaluated and validated using Rasch measurement models. RESULTS The final 6-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (23 items) fit their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12-15-year-olds vs. 16-18-year-olds), and ethnicity in all assessments. The assessments had good convergent validity with an established measure of functional HL and scores on the assessments were positively related to reading instructions before taking medicine and questioning the truthfulness of health information found online. CONCLUSIONS These assessments are the first test-based measures of adolescents' interactive and critical HL, the first test-based measure of functional HL designed for adolescents, and the first composite test-based assessment of all three major areas of HL. These assessments should be used to inform strategies for improving adolescents' HL, decision-making, and behaviors.
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Affiliation(s)
- Sasha A Fleary
- Current address: Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA. .,Eliot-Pearson Department of Child Study and Human Development, Tufts University, 105 College Ave, Medford, MA, 02155, USA.
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Claudio R Nigg
- Department of Health Science, Institute of Sports Science, University of Bern, Bremgartenstrasse, 145 3012, Bern, Switzerland
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Desman AR, Fields HW, Ni A, Robinson FG, Skulski B, Firestone AR, Heinlein DJ. Rehearsal's effect on long-term recall and comprehension of orthodontic informed consent. Am J Orthod Dentofacial Orthop 2021; 161:e114-e126. [PMID: 34625316 DOI: 10.1016/j.ajodo.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices. METHODS A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later. RESULTS Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P <0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge >20% was common. CONCLUSIONS Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.
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Affiliation(s)
- Alexander R Desman
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Henry W Fields
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio.
| | - Andy Ni
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Fonda G Robinson
- Division of Oral and Maxillofacial Radiology, The Ohio State University College of Dentistry, Columbus, Ohio
| | | | - Allen R Firestone
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio
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Park SK, Kim EG. A Study on the Reliability and Validity of the Korean Health Literacy Instrument for Late School-Aged Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910304. [PMID: 34639605 PMCID: PMC8508180 DOI: 10.3390/ijerph181910304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to develop and validate the Korean Health Literacy Instrument, which measures Korean late school-aged children's understanding capacity. The construct's concepts were drawn from the literature review and interviews with school nurses and teachers. A survey was then conducted in 552 fifth and sixth graders in nine elementary schools, from 1 to 9 May 2014. The KR-20 coefficient for reliability, difficulty index, discrimination index, item-total correlation, and known group technique for validity were performed. An exploratory factor analysis was performed to test the construct validity of the instrument and its unidimensionality. The results reveal that a two-factor structure was appropriate for the Korean school-age health literacy tool (root mean square error of approximation = 0.06, Comparative Fit Index = 0.96, and Tucker-Lewis Index = 0.95). From the remaining 16 items, the internal consistency reliability coefficient of this instrument was 0.85, and the criterion-related validity was 0.62 (p < 0.001). The Korean health literacy instrument for late school-aged children was suitable for screening individuals who have limited health literacy. Based on the findings of this study, future studies must continue to conduct empirical investigations on the Korean health literacy instrument for late school-aged children.
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Affiliation(s)
- Sook-Kyoung Park
- College of Nursing, Jeonbuk National University, Jeonju 54896, Korea;
| | - Eun-Gyeong Kim
- Department of Nursing, Kunsan National University, Gunsan 54150, Korea
- Correspondence: ; Tel.:+82-63-469-7429
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Rehearsal's effect on recall and comprehension of orthodontic informed consent. Am J Orthod Dentofacial Orthop 2021; 159:e331-e341. [PMID: 33573895 DOI: 10.1016/j.ajodo.2020.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Proper informed consent allows patients to take an active role in their own treatment decisions, and enhanced compliance might improve treatment outcomes. The objective of this research was to determine if handwritten rehearsal of core and custom consent items would increase short-term recall and comprehension. METHODS A total of 90 patient-parent pairs were randomly assigned to 2 groups. After case presentation, each subject was provided 10 minutes to read a modified informed consent document. Group A received visual printouts containing the 4 core elements (root resorption, decalcification, pain, and relapse/retention) likely to be encountered by all patients and up to 4 custom elements (eg, impacted teeth, orthognathic surgery, or other case-specific treatment issues). Subjects identified and wrote what the image depicted and how it could affect treatment. Group B viewed a slideshow presentation on all 18 consent elements arranged from general to specific. All participants were interviewed, and each provided their sociodemographic data, as well as completed literacy, health literacy, and state anxiety questionnaires. The groups were compared for recall and comprehension through an analysis of covariance. RESULTS The rehearsal intervention significantly improved recall and comprehension of the core elements (P = 0.001). Rehearsal also improved custom recall and comprehension, but not significantly. Group B performed significantly better on treatment questions (P = 0.001). Overall, as anxiety increased, correct responses decreased. CONCLUSIONS The rehearsal group improved recall and comprehension of the core and custom elements of informed consent and proved a more efficient method than an audiovisual presentation to provide informed consent. It also improved meeting legal obligations.
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Lane HG, Aldoory L. Recommendations for Measurement of Child Health Literacy: A Pragmatic Approach. Health Lit Res Pract 2019; 3:e165-e169. [PMID: 31410387 PMCID: PMC6685604 DOI: 10.3928/24748307-20190521-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Hannah G. Lane
- Address correspondence to Hannah G. Lane, PhD, MPH, Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD 21201;
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Guo S, Armstrong R, Waters E, Sathish T, Alif SM, Browne GR, Yu X. Quality of health literacy instruments used in children and adolescents: a systematic review. BMJ Open 2018; 8:e020080. [PMID: 29903787 PMCID: PMC6009458 DOI: 10.1136/bmjopen-2017-020080] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Improving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use. DESIGN Systematic review. SETTING A wide range of settings including schools, clinics and communities. PARTICIPANTS Children and/or adolescents aged 6-24 years. PRIMARY AND SECONDARY OUTCOME MEASURES Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments. RESULTS There were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability. CONCLUSIONS More rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.
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Affiliation(s)
- Shuaijun Guo
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Community Child Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Rebecca Armstrong
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Waters
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thirunavukkarasu Sathish
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sheikh M Alif
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Geoffrey R Browne
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xiaoming Yu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
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