Health literacy and health outcomes among older patients suffering from chronic diseases: A moderated mediation model

The Association Between Medication Adherence and Rational Drug Use Knowledge and Health Literacy in Older Adults Residing in Nursing Homes

BACKGROUND

Medication adherence is a crucial factor in managing and treating chronic diseases in older adults. Health literacy (HL) skills and rational drug use (RDU) knowledge are important for individuals to make informed decisions about medication adherence behaviours.

AIM

This study was conducted to determine the association between medication adherence and rational drug use knowledge and health literacy in older adults residing in nursing homes.

METHODS

The cross-sectional study was conducted with 121 older adults residing in a nursing home in Turkey. The data were collected using the Participant Information Form, the Medication Adherence Report Scale (MARS-5), the Rational Drug Use Scale (RDUS), and The Turkish version of the European Health Literacy Survey Questionnaire (HLS EUEU-Q-TR).

RESULTS

The mean age of the older adults was 69.92 ± 6.45 years and 76.9% were male. The mean score of MARS-5 was 21.80 ± 3.55. Among older adults, 43.8% were found to have inadequate RDU knowledge, 28.9% had inadequate HL, and 46.3% had problematic-limited HL. The RDU knowledge was a statistically significant strong predictor of medication adherence (R2 = 0.495, p < 0.001). The HL was a statistically significant predictor of medication adherence (R2 = 0.037, p < 0.05).

CONCLUSION

The study found that medication adherence among older adults residing in nursing homes was moderate, RDU knowledge and HL levels were low, and medication adherence increased as RDU knowledge and HL levels increased.

Understanding of Health literacy among Healthcare students in Saudi Arabia: a cross-sectional study

BACKGROUND AND OBJECTIVE

Health literacy is the cognitive and social abilities that influence a person's motivation and capacity to learn, comprehend, and use information to improve and maintain good health. We aimed to investigate Healthcare Students' knowledge, attitudes, and practices regarding Health Literacy in the Riyadh Province of Saudi Arabia.

METHODS

This study used prevalidated electronic questionnaires among healthcare undergraduates from colleges affiliated with Saudi University in Riyadh, Saudi Arabia, from December to April 2024. Healthcare students were asked to answer a self-designed online questionnaire sent to them through social media platforms.

RESULTS

The response rate was 560 out of 600 (93.3%); 293 of the 560 students (52.3%) were aged between 23 and 24 years (mean age was 21.29 SD = 1.852). The mean GPA among the students was 4.31(± 0.682). The average overall score for health literacy among healthcare students was 100.92 ± 11.80. The mean scores for knowledge were 24.17 ± 4.67, attitudes were 38.65 ± 4.20, and practice in health literacy was 38.09 ± 5.09. Among all healthcare students, 50.2% reported good knowledge, 54.1% had good attitudes, and 50.1% exhibited good practices in health literacy. However, students' knowledge (p = 0.019) and training (p = 0.024) in health literacy were significantly associated with smoking cigarettes. Additionally, smoking shisha was significantly associated with students' knowledge (p = 0.022), attitudes (p = 0.001), and practices (p = 0.001) in health literacy.

CONCLUSION

Our study highlights that half of the healthcare students reported limited knowledge, attitude, and practice in health literacy. Age, gender, and course of study did not show significant differences. Rather, students who did not smoke cigarettes or shisha were found to have higher knowledge, attitudes, and practice in health literacy compared to smokers. However, to improve health literacy, additional education and increased awareness are needed. Further investigation is warranted to address the factors related to poor health literacy.

An Exploration of Self-Efficacy and Its Associated Factors among Rheumatoid Arthritis Patients in Taiwan

Self-efficacy is an important ingredient in successful disease management, especially in patients with chronic conditions such as rheumatoid arthritis (RA). However, the information on self-efficacy and its influencing factors among RA patients is scarce. This study investigated the level of self-efficacy and its pertinent predictors among RA patients in Taiwan. This cross-sectional study recruited patients with RA from a hospital in Taiwan between January and October 2023. A structured questionnaire was used to collect data on respondents' demographic and job characteristics and included a Chinese version of the Arthritis Self-Efficacy Scale (ASES). Multiple linear stepwise regression analysis was employed to identify predictors of self-efficacy. A total of 284 RA patients were enrolled during the study period. The mean ASES score among enrollees was 1607.1, indicating a moderate level of self-efficacy (score range of 200-2000). The regression model displayed that those with higher disease activity scores, Taiwanese Depression Questionnaire scores, fatigue level, shorter disease duration, swollen upper limb joints, and no regular exercise regimen reported lower ASES scores, accounted for 46% of the total variance. The study findings may be useful for healthcare providers in identifying RA patients with low self-efficacy attitudes, a trait that appears to be linked to several medical indicators, and thus facilitating the provision of future tailored healthcare regimens.

Serial mediation roles of empowerment and self-care activities connecting health literacy, quality of life, and glycemic control in people with type 2 diabetes

BACKGROUND

Health literacy, empowerment, and self-care activities are likely the crucial concepts affecting the quality of life and glycemic control in people with type 2 diabetes (T2D). However, evidence demonstrating the mechanisms underlying these concepts is scarce.

AIMS

The aim of this study was to test the serial mediation roles of empowerment and self-care activities on the relationships between health literacy and quality of life and between health literacy and hemoglobin A1c (HbA1c) in people with T2D.

METHODS

A cross-sectional study was conducted among 319 people with T2D in Guangzhou, China, from July 2019 to January 2020. Data were collected using the Health Literacy Scale, the Diabetes Empowerment Scale-Short Form, the Summary of Diabetes Self-Care Activities Measure, and the Adjusted Diabetes-Specific Quality of Life Scale. RStudio 4.2.1 was used for serial mediation analysis.

RESULTS

The dimension of communicative health literacy accounted for the most total variance (β = 0.810, p < .001) in the construct of health literacy. The serial multiple mediation of empowerment and self-care activities in the associations between health literacy and quality of life (β = -.046, p = .019) and between health literacy and HbA1c (β = -.045, p = .005) were statistically significant.

LINKING EVIDENCE TO ACTION

This study emphasized the vital role of communicative health literacy when improving health literacy in people with T2D. Diabetes care and education specialists could implement empowerment approaches and flexible self-care strategies to improve the quality of life and glycemic control in people with T2D. Enhancing health literacy was suggested as a favorable strategy for promoting empowerment and self-care activities in people with T2D.

Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model

BACKGROUND

Health literacy is the important for the prevention of non-communicable disease to make informed health decisions, and practice healthy and protective behaviours. Therefore, application of socioecological model to this study aimed to identify multilevel factors on health literacy among patients and develop scientific health communication interventional strategies to improve health literacy on non-communicable disease prevention and care.

OBJECTIVE

To explore barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public Hospitals, Northeast Ethiopia, 2023.

METHOD

In this study phenomenological study design was conducted from February 5 to 30/2023.We have used purposive sampling technique to select study participants from chronic follow up clinics. Data were collected using in-depth interview and focused group discussion in which audio was recorded, transcribed verbatim and translated to English. Thematic analysis was performed with atlas ti. 7 software.

RESULT

In this study four main themes with seven subthemes were developed. The main themes were factors at the organizational, community, interpersonal, and intra-personal factors. The poor knowledge, lack of enough money for transportation and medication at the hospital were identified as barrier to get early diagnosis and treatment. Some participants explored that they have no any support from family or others. The cultural norms like weeding and funeral ceremonies enforce patients to consume prohibited substances like alcohol and salty foods.

CONCLUSION

In this study different barriers of health literacy were explored. Lack of knowledge, economic problems, lack of social support, poor communication with health care providers, cultural influences, lack of regular health education, lack of access to health care services and poor infrastructure were main barriers of health literacy in patients with NCD. Therefore, we recommended all concerned bodies to work on social and behavioral change communication intervention focusing on awareness creation, supply of drugs and create supportive environment to get accessible and affordable health care service to decrease the impact of non-communicable disease at personal, community and national level.

Health Literacy and Self-Care in Patients with Chronic Illness: A Systematic Review and Meta-Analysis Protocol

Self-care plays a critical role in symptom recognition, management, and risk factor modification for patients with chronic illnesses. Despite its significance, self-care levels in this population are generally poor. Health literacy (HL) is pivotal for promoting effective self-care, yet the association across specific chronic illnesses remains fragmented and conflicting. Therefore, a systematic review and meta-analysis will be conducted. Inclusion criteria encompass quantitative studies involving adult patients with at least one chronic illness reporting on the association between a measure of HL and one or more elements of self-care behaviors as outcomes. Databases to be searched include PubMed, CINAHL, APA PsycINFO, Embase, Web of Science, and Cochrane Central Register of Controlled Trials. The studies will undergo risk of bias and certainty of evidence assessment using ROBINS-E and GRADE. Extracted data will include authors, publication date, aim(s), study location, design, sample characteristics, chronic illness type, study length, HL, and self-care measures. Understanding the link between HL and self-care can aid healthcare providers in implementing strategies to enhance health-promoting behaviors, contributing valuable insights to the scientific community and fostering nuanced discussions. This protocol ensures methodological transparency, stimulates discourse, and paves the way for informed interventions to improve overall health outcomes.

Health literacy, worry about unmet needs for medical care, and psychological well-being among older Chinese adults

AIM

This study aims to examine the relationship between older adults' health literacy and their psychological well-being and the role of worry about future unmet needs for medical care in mediating this relationship.

METHODS

We adopted a sample of 965 older Chinese people aged 60+ (49.74% female) from the 2021 Chinese General Social Survey. A series of structural equation models (SEMs) were performed. Health literacy was measured by three items regarding older people's ability to understand medical professionals, ask them questions, and read medical instructions. A single-item question was adopted to measure participants' worry about unmet needs for future medical care. Psychological well-being was measured by three items regarding emotional problems and depressed or anxious mood in the past 4 weeks.

RESULTS

Worry about future unmet needs for medical care mediates the relationship between lack of health literacy and Chinese older people's psychological well-being. The indirect effect accounts for 22.3% of the total effect. The SEM model has a satisfactory model fit (goodness of fit index = 1.000, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.009, standardized root mean square residual = 0.023, chi-square test = 50.96,  P = 0.321).

CONCLUSIONS

The findings of this study underscore the importance of improving communication quality between healthcare providers and older adults. Clinical interventions that promote health literacy and address worries about unmet needs for medical services may benefit older adults. Geriatr Gerontol Int 2024; 24: 202-207.

Health Literacy, Self-Efficacy and Glycemic Control in Patients With Diabetes Type 2 in a Greek Population

Aim  To investigate the relationship between health literacy (HL), self-efficacy (SE), and achievement of treatment goals in patients with type 2 diabetes mellitus (T2DM). Method The cross-sectional study was conducted with a random sample of patients with T2DM attending the diabetology clinic and the Home Care department of the General Hospital of Drama, Greece. They completed two questionnaires: the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to measure HL and the Diabetes Management Self-Efficacy Scale (DMSES) for people with T2DM to measure SE. Medical history, demographic characteristics, and values related to glycemic control were also recorded. Linear regression analysis was used to search for the dependence of glycosylated hemoglobin (A1C) values with HL and SE and the dependence between them. Result About 120 patients with T2DM (response rate of 92.3%) were enrolled in the study. The mean age of the participants was 62.5 years [standard deviation (SD) = 10.6 years] and most of them were female (53.3%). A1C was found to be significantly negatively associated with diet, physical activity, and SE score. Also, a statistically significant positive correlation was found between HL and SE. HL was correlated with age, gender, education level, and A1C, with women and older people having lower HL, while conversely higher education level was significantly associated with higher HL. Higher A1C was significantly associated with lower HL. Also, SE partially mediates the relationship between HL and A1C, in a significant way. Conclusion The results of the study confirm the important role of HL and SE in the successful management of T2DM. Multi-level educational interventions for diabetic patients could improve HL and SE and promote diabetes self-management.

Is Arabic online patient-centered information about dental extraction trustworthy? An infodemiological study

Background

Assessment of the Arabic online patient-centered information is understudied. The study aims to assess the quality and readability of the Arabic web-based knowledge about dental extraction.

Methods

The first 100 Arabic websites focusing on dental extraction were gathered using popular terms from Google, Bing, and Yahoo searches. These sites were organized and their quality was assessed using three key standards: the Journal of the American Medical Association (JAMA) benchmark criteria, the DISCERN instrument, and the inclusion of the Health on the Net Foundation Code of Conduct (HON code) seal. Additionally, the ease of reading of these websites was evaluated through various online readability indexes.

Results

Out of 300 initially reviewed websites on dental extraction in Arabic, 80 met the eligibility criteria. Nonprofit organizations were most common (41.3%), followed by university/medical centers (36.3%), and commercial entities (21.3%). Government organizations were minimally represented (1.3%). All websites were medically oriented, with 60% offering Q&A sections. Quality assessment showed moderate scores on the DISCERN instrument, with no site reaching the highest score. JAMA benchmarks were poorly met, and none had the HON code seal. Readability was generally high, with most sites scoring favorably on readability scales.

Conclusions

The rapidly evolving online information about dental extraction lacks readability and quality and can spread misinformation. Creators should focus on clear, unbiased content using simple language for better public understanding.

The role of self-efficacy and self-care agency as mediating factors in the link between health literacy and health-promoting lifestyle among older adults post covid 19 era: A multiple mediator model

Health-promoting lifestyle is poor in older adults during COVID-19 pandemic. Elucidate the underlying mechanisms between health literacy and health-promoting lifestyle is important. Therefore, we investigated the mediating effect of self-efficacy and self-care agency in relation between health literacy and health-promoting lifestyle among older adults post covid 19 era. A cross-sectional descriptive survey on 200 older adults with the mean age of 68.3 were recruited from Lecai urban community in China, through convenience sampling. Information was assessed using Health literacy Assessment Scale for Infectious Diseases of Chinese Residents, the General Self Efficacy Scale, Chinese version of the Elderly Self-care Ability Scale, and the Health-Promoting Lifestyle Profile-Chinese Elderly. A serial multiple mediation modeling was tested using the PROCESS macro for SPSS to validate the pathways. Results indicated that positive correlations were found between health literacy, self-efficacy, self-care agency and health-promoting lifestyle in older adults. Meanwhile, health literacy was linked to enhanced health-promoting lifestyle through two pathways: (1) self-efficacy; (2) chain combination of self-efficacy and self-care agency. Self-efficacy and self-care agency mediated the relationship between health literacy and health-promoting lifestyle in older adults. Therefore, attention to improving self-efficacy, self-care agency and health literacy should be considered crucial for improving health-promoting lifestyle.

Navigating Health Literacy and Practices: A Cross-Sectional Study on Nursing Undergraduates in Riyadh, Saudi Arabia

BACKGROUND This study aimed to assess the health literacy (HL) and health practices (HP) among nursing undergraduates at King Saud University in Riyadh, Saudi Arabia. MATERIAL AND METHODS A cross-sectional survey-based study was conducted in 2023 to assess how nursing students perceive HL and HP. HL is the ability of individuals to acquire, interpret, assess, and act on information to promote and maintain good health, while HP involves the application of knowledge and skills. HL was assessed using a total of 16 items, subdivided into 4 domains (understanding, evaluating, accessing, and utilizing health information) while HP was assessed using 11 items on a 5-point Likert scale. RESULTS In this study, 53.9% of the students were found to have poor HP, while 40.9% (n=166) reported moderate HP, and 5.2% (n=21) reported good HP. With regards to HL, 38.9% (n=158) of students were found to have good HL while 52.2% (n=212) reported moderate HL, and 8.9% (n=36) reported poor HL. The findings indicated that there was a relationship between age and HP, indicating that age is a major predictor of HP (P=0.001). Other comparisons, including year of study, income source, marital status, and the prevalence of chronic conditions, were discovered to have a significant relationship (P=0.001) with HP levels. CONCLUSIONS According to these findings, most students reported poor HP, while one-third claimed good HL. Therefore, there is a need to address the factors related to poor HP while also recommending methods to support good HP among students.