Strengthening Critical Health Literacy for Health Information Appraisal: An Approach from Argumentation Theory

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.

Strengthening adolescents' critical health literacy and scientific literacy to tackle mis- and dis-information. A feasibility study in Switzerland

Objectives

We aimed to develop and test the feasibility of a critical health literacy (CHL) and science literacy (SL) training course targeting secondary school students in Switzerland.

Methods

Using a community-based participatory approach, we developed a two-block training program, the first centered on argumentation skills and the second on scientific skills. We combined an ex-cathedra and a flipped-classroom approach, providing students with a deep understanding of CHL and SL concepts and the translational capability of implementing theoretical notions to real case scenarios. The feasibility study was designed as a one-group pretest-posttest quasi-experiment. Beyond socio-demographics, questionnaires included measures of CHL, SL, trust in science, and perceived quality of the course.

Results

The curriculum was feasible and well-accepted by the target groups, teachers, and students. Students convincingly specified their perceived personal benefits associated with a positive change in CHL and SL scores after the training course.

Conclusion

Training CHL and SL in secondary school students is feasible and can improve their competencies. Results from present study can inform a large-scale study.

Institutional crisis communication during the COVID-19 pandemic in Switzerland. A qualitative study of the experiences of representatives of public health organizations

OBJECTIVES

To identify the main challenges in public communication encountered by representatives in Swiss health institutions during the first two waves of the COVID-19 pandemic.

METHODS

In-depth qualitative interviews were conducted with representatives of key public health institutions (N = 25) across Switzerland. Participants were asked to identify barriers, facilitators, problems, and solutions in their public communication. The interviews were analyzed thematically.

RESULTS

Swiss institutional communication faced internal challenges (e.g., lack of human resources and training, rigid organizational structure), external challenges related to the public (e.g., low health and scientific literacy, low levels of trust), and environmental challenges related to the broader context (e.g., infodemics). At the same time, institutions developed best practices to foster collaboration, promote transparency, and address misinformation.

CONCLUSION

Health organizations need a cultural shift to account for the increasing complexity of crisis communication. Their awareness of the importance of communication should match the implementation of enhanced dedicated infrastructures and processes.

PRACTICE IMPLICATIONS

Institutions need mechanisms allowing innovation and adaptation to prepare for future pandemics. Emphasis should be placed on training communication professionals who can design, develop, deliver, and evaluate texts that meet the information needs of the public, enhance health and scientific literacy, and counter mis/disinformation.

Psychometrics of the Persian version of the COVID-19-related health literacy in the Iranian population

Background

Since the occurrence of the COVID-19 pandemic, information dissemination has increased rapidly. Promoting health literacy is currently crucial to prepare people to respond quickly to situations, such as the COVID-19 pandemic. Due to the importance of health literacy in this critical situation, we are looking for a questionnaire to measure COVID-19 health literacy. The COVID-19 Germany Health Literacy Questionnaire (HLS-COVID-Q22) is an excellent tool, so the study aimed to create a cultural validity of this questionnaire for the Iranian population.

Methods

In this validation study, 880 samples were enrolled using a convenient sampling method. The questionnaire was translated through a backward forwarding procedure. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were employed for Persian version validity. McDonald's omega (Ω), Cronbach's alpha, and average inter-item correlation (AIC) coefficients were assessed for reliability.

Results

Using EFA on the random half sample (n = 440), the EFA indicated that the scale had four factors: accessing, understanding, appraising, and applying health-related information in the COVID-19 pandemic context, which explained 59.3% of the total variance. CFA was used for the sample's second part (n = 440) to evaluate the goodness of fit of the four-factor solution. CFA showed the model fit. All indices RMSEA = 0.067, CFI = 0.934, IFI = 0.934, PCFI = 0.772, PNFI = 0.747, and CMIN/DF = 2.972 confirmed the model fit. The convergent validity of the HLS-COVID-Q22 was confirmed. McDonald's omega and Cronbach's alpha were very good (α and Ω >0.80).

Conclusion

The Persian version of the HLS-COVID-Q22 had acceptable psychometric properties and is applicable to measure COVID-19 health literacy.

Effects of Health Literacy in the Fight Against the COVID-19 Infodemic: The Case of Japan

This study quantitatively examines whether health literacy can reduce belief in COVID-19 misinformation and conspiracy theories. Conducting path and cluster analyses on survey data collected from 1,488 adults in Japan in 2021, we found that while health literacy reduces people's belief about COVID-19 and vaccination misinformation, it has no direct effect on their belief in COVID-19 conspiracy theories. That said, the results also highlighted the importance of health literacy. It is found that even though high health literacy does not guarantee a low degree of conspiracy beliefs, low health literacy is associated with high susceptibility to both misinformation and conspiracy theories. Moreover, people who relied more on social media than mass media for COVID-19 news and reported on having been more severely affected by the pandemic were found to be more likely to have lower health literacy and higher belief in misinformation and conspiracy theories. Based on the findings, we discussed ways to enhance health literacy research and promotion in Japan.

Current Status and Associated Factors of Health Information Literacy Among the Community Elderly in Central China in the COVID-19 Pandemic: A Cross-Sectional Study

Purpose

COVID-19 posed a threat to the public’s physical and mental health, and under outbreak control, the opportunities to go outside of the elderly have been reduced and making it more difficult to access health information and detrimental to their health management. This study aims to assess the current status of health information literacy (HIL) among older adults in the community in the context of COVID-19 and to identify its associated factors.

Methods

A cross-sectional survey was conducted from April to July, 2021, for which 617 community elderly members were recruited in Chenzhou, China. Data were collected through a general information questionnaire, The Chinese residents’ HIL self-rated scale and a reliability evaluation form.

Results

The average score of HIL was 75.87 ± 9.85, and after processed by the 100-point system, we found 84.12% (519/617) of the participants scored less than 60 points, which indicates that the overall level of HIL among the community elderly is low. Multiple linear regression showed that age, gender, education, annual family Income, living arrangement, and chronic disease status (β = –0.341, –0.296, 0.384, 0.327, 0.296, 0.356, respectively; all P < 0.001) were significantly associated with the level of HIL found among the community elderly, out of which education was the most important associated factor.

Conclusion

The overall HIL level among the community elderly was low in Central China during the COVID-19 pandemic. Our results further prove the need for tailor-made health education programs for this group, with particular attention paid to the low-educated and low-income among them. Those measures must highlight on three aspects of health information search, evaluation, and application skills to offer useful experiences that improve the HIL level of the elderly and strengthen their ability to cope with emerging public health events.

Vaccine Literacy and Source of Information about Vaccination among Staff of Nursing Homes: A Cross-Sectional Survey Conducted in Tuscany (Italy)

Vaccine literacy (VL) mediates the transfer of information and facilitates vaccination acceptance. The aims of this study are to validate the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano—Vaccine health literacy for adults in Italian language) for the staff of nursing homes (NHs), to measure VL in such a peculiar target group, and to assess its relationship with the sources used to obtain information about vaccines and vaccinations. A survey has been conducted in a sample of Tuscan NHs using an online questionnaire. Eight-hundred and fifty-three questionnaires were analyzed. Two dimensions of the HLVa-IT appeared (functional and interactive/communicative/critical VL). The HLVa-IT interactive/communicative/critical subscale score was slightly higher than the functional subscale, although with no statistical significance. General practitioners (GPs) or other professionals have been reported as the main source of information by most of the respondents (66.1%). The HLVa-IT total score was significantly higher among those who have declared to use official vaccination campaigns (mean score: 3.25 ± 0.49; p < 0.001), GPs or other health professionals (3.26 ± 0.47; p < 0.001), and search engines (3.27 ± 0.48; p = 0.040) as the main sources of information. In conclusion, the HLVa-IT could be reliable test to investigate VL for staff of NHs, and also to highlight criticalities related to information sources.

Exploring the Online Health Information-Seeking Behavior in a Sample of Italian Women: The "SEI Donna" Study

There is much discussion about the skills of people in understanding and managing online health information. The Italian survey “SEI Donna” aimed to investigate perceptions and use of the web in women regarding health issues considering their health literacy (HL) and healthcare skills. We used an online questionnaire to explore different aspects of online health-related information-seeking behavior. The study participants (n = 7027) were categorized into healthcare workers (HW), healthcare students (HS), and non-healthcare women (non-HW). Half the sample (52%) searched online for a second opinion after the medical examination without statistical difference among HW, HS, and non-HW. Women in the age range of 26−40 years (OR = 1.28, p < 0.001), having chronic illness (OR = 1.48; p < 0.001), and being moderately (OR = 1.58; p < 0.001) or not satisfied (OR = 2.04; p < 0.001) with healthcare professionals were more likely to use the Internet to seek medical insight. Overall, 34% of women had a functional HL, the same being higher in HW (64%) and in HS (43%) than the rest of the women (18%) (p < 0.0001). The suboptimal HL suggests the need to improve HL in the general population to be skilled in surfing the web and, at the same time, to reorganize health training to improve the HL of healthcare professionals, also enriching their communication skills.