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Annual Review of Public Health Apr 2021Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not... (Review)
Review
Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not a panacea for addressing health inequities created by the maldistribution of opportunity and resources. It is possible to optimize the contribution health literacy makes in mediating the causes and effects of established social determinants of health. Existing interventions demonstrate the feasibility of improving health literacy among higher-risk populations, but research remains underdeveloped and effects on health inequity are largely untested. Future health literacy intervention research should focus on () improving the quality of health communication that reaches a diversity of populations, especially by improving frontline professional skills and support; () enabling people to develop transferable skills in accessing, understanding, analyzing, and applying health information; and () ensuring that priority is proportionate to need by reaching and engaging the population groups who are disproportionately affected by low health literacy.
Topics: Health Literacy; Humans; Social Determinants of Health
PubMed: 33035427
DOI: 10.1146/annurev-publhealth-090419-102529 -
JCO Clinical Cancer Informatics Sep 2022Given the impact of health literacy (HL) on patients' outcomes, limited health literacy is a major barrier to improve cancer care globally. HL refers to the degree in... (Review)
Review
Given the impact of health literacy (HL) on patients' outcomes, limited health literacy is a major barrier to improve cancer care globally. HL refers to the degree in which an individual is able to acquire, process, and comprehend information in a way to be actively involved in their health decisions. Previous research found that almost half of the population in developed countries have difficulties in understanding health-related information. With the gradual shift toward the shared decision making process and digital transformation in oncology, the need for addressing low HL issues is crucial. Decision making in oncology is often accompanied by considerable consequences on patients' lives, which requires patients to understand complex information and be able to compare treatment methods by considering their own values. How health information is perceived by patients is influenced by various factors including patients' characteristics and the way information is presented to patients. Currently, identifying patients with low HL and simple data visualizations are the best practice to help patients and clinicians in dealing with limited health literacy. Furthermore, using eHealth, as well as involving HL mediators, supports patients to make sense of complex information.
Topics: Health Literacy; Humans; Telemedicine
PubMed: 36194843
DOI: 10.1200/CCI.22.00005 -
American Family Physician Jul 2015Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading,... (Review)
Review
Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information.
Topics: Adult; Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Patient Education as Topic; Primary Health Care; Professional-Patient Relations; United States
PubMed: 26176370
DOI: No ID Found -
The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis.Journal of General Internal Medicine Jun 2019Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment.
DATA SOURCES
Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018.
METHODS
Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included.
RESULTS
The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment.
DISCUSSION
Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.
Topics: Blood Glucose; Diabetes Mellitus, Type 2; Glycemic Index; Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Self Care
PubMed: 30877457
DOI: 10.1007/s11606-019-04832-y -
International Journal of Cardiology Oct 2019Mobile health, or mHealth, is the implementation of digital health services with mobile and wearable devices, and has ample potential to enhance self-management of... (Review)
Review
Mobile health, or mHealth, is the implementation of digital health services with mobile and wearable devices, and has ample potential to enhance self-management of chronic conditions, especially cardiovascular risk factors (e.g., blood pressure control and supporting tobacco cessation and physical activity). It remains ambiguous, however, whether such technologies can improve cardiovascular outcomes. More importantly, mHealth carries the additional challenge of digital health literacy, which demands particular skills complementary to general and health literacy. Populations at risk for limited health literacy are similarly vulnerable to having challenges with digital health literacy. We identify such challenges and outline solutions to improve access to digital health services and their use for individuals with limited digital health literacy. We present an 18-point "Digital Universal Precautions" as a mandate for health care organizations committed towards addressing and facilitating eHealth literacy. As health care institutions increasingly advance mHealth through delivery of on-line material and patient portals, they face the challenge of ensuring that digital health services and content are available to all patients.
Topics: Health Literacy; Healthcare Disparities; Humans; Telemedicine
PubMed: 31171391
DOI: 10.1016/j.ijcard.2019.05.066 -
Journal of Medical Internet Research Jan 2023With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors.
OBJECTIVE
To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis.
METHODS
The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale.
RESULTS
Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors.
CONCLUSIONS
Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.
Topics: Humans; Aged; Surveys and Questionnaires; Health Literacy; Health Behavior; Telemedicine; Health Promotion
PubMed: 36716080
DOI: 10.2196/40778 -
The Journal of Cardiovascular Nursing 2016Low health literacy affects millions of Americans, putting those who are affected at a disadvantage and at risk for poorer health outcomes. Low health literacy can act... (Review)
Review
BACKGROUND
Low health literacy affects millions of Americans, putting those who are affected at a disadvantage and at risk for poorer health outcomes. Low health literacy can act as a barrier to effective disease self-management; this is especially true for chronic diseases such as heart failure (HF) that require complicated self-care regimens.
PURPOSE
This systematic review examined quantitative research literature published between 1999 and 2014 to explore the role of health literacy among HF patients. The specific aims of the systematic review are to (1) describe the prevalence of low health literacy among HF patients, (2) explore the predictors of low health literacy among HF patients, and (3) discuss the relationship between health literacy and HF self-care and common HF outcomes.
METHODS
A systematic search of the following databases was conducted, PubMed, CINAHL Plus, Embase, PsycINFO, and Scopus, using relevant keywords and clear inclusion and exclusion criteria.
CONCLUSIONS
An average of 39% of HF patients have low health literacy. Age, race/ethnicity, years of education, and cognitive function are predictors of health literacy. In addition, adequate health literacy is consistently correlated with higher HF knowledge and higher salt knowledge.
CLINICAL IMPLICATIONS
Considering the prevalence of low health literacy among in the HF population, nurses and healthcare professionals need to recognize the consequences of low health literacy and adopt strategies that could minimize its detrimental effect on the patient's health outcomes.
Topics: Adaptation, Psychological; Female; Health Knowledge, Attitudes, Practice; Health Literacy; Heart Failure; Humans; Male; Self Care; United States
PubMed: 25569150
DOI: 10.1097/JCN.0000000000000229 -
European Journal of Public Health Dec 2015Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among...
BACKGROUND
Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
M ETHODS
The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
R ESULTS
The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
DISCUSSION
Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Europe; Female; Health Literacy; Health Status; Humans; Male; Middle Aged; Sex Factors; Socioeconomic Factors; Surveys and Questionnaires; Young Adult
PubMed: 25843827
DOI: 10.1093/eurpub/ckv043 -
Frontiers in Public Health 2022With the rapid development of digital health today, the lack of digital health literacy in older adults is an urgent problem. It is crucial that older adults adapt to... (Review)
Review
With the rapid development of digital health today, the lack of digital health literacy in older adults is an urgent problem. It is crucial that older adults adapt to the digital reform in medical treatment, pension, health management, and other fields. Therefore, we reviewed the current development status of digital health literacy among older adults. A total of 47 articles were included in this scoping review. Our findings revealed that research on digital health literacy in older adults is still in its infancy. Further development is warranted especially in terms of assessment tools and intervention methods.
Topics: Health Literacy
PubMed: 35991040
DOI: 10.3389/fpubh.2022.906089 -
Journal of Racial and Ethnic Health... Jun 2019Poor adherence to prescribed antihypertensive medication is a major contributor to disparities in effective blood pressure control among Hispanics. The purpose of this...
BACKGROUND
Poor adherence to prescribed antihypertensive medication is a major contributor to disparities in effective blood pressure control among Hispanics. The purpose of this study was to investigate the association between health literacy level and adherence to antihypertensive medications among Hispanic adults, who self-reported hypertension, controlling for potential covariates of adherence and/or health literacy.
METHODS
We conducted a cross-sectional survey of 1355 Hispanic adults, primarily Dominicans, who self-reported hypertension. Antihypertensive medication adherence and health literacy were evaluated along with covariates, including sociodemographic characteristics, depression, anxiety, and sleep disturbance. Linear regression models were created for health literacy, each covariate, and adherence. Factors found to be significantly associated with adherence in the individual regression models at a p value of < 0.20 were included in a hierarchical multiple linear regression model.
RESULTS
Overall, the majority of participants had low adherence levels to antihypertensive medications (88.4%; n = 1026) and inadequate health literacy (84.9%; n = 1151). When controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance, having adequate as compared to inadequate health literacy was associated with a higher adherence score (b = 0.378, p = 0.043). The full model explained 13.6% of the variance in medication adherence (p value < 0.001), but the unique contribution of health literacy to the model was minimal (R change = 0.003).
CONCLUSIONS
Tailored interventions considering health literacy are needed to support medication adherence in order to improve hypertension outcomes of Hispanics. Additional studies are needed to identify and prioritize factors in the development of targeted and effective adherence interventions for Hispanics with hypertension.
Topics: Antihypertensive Agents; Cross-Sectional Studies; Female; Health Literacy; Hispanic or Latino; Humans; Hypertension; Male; Medication Adherence; Middle Aged
PubMed: 30607576
DOI: 10.1007/s40615-018-00550-z