Background Health literacy plays a crucial role in physical and mental health outcomes. Patients with chronic diseases, cancer patients in particular, shoulder a disproportionate burden due to limited health literacy. Limited cancer health literacy (LCHL) is a risk factor for disease prevention, treatment adherence, and management, leading to poor health.Aims Currently, there are no standardized instruments to measure cancer health literacy in Arabic and identify Arabic-speaking cancer patients with LCHL. This study aimed to test the psychometric properties of the Arabic translation of Cancer Health Literacy Test (CHLT-30-Arabic and CHLT-6-Arabic) for use among cancer patients.Methods Data collected from a sample of cancer patients (N = 260) from a comprehensive medical center in Riyadh, Saudi Arabia were used to test the measurement structures and estimate item statistics using classical test theory, factor analysis and Item Response Theory driven two-parameter logistic model (2PL). Additionally, an independent sample of 19 patients was used to estimate one-month stability of CHLT-30-Arabic scores.Results A one-factor model was confirmed as the measurement structure of CHLT-30-Arabic (RMSEA = 0.04; CFI = 0.92; TLI = 0.91). Test scores were highly reliable (Cronbach’s α = 0.86; McDonald’s ω = 0.92; one-month test-retest r = 0.93). The CHLT-6-Arabic measurement structure, latent class analysis with two classes (adequate vs. limited), was consistent with the observed response patterns of six items (LR χ2(50) = 59.95, p = 0.16) with high class separation (entropy = 0.81). The model estimated LCHL rate was 22% (accuracy = 93%). Both instruments had invariant measurement properties across age, gender, educational attainment, and income groups.Discussion The CHLT-30-Arabic and CHLT-6-Arabic offer valuable standardized instruments for measuring cancer health literacy needs among Arabic-speaking patients with cancer and help to improve care management and healthcare services for this population. These instruments can identify cancer patients with LCHL and inform targeted interventions to potentially minimize adverse health and financial consequences of LCHL.
Background In the context of an aging population, older adults with fewer basic skills face compounded challenges in achieving healthy aging. These individuals often experience barriers to health literacy and self-reliance, exacerbated by conventional educational programs that inadequately reflect their needs and experiences. Little is known about how to develop educational solutions that match this groups preferences and language that supports access to, comprehension, and application of health information in everyday life.Aims To fill this gap, we describe and reflect on the participatory development of a healthy aging educational program. Our goal is twofold in showing: 1) how the co-design process was shaped by participants needs and preferences, and 2) to identify what practice-based lessons can be drawn from this process for developing inclusive educational programs for this population.Methods The educational program was co-created with community-dwelling older adults (50+) with fewer basic skills in three countries: Denmark, the Netherlands, and Portugal. Following a participatory design approach, our process involved three phases; 1) exploration of the learning needs and formats of our target audience (N = 55), 2) co-design of the program with participants (N = 7) and interdisciplinary experts (N = 11), 3) field testing with iterative adjustments based on participant feedback (N = 73).Results Phase one yielded five core curriculum themes – the aging body, nutrition, wellbeing, being heard, digital (safety) - as well as two learning approaches: meaningful play and collaborative learning. The resulting program took the form of a physical, card-based game designed with accessible language, peer-learning, and practical information on healthy aging. Field testing showed that focusing on lived experiences through playful and collaborative activities helped participants engage with health and digital literacy skills without stigma, while learning together about healthy aging.Discussion We distilled three practice-based lessons for inclusive co-design: 1) centering learners lived experiences through co-creation, 2) playful and collaborative learning methods that reduce barriers to participation, and 3) iterative and flexible design that builds trust and agency. These lessons demonstrate how participatory design focused on participants’ needs and lived experiences, has the potential to promote more equitable health literacy programs and support healthy aging among underserved older adults.
Background: Improving health literacy has been identified by the World Health Organization as a priority in the 2030 Agenda for Sustainable Development. In many countries, Health and Physical Education and primary education teachers are responsible for teaching health education and supporting students to develop health literacy. Preservice teachers have expressed concerns about their own health literacy and eHealth literacy levels and teaching practices.Aims: The aim of this systematic literature review was to examine health literacy and eHealth literacy intervention programs in higher and further education settings and evaluate their impact on participants’ health literacy and eHealth literacy levels.Methods: A systematic search of five electronic databases (EBSCOhost, ProQuest Central, PubMed, Scopus, and Web of Science) identified peer-reviewed studies published between 1 January 1974 and 31 December 2023. Studies were included if they targeted higher or further educational settings and measured health literacy or eHealth literacy pre- and post-intervention. A narrative synthesis was conducted, and the targeted health literacy level of each intervention was categorised using an adapted version of Nutbeam’s hierarchy of health literacy.Results: Of 5254 articles screened, 14 studies were included, involving 4184 students. Cluster-randomised controlled trials (n = 5, 36%) reported effect sizes ranging from small to large (d = 0.14–0.97). Eleven studies (78%) used validated measurement tools, 10 measured health literacy, and four measured eHealth literacy. Functional health literacy content was embedded in 12 studies (86%), 12 included interactive components, and seven (50%) incorporated critical health literacy content. Six studies (43%) exceeded six hours in duration, and six addressed multiple health topics. Only two studies (14%) focused specifically on preservice teachers.Discussion: Interventions consistently improved health and eHealth literacy levels, although the change varied. Larger improvements were associated with longer interventions, online delivery, clearly stated learning objectives, and coverage of multiple health education topics. The review highlights the possibilities of consistent use of validated measurement tools, clearer application of theoretical frameworks, and transparent reporting of intervention content to strengthen future health and eHealth literacy programs in higher and further education.Registration: PROSPERO CRD42024523008.
Background Socially disadvantaged groups face heightened vulnerability to environmental risks (e.g., heat) due to socioeconomic inequalities, cultural contexts, and daily living conditions. It is, therefore, crucial to have the skills to find, understand, and assess the credibility of environmental health information (EHI), to make informed decisions, and protect their health. This is part of environmental health literacy (EHL).Aim This study examines the accessibility, comprehensibility, and credibility of EHI to provide recommendations for EHI that can promote EHL among socially disadvantaged groups.Methods Twelve semi-structured interviews were conducted with German-speaking adults who are socially disadvantaged. Interviewees were recruited via various channels (e.g., flyer or multipliers). Six women and six men participated in the interviews, which were thematically analyzed. Identified themes included: 1) knowledge of environmental health risks, 2) access to EHI, 3) understanding and design of EHI, and 4) credibility of EHI.Results Our findings suggest that socially disadvantaged groups have a broad understanding of environmental health risks. Their exposure to information is often unintentional, occurring by chance mainly through social media or personal experience. EHI is understandable, but not for everyone, even though short texts and visualizations help. Information from government institutions is the most credible, but also the most difficult to understand due to the technical terms used.Discussion EHI for these groups should use concise and visually appealing materials, centring government institutions that interviewees deemed to be highly credible sources. Further tailoring of communication strategies to address different population groups is a priority in EHL promotion. Social media could play a crucial role in this regard.
Health and medical journals have a mission to evaluate and disseminate information generated from rigorous and peer reviewed scientific enquiry. As journal editors, we are entrusted with safeguarding the integrity of the scientific record, supporting the researchers who advance discovery, and honoring the excellence of academic institutions that cultivate rigorous and unbiased inquiry. Maintaining the integrity of the information published in our journals helps ensure that scientists, health professionals, policymakers and the public can benefit from information that is accurate, trustworthy, accessible, and understandable.
Background Health literacy is a key factor for health communication efforts. This is especially true for preventing noncommunicable chronic diseases such as cancer. Specifically, limited cancer health literacy (LCHL) is a risk factor for not engaging in disease prevention and treatment.Aims This study aimed to obtain model-based estimates of LCHL rates and explore rate differences in sociodemographic characteristics.Methods Data from cancer patients (N = 1,306) and those without cancer (N = 512) collected from the U.S. were used to estimate crude and adjusted LCHL rates using latent class analysis. Measurement invariance tests were conducted between demographic groups to test the assumption that LCHL has the same meaning across subpopulations.Results Scalar invariance model was supported in all comparisons. Among cancer patients, approximately 10-fold crude rate differences in LCHL were found between Blacks (50%) and Whites (5%), patients with education level up to high school (54%) and above high school (6%), as well as patients earning less than $40K (50%) and $40K or above (4%) annually. A parallel 10-fold difference between race, education, and income groups was also found among persons without cancer but the LCHL rates were somewhat higher among persons without cancer than those with cancer across all groups.Discussion Adjusted rate differences between groups were quite similar. LCHL is highly prevalent among Blacks, under-educated, and low-income persons with and without a diagnosis of cancer. Race, educational attainment, and income are the primary drivers of disparities in cancer health literacy. Our findings help to inform targeted health communication efforts to minimize adverse health and financial consequences of LCHL.
Background Uncertainty is an important and frequently studied topic in health communication. It can be caused by many different sources. However, research in which the effects of different sources of uncertainty are compared is limited, and little is known about the impact of recipient characteristics on these effects.Aims We investigate whether different sources of message uncertainty impact perceived medication effectiveness and behavioral intentions. In addition, we explore the potential impact on message credibility, as well as the moderating role of recipients’ intolerance of uncertainty, science literacy, and health literacy.Methods In our preregistered, online between-subjects experiment, we manipulated the independent variable ‘uncertainty of the medicine’s effectiveness’. Participants (N = 946, Dutch) were asked to imagine that they suffered from a severe headache for which existing medication proved ineffective. Subsequently, they were randomly exposed to one of four experimental messages. In the certain outcome condition, the message communicated that a recently introduced medicine will be effective in reducing this type of headache. In the three uncertain outcome conditions, the message read that effectiveness was unsure for different reasons; i.e., limited scientific evidence, expert disagreement, or conditional effectiveness.Results The certain outcome message resulted in higher perceived effectiveness of the medicine and higher intentions to take the medicine compared to the conditions presenting an uncertain outcome. There were no differences in perceived effectiveness and intentions to take the medicine between the three uncertain conditions. Furthermore, the uncertainty sources did not impact perceived message credibility, nor did uncertainty intolerance, science literacy, or health literacy play a moderating role.Discussion Our study concludes that communicating uncertainty about a new treatment decreases the perceived effectiveness and acceptance of this treatment, but this effect does not depend on the source of the uncertainty.
Background Deprescribing is the process of reducing or stopping medicines that may no longer be needed or helpful. Effective deprescribing depends on understanding patients’ beliefs, concerns, and preferences, which influence how they participate in decisions about their medicines. Clear, patient-centered communication is important to make sure decisions about medicines are understood, supported, and safely implemented. The Patient Deprescribing Typology (PDT) offers a novel, preference-based approach that categorizes patients into distinct groups based on their beliefs and preferences regarding medicine use and deprescribing.Aims The PDT was adapted for this exploratory study to compare responses to a diabetes-specific version (administered to participants with diabetes) or a standard version (administered to all other participants).Methods We surveyed adults aged 65 years and older in Australia and the United States (n = 2,199), and compared responses to standard versus diabetes-specific PDT questions.Results Participants answering the diabetes-specific version perceived their medicine as more important, favored physician-led decision-making, and were less open to deprescribing compared to those receiving the general PDT. Preferences for starting or stopping a hypothetical diabetes medicine were associated with distinct attitudes and decision-making styles, suggesting the importance of aligning communication strategies with patients’ typologies.Discussion This study represents a first step toward exploring how condition-specific versions of the PDT may better capture nuanced, medicine-specific patient attitudes and preferences.
Background Adequate health literacy is integral to support self-management behaviours, including home blood pressure (BP) monitoring, which is recommended for hypertension management. Using a validated device that has been tested for accuracy is essential to obtain reliable BP readings, but only 25% of devices available for purchase at pharmacies meet this standard. Little is known about how consumers obtain BP devices, factors influencing their choices, and the impact of health literacy on device selection.Objective To determine how consumers obtain BP devices and explore the impact of health literacy on device ownership.Methods Mixed-methods study with an online survey and phone interviews among adults who measure BP at home in Australia (June-Dec 2023). Survey questions determined health literacy status, BP device make/model, validation status (evidence the device had been tested for accuracy) and factors influencing selection. Interviews further explored these topics among a subset of purposively sampled participants.Results Participants (n = 241) were middle aged (58 ± 16 years, 52% women) and 74% had adequate health literacy. Only 51% (n = 123) of participants used validated BP devices. Most participants purchased their device (91%, n = 189), with 69% (n = 130) from pharmacies. Regardless of health literacy level, accuracy, quality and recommendations from a medical professional were the most important considerations when selecting a BP device. More participants with inadequate health literacy considered medical professional recommendations as most important (48.8% vs. 29.1%, p = 0.035). However, no education was provided to support obtaining a validated BP device by healthcare providers. In the absence of education, interviewees (n = 27) used brand recognition, online reviews and avoided cheaper devices to select an ‘accurate’ device. Health literacy status did not impact ownership of a validated BP device or how devices were obtained.Conclusion Only 51% of Australian adults that measure BP at home use a device that has been tested for accuracy. Despite accuracy and medical professional recommendations being key considerations when choosing a device, little support was provided to aid participants to obtain a validated device. Our findings highlight the need for health services and providers to be more responsive to support consumers to obtain validated devices for home BP monitoring.
Introduction Cardiovascular disease is the leading cause of mortality and morbidity worldwide. Cardiovascular disease is preventable by managing modifiable risk factors, but this requires support to improve patients’ health literacy. Patients with cardiovascular disease have significant challenges understanding and engaging with healthcare, which can compromise their health outcomes.Aims This commentary reviews relationships between health literacy and cardiovascular disease and proposes recommendations for improving cardiovascular management in healthcare settings.Results Improving health literacy is a significant issue in cardiovascular disease prevention. There are factors that are associated with health literacy at both individual and system levels which may influence a patient’s health literacy. Health professionals can support heart health literacy through checking their patients’ health literacy needs, being aware of their own misconceptions and biases, using written, verbal, and visual communication strategies that are easy to understand, and avoiding unexplained medical jargon. Organisations can support this through training multidisciplinary teams and providing clear discharge information that patients can understand and act on.Conclusion Supporting health literacy among cardiovascular disease patients is paramount to (1) enable patients to regain control over their health, (2) decrease cardiovascular disease hospital admissions and (3) reduce costs to the public health sector. Both individual and system level interventions are needed to support heart health literacy and improve patient outcomes in healthcare settings.
Background Deprescribing to reduce polypharmacy often involves conversations between patients and their providers. Prior studies have surveyed healthcare providers’ willingness to deprescribe medications for hypothetical patients and defined barriers and enablers to deprescribing from provider perspectives. Few studies, however, have examined provider barriers and enablers based on their response to actual deprescribing recommendations for patients during care transitions.Aims To assess providers’ response to deprescribing recommendations for patients enrolled in the Shed-MEDS clinical trial.Methods This was a mixed methods study within the Shed-MEDS clinical trial, which included older patients with polypharmacy transitioning from the hospital to post-acute care (PAC) for short-term rehabilitation to home. During hospitalization, a study clinician reviewed all medications taken by each patient at home and in hospital, including prescribed and over-the-counter medications. The study clinician then discussed deprescribing recommendations for medications with the patient. If the patient agreed, the study clinician contacted the outpatient prescribing provider to discuss deprescribing recommendations and assess provider agreement. Providers’ responses were categorized into barriers and enablers using a published framework: awareness, inertia, self-efficacy, feasibility, and/or tacit (no clear reason given). Responses were analyzed using descriptive statistics.Results Of 186 patients randomized to the intervention, 177 completed the deprescribing discussion with the study clinician. The study clinician was successful in contacting at least one outpatient provider for 101 patients. Among 101 patients, 983 outpatient medications were recommended for deprescribing. Patients agreed to deprescribe most of these medications (72%). The study clinician was able to discuss deprescribing with outpatient providers for 315 medications, of which they agreed to deprescribe 273 (87%). Vitamins and supplements were discussed most often. Ultimately, 242 (89%) medications that providers agreed to were successfully deprescribed. The most common provider enablers to deprescribing were categorized as tacit (37%), self-efficacy (30%), and inertia (27%). However, inertia (60%) and self-efficacy (42%) also were common provider barriers.Conclusions Outpatient providers agreed with most deprescribing recommendations shared by a study clinician following patient agreement. The most common barrier to deprescribing among outpatient providers was their preference not to change medicines (inertia) and/or not feeling confident in their ability to make these changes (self-efficacy).
Background A standard General Practice (GP) consultation falls under Level B of the Medicare Benefit Scheme (six to 20 minutes) with consultations averaging 10-15minutes. This imposes time constraints on the consultation, that could be a limiting for patients with multiple or complex concerns. This limitation may lead GPs to compromise on the quality of care either by inadequately addressing patient’s concerns by prioritising time or by extending consultations and running late due to systemic pressures in the consultation length model.Objectives This study of communication in healthcare adopts a novel approach to assess how external factors, such as patient age and education, and internal factors, such as how multiple medical concerns were raised, impact the length of general practice consultations.Design This study used a mixed-method design using conversation analysis and econometric models to explore the influence of external factors and internal factors affecting consultation length.Setting This study use data available for secondary analysis from three General Practice (GP) Clinics in metropolitan Sydney, Australia, collected between 2018 and 2019.Participants Forty-one consultations across three GPs were video recorded, with linked patient surveys. All participants were 18 years and older and spoke English fluently.Results Both external and internal factors affect consultation length. Older patients (35–64 years-old & 65-85 + years-old) had shorter consultations than younger patients (18–34 years-old). Patients with tertiary education had shorter consultation length than patients with only High School Certificate/School Certificate qualifications. Consultations with agenda setting to establish a medical concerns list and consultations which had a clear “driver” were shorter.Conclusions Factors beyond number of medical concerns presented can influence GP consultation length. Thus, the standard length of consultation could be limiting not only for patients with several presenting concerns or single complicated concerns, but also for those who may otherwise benefit from a longer consultation time, such as younger people. Future policy development and workload planning should consider aspects of patient age and education when determining consultation length. As internal conversational factors can reduce consultation length, training for GPs in specific consultation approaches may also improve efficiency.
Background Health literacy capability is thought to increase participation in shared decision-making, subsequently contributing to successful deprescribing or medication discontinuation. Deprescribing often requires complex decision-making processes where real or potential benefits and harms are considered alongside treatment preferences, attitudes, assumptions and beliefs about medication use. During this process, older adults may utilise health literacy skills to gather, evaluate, reflect on and apply information to their contexts and to effectively communicate their treatment preferences.Aims This study explores older adults’ reports of their use of different types of health literacy skills (functional, interactive and critical) when making decisions about reducing or stopping their medicines. We seek to explain what influence, if any, health literacy has on their willingness to participate in making decisions about deprescribing.Methods We conducted a secondary qualitative analysis of interview data from 25 older adults taking five or more medications in Australian primary care settings. The previously transcribed and coded interviews were re-examined using NVivo 12 software, applying Nutbeam’s health literacy framework to guide the analysis.Results All participants used functional health literacy in the day to day management of their medications. However, some described knowledge gaps in their understanding of their medicines, the benefits of deprescribing and who is responsible to deprescribe. Interactive health literacy skills were used to question health care providers. Some expressed their general deprescribing preferences or applied medication information to request specific medications be discontinued. Fewer participants mentioned the use of critical health literacy, which is noteworthy as this capability facilitates empowerment and is likely to influence participation in shared decision-making.Discussion We recommend changes in primary care practice to promote opportunities for older adults to develop and apply health literacy skills. Additional medicine and deprescribing information should be provided, regardless of older adult preferences for involvement in decision making. Deprescribing trials may provide opportunities to build experiential knowledge. Information about who is responsible for deprescribing is required to enable older adults to navigate health services. Improved health literacy, especially critical health literacy, may modify preferences for involvement in shared decision-making regarding deprescribing.
Background Although graphical modalities have emerged as a potential medium to communicate health information, few studies have examined measurement instruments used to evaluate such modalities. This study examined the use of a Comic Book Rating Scale (CoBoRs) adapted from an existing Mobile Application Rating Scale (MARS) for assessing the quality of a comic book that delivers health information.Aims The aims of this study were to examine the psychometric properties of the CoBoRs by assessing both the reliability and validity of the scale.Methods A cross-sectional survey was administered to a convenience sample (N = 402) of participants obtained from both internet and college student settings. The CoBoRs scale included 10 items across four dimensions (engagement, functionality, aesthetics, and information quality). The psychometric properties of the CoBoRs were assessed by examining internal consistency and item-item correlations; the construct validity of the scale was examined by both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) using Analysis of Moment Structure (AMOS) software (i.e., structural equation modeling).Results Respondents were mostly White Non-Hispanic (69.4%), female (65.2%), 18–25 years of age (78.6%), and had a high school education or greater (89.1%). There was a medium correlation between CoBoRs constructs (.35 to .70), and the total scale, indicating excellent internal consistency (Cronbach’s alpha=.91). The “Engaging” subscale (Cronbach’s alpha=.75) demonstrated acceptable internal consistency, while informational (Cronbach’s alpha=.82) and Functional (Cronbach’s alpha=.82) subscales demonstrated good internal consistency. However, the Appealing (Cronbach’s alpha=.65) subscale had lower internal consistency. The EFA yielded one factor loading. However, the CFA highlighted that a four-factor model of the CoBoRs provided more robust fit indices than a one-factor model. Additionally, there were high correlations between the CoBoRs and an investigator-developed scale assessing the quality of the comic book through eight statements.Discussion This is the first study to develop and evaluate the psychometric properties of CoBoRs and may be adapted to evaluate other novel knowledge translation products. Future studies may adapt the CoBoRs to evaluate other comic books and health information products.
Background The provision of psychological services via telecommunication modalities, including videoconferencing, has increased in recent years, particularly subsequent to the COVID-19 pandemic. However, whilst previous research points to the efficacy and potential benefits of synchronous telepsychology in comparison to in-person therapy, the nuanced experiences and perspectives of consumers receiving psychological therapy via videoconferencing in real-world specialist public mental health services remain relatively unexplored.Aims This qualitative study aimed to explore how consumers with anxiety disorders treated at a public mental health clinic experienced psychological treatment via video-conferencing during and following the COVID-19 pandemic, with consideration of recommendations for future telepsychology implementation.Methods Semi-structured telephone interviews were conducted with 25 consumers with mixed anxiety diagnoses who received telepsychology treatment from clinical psychologists via videoconferencing at a community mental health service in Sydney, Australia. Transcribed interviews were analysed using thematic analysis.Results There was significant diversity in consumers’ opinions and experiences, with participants experiencing telepsychology as dually fostering warmth and disconnection, feeling both safer and less secure, and being at the same time accessible and anxiety-inducing. These experiences centred around four central themes: (1) Initial expectations of telepsychology, (2) Interplay with anxiety, (3) Psychological therapeutic interventions, and (4) Safety within the therapeutic context.Discussion Variation in consumer experiences potentially reflects the dialectical nature of the telepsychology experience. Participants with pre-established therapeutic relationships largely felt confident in technology and safe to exhibit emotional vulnerability during videoconferencing sessions, perceiving telepsychology to be a suitable alternative to in-person therapy. However, use of telepsychology should be individually determined, guided by the presenting psychological concerns, circumstances and consumer preferences. Consideration should also be given to potential therapy-process-related factors.
Background Health literacy supports comprehension, decision-making, and navigation of healthcare systems to maintain well-being. In Brazil, few studies assess the prevalence of health literacy in this context.Aim To assess health literacy among adult users of a Primary Care Center in Florianópolis, Brazil, and to examine its associations with sociodemographic variables, morbidity, and polypharmacy.Method Cross-sectional study with adult users of the Saco Grande Health Center in Florianópolis, Brazil. Demographic, socioeconomic, morbidity, and polypharmacy data were collected. The Brazilian version of the Health Literacy Questionnaire was used, and domain means were analyzed using Kruskal-Wallis test, Welch’s t-test, and Pearson correlation.Result We had a 41.8% response rate. A total of 42.4% of participants had a chronic disease, most not polymedicated. Mean scores for health literacy domains ranged from 2.7/4 to 3.8/5. Domains with lowest averages were “Having sufficient information to manage my health” (2.7/4), “Actively managing my health” (2.7/4), and “Social support for health” (2.7/4). The domain with the highest average was “Understanding health information well enough to know what to do” (3.8/5). Individuals with at least one chronic condition had significantly higher averages in the following domains: “Feeling understood and supported by healthcare providers” (3.01/4 vs. 2.56/4), “Ability to actively engage with healthcare providers” (3.97/5 vs. 3.59/5), “Navigating the healthcare system” (3.61/5 vs. 3.27/5), and “Understanding health information well enough to know what to do” (3.95/5 vs. 3.65/5). Number of medications exhibited positive association with domains “Feeling understood and supported by healthcare providers” (R = 0.43, p < .001), “Ability to actively engage with healthcare providers” (R = 0.28, p =.015), and “Having sufficient information to manage my health” (R = 0.30, p =.007).Conclusion While conclusions are limited by low response rate, the findings suggest that individuals with greater healthcare needs develop stronger skills in navigating the healthcare system and interacting with healthcare professionals. This highlights the importance of patient-provider relationships and care continuity in primary healthcare.
Background Recent studies indicate that risk factors for cardiovascular disease (CVD) begin to develop in childhood. Interventions that support the development of health literacy related to cardiovascular health (CVH) in childhood may be beneficial for improving cardiovascular risk factors in young people, however it is unclear whether such interventions exist.Aim To conduct a scoping review to identify all previous interventions that have combined health literacy (or related constructs) and CVH metrics in childhood settings.Methods Two reviewers systematically searched four databases: Medline, Scopus, CINAHL and Web of Science from inception to October 21, 2024. Studies were analysed following the Joanna Briggs Institute (JBI) framework for scoping reviews. Health literacy was defined based on Nutbeam’s health literacy framework. Related constructs included health promotion, health education and health knowledge among others. CVH metrics were defined based on the American Heart Association’s Life’s Essential 8 and included diet, physical activity, body mass index, blood pressure, cholesterol, glucose, smoking and sleep. Studies were included if they considered health literacy or related constructs and at least three CVH metrics.Results We reviewed 5,453 published papers written in English. These papers included empirical studies (original research) and intervention studies. They also covered quantitative studies such as cross-sectional, longitudinal, protocol, cohort, and case-control studies. From these, we identified 46 studies for inclusion in the review, of which 6 were protocols. The largest number of studies were conducted in the US (n = 13); the intervention length ranged from 5 weeks to 4 years and were conducted between 2007 and 2022. Only one intervention explicitly considered health literacy. This 6-week Canadian study, conducted with 126 children aged 9-14 years, measured digital health literacy using a validated questionnaire and CVH metrics (diet, physical activity and sleep). Forty-five other studies used constructs related to health literacy, including health promotion (n = 11), health education (n = 10) and health knowledge and behaviour (n = 8), among others.Conclusion This review identified one intervention that comprehensively measured health literacy and CVH in children. More work is required to understand whether interventions which combine health literacy (or related constructs) and CVH metrics in childhood settings may improve CVH.
Background Cardiovascular health literacy (HL) is essential for preventing cardiovascular disease (CVD), yet disparities persist among women of reproductive age, particularly those from racially and socioeconomically diverse backgrounds. Limited research has examined cardiovascular HL in this population, and effective strategies to improve cardiovascular HL remain understudied.Aims The SAFE HEART Study sought to assess and improve cardiovascular HL among women of reproductive age through a targeted educational intervention.Methods This cross-sectional and quasi-experimental study recruited women aged 18–44 years from (1) community outreach in Baltimore-Washington, D.C., and (2) the American Heart Association Research Goes Red (RGR) registry. All participants completed a validated cardiovascular HL questionnaire. Community-enrolled participants received a four-month culturally tailored educational intervention consisting of newsletters and webinars and cardiovascular HL was reassessed at follow-up. We compared the sociodemographic and cardiovascular HL scores between the RGR- and community-enrolled participants. Paired t-tests assessed pre-post changes among the community-enrolled participants who completed the intervention.Results Among 313 participants (mean age: 30.8 ± 6.3 years), 228 were community-enrolled and had higher rates of hypertension (45.2% vs. 29.4%), diabetes (40.8% vs. 14.1%), and hyperlipidemia (41.2% vs. 30.6%) than RGR-enrolled participants. Correctly identifying CVD risk factors varied, with 38.3% recognizing high cholesterol, 40.9% HDL cholesterol risk, and 38.0% diabetes-related heart disease risk. Post-intervention, community-enrolled participants improved in overall cardiovascular HL (69.8–73.9, p < 0.001), exercise (66.7–74.7, p = 0.007), diet/cholesterol (58.8–63.9, p = 0.023), and therapeutic knowledge (80.5–86.1, p = 0.010).Discussion This study is among the first to examine cardiovascular HL in a diverse cohort of women of reproductive age, revealing knowledge gaps and moderate improvements following intervention. Findings support the potential of culturally tailored education but highlight the need for sustained engagement strategies and digital tools to enhance cardiovascular HL retention and accessibility.
