Background: Evidence indicates a lack of school-based interventions targeting adolescents' health literacy. To date, no structured, theory-driven, Delphi-guided health literacy intervention has been designed for Nepalese adolescents. Objective: This study aims to report the systematic development of a context-specific intervention to enhance adolescent health literacy and health-promoting actions. Methods: Using a concurrent mixed-methods design and a comprehensive health literacy model, the research involved 501 9th grade students from four randomly selected community schools in Birendranagar Municipality, Surkhet District, as well as their health and physical education teachers (HPE) and school nurses. Quantitative data were collected using self-administered standardized questionnaires measuring health literacy, self-efficacy, perceived social support, school environment, community environment, and health-promoting actions. Qualitative data were obtained through focus group discussions with students and key informant interviews with HPE teachers and school nurses. Key Results: The intervention design process followed the fundamental steps of the intervention mapping approach. After engaging with the school through formal and informal means, health literacy needs were identified and prioritized. Goals were then set, focusing on the individual and interpersonal levels. Next, all components of the intervention, including objectives, content, facilitators, methods, materials, modes, and evaluation techniques, were refined through a two-round modified Delphi process, resulting in the first draft. This draft was discussed with students, teachers, and school nurses before finalizing. The completed intervention, consisting of 13 sessions, is designed to be implemented by nine interdisciplinary facilitators using the SHOWED questioning framework (What do you see here? What is happening? How does this relate to our lives? Why does the problem exist? What can we do?). Conclusions: This article reports on an intervention development process, systematically using mixed methods and the Delphi process, to offer a replicable approach to enhance adolescent health literacy and health-promoting actions.
Background: Plain language summaries (PLSs) play a crucial role in communicating complex clinical trial information to patients and the public. Due to the European Union Clinical Trials Regulation (EU CTR) 536/2014 requirement to disclose PLSs in parallel with the technical results, clinical trial sponsors will need to develop such summaries swiftly and efficiently, while avoiding potential obstacles. Their creation can be challenging for sponsor company stakeholders who typically use highly technical, scientific language. Brief Description of Activity: This manuscript describes the PLS development and review process established at our company. It also considers the collection of feedback via an anonymous survey, both of which were intended to optimize PLS preparation. Finally, it explores internal stakeholder preparedness for EU CTR requirements, and further opportunities to enhance PLS quality to better support patient centricity. Implementation: We observed a learning curve among stakeholders (content contributors and reviewers) and an enhanced appreciation for the PLS process. Results: This resulted in improved best practice principles for PLS writing, such as describing only the primary endpoint(s) and adverse drug reactions. The process of PLS development was streamlined following implementation of stakeholders' feedback received in PLS surveys circulated in 2023 and 2024. This led to increased satisfaction with the instructions provided for stakeholders and with the processes for PLS development, including the company-developed PLS template and glossary of plain language terms. Here we suggest that regularly adjusting PLS tools based on continuous feedback from internal stakeholders contributes to a more efficient and clear process. Lessons Learned: Optimization of the PLS development process using feedback from internal stakeholders supports efficiency, clarity, and patient-centricity, as well as ensuring preparedness for EU CTR requirements.
Experts recommend incorporating health literacy into training to enhance providers' self-awareness and ability to implement these techniques, ultimately improving health outcomes. Interprofessional faculty developed training on plain language and health literacy as a social determinant of health. Clinical students participated in an asynchronous orientation, live educational sessions, and patient visits. Pre- and post-surveys assessed students' knowledge and attitudes toward health literacy and plain language. A faculty member collected unclarified jargon terms during each patient visit. Results were analyzed using descriptive statistics. Paired t-tests were performed for jargon use frequency and McNemar's test for knowledge scores. The purpose was to develop and pilot an interprofessional training program to improve students' knowledge and use of plain language communication in a pediatric ambulatory clinic. Fifty-five pharmacy, medicine, nursing, social work, physical therapy, and dentistry students participated. Composite knowledge scores about health literacy increased, p < .001. 93.3% of students understood how this course contributed to their professional development, and 81.6% rated live content as effective. The average number of unclarified jargon terms per visit decreased from 2.8 in week 1 to 2.4 in week 2. This study is a pilot of a real-world application that prioritizes patient-centered plain language and can be modeled in other clinical settings to support early exposure to health literacy concepts and enhance learners' knowledge.
Objective: Functional health literacy (FHL) plays a dynamic role in diabetes care, yet research on its implications is erratic in Bangladesh. The aim of this study was to ascertain the level of FHL among patients with type 2 diabetes (T2D) in Dhaka and its correlation with their glycemic level, lifestyle, sleep quality, and sociodemographic characteristics. Methods: A total of 401 patients with T2D were included by simple random sampling method in this cross-sectional study from three diabetes centers in Dhaka. A Bengali adaptation of the S-TOFHLA (Short Test of Functional Health Literacy) and a semi-structured questionnaire was used to collect data on FHL and other study information. Bivariate analysis, multi-nominal regression, Pearson's χ2 test, and Cramér's V coefficient was used to assess the correlations between variables, with a significance threshold of p < .05. Key Results: Among the 401 participants, 59% were female and 34.9% lived in rural areas; among whom only 27.3% had adequate FHL. Sex, occupation, education, income, physical activity regularity, diabetes treatment regimen, family history, current fasting blood sugar (FBS), 3-month average FBS, 3-month average 2-hour after breakfast blood glucose, and hemoglobin A1c showed significant associations (p < .0001) with the level of FHL. Higher education level significantly increased the odds for adequate FHL (adjusted odds ratios (AOR) = 5.70 to 78.81). Adequate FHL was significantly associated with higher sleep metrics (AOR = 5.67 and 9.17). Longer sleep duration and higher quality sleep increased the likelihood of having adequate FHL (AOR = 9.17 and 5.67, respectively; p < .05) and higher glucose levels were linked to reduced FHL odds (AOR <1). Conclusions: Higher FHL was associated with better diabetes management. FHL interventions should be evaluated to determine if increasing a patient's health literacy will improve their diabetes management.
Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Many patients with COPD lack the necessary skills to manage their condition independently, often due to insufficient health literacy. This deficiency leads to frequent re-hospitalizations and decreased quality of life. Implementing interventions to address these factors is essential, with the self-management promotion model being a particularly effective approach for chronic patients. Therefore, this study was designed to examine the impact of implementing care based on the self-management promotion model on health literacy levels among patients with COPD attending Shahrekord teaching hospitals in 2024. Objective: The aim of this study was to examine the impact of implementing care based on the self-management promotion model on health literacy levels among patients with chronic obstructive pulmonary disease attending Shahrekord teaching hospitals in 2024. Methods: This semiexperimental study involved 70 patients with COPD at educational hospital afield to Shahrekord University of Medical Sciences. Participants were selected gradually based on study criteria, and random assignment divided them into control and intervention groups, with 35 individuals in each group. In addition to routine care, the intervention group received a self-management enhancement program consisting of eight in-person and virtual sessions. Patients completed demographic questionnaires and health literacy assessments at the study's commencement, immediately postintervention, and 2 months later. Data analysis was conducted using SPSS 21 software. Key Results: The average age of participants was 57.19 ± 11.2 years. Three months' postintervention, a significant improvement in health literacy scores was noted in the intervention group (p = .001), while no significant change was observed in the control group (p = .183). Conclusion: The findings of this study demonstrate the effectiveness of the self-management promotion model intervention in enhancing health literacy among patients with COPD. Consequently, implementing this model is recommended as a valuable component of chronic patient empowerment programs. Additionally, the inclusion of patients' families was identified as a positive factor contributing to improved health literacy and self-care in this patient population.
Background: Having knowledge of out-of-pocket cost and access to services constitutes an advanced level of health literacy within the Medicare population. The cost and services offered within Medicare change annually, yet less than 30% of beneficiaries compare their coverage options (between traditional or fee-for-service Medicare and Medicare Advantage)-an important application of health care knowledge. Failure to compare can expose the financing of the Medicare program and the beneficiary to financial risk if a beneficiary has not elected a coverage option that best suits their individual needs. The factors driving beneficiaries to compare are poorly understood. Objective: Our objective was to examine the association between different levels of information reviewed (exposure) and comparing coverage (outcome). Methods: This pooled cross-sectional study included 28,924 Medicare beneficiaries using data from the 2019-2021 Medicare Current Beneficiary Survey. Multivariable probit regressions were performed using Stata version 18. Key Results: Reviewing both cost and service information increased the probability of comparing coverage by 159% (44.4 percentage points). Exposure to service-only information increased the probability of comparing coverage by 97% (27.2 percentage points) and 68% (19.1 percentage points) for cost-only information, relative to those who reviewed neither cost nor service information. Forty-seven percent of beneficiaries did not review cost nor service information, followed by 39% who reviewed both, 8% cost-only, and 6% service-only. The probability of comparing coverage increased by 8.2% (2.3 percentage points) for beneficiaries who reviewed both cost and service information and those who had an education greater than high school. Conclusion: A targeted outreach and education campaign geared toward increasing the type of information reviewed could result in an increase in comparing Medicare coverage options.
Objective: Informed consent forms for research are often lengthy and complex. One way to improve consent forms is to clarify the key information page required for federally funded research in the United States. We developed a visual key information page using color, plain language, bulleted text, and icons. In formative studies, the visual key information page was positively received, but some asked whether icons improve outcomes or distract from information. This study tested whether icons affect knowledge, satisfaction, or engagement with study information. Methods: We recruited English-speaking, U.S.-based adults through Prime Panels. Participants were randomized to view one of three versions of a key information page about a hypothetical biobank study: Version A used bulleted, plain language text organized in boxes, incorporating icons and visual elements; Version B was identical but with no icons or other visual elements; Version C displayed identical plain language text only. We measured participants' intention to join the study, decisional conflict about choice intention, knowledge of study details, satisfaction with the information, and engagement with the information. Finally, they viewed all versions and reported their preference among the three and their attitudes about icons in Version A. Key Results: A total of 453 participants responded; we analyzed 422 valid responses. There were no significant differences in outcomes by version (all p values > .05), including when stratifying by health literacy. After viewing all versions, most (69.4%) preferred Version A over other versions. In addition, most liked the icons (78.2%), found them helpful (74.2%) and did not find them distracting (77%). Conclusions: Although participants preferred icons and visual elements over text alone, icons and visual elements did not affect knowledge, satisfaction, or engagement with study information. Future research will investigate whether and how visual key information enhances text-based consent forms in a multisite randomized trial with ongoing studies.
Objective: The purpose of this qualitative study is to explore and identify elements used in bowel cancer screening visuals that promote health literacy and participation in screening tests in the United Kingdom and India. Methods: A total of 17 participants from the United Kingdom and India took part in a thematic analysis study. Individuals were eligible for this study, if they were within the National Health Service bowel cancer screening target between ages 50 and 74 years. A total of 58 bowel cancer screening promotional images were presented to the participants, and they had to indicate whether they believed the image effectively encouraged participation in bowel cancer screening. Then, participants were invited for a remote interview to explore their verbal constructions of the bowel cancer screening images. The interview questions were designed to explore participants' preferences and aversions toward the visual elements used in promoting health literacy around bowel cancer screening. Key Results: The findings highlight key visual features that resonate with the target audience and those that may hinder the effectiveness of screening messages. Encouraging elements include images of happy families, the portrayal of screening consequences, clear details about the screening process, and the inclusion of health care professionals. The study also underscores the importance of using both gain-framed and loss-framed messages. In contrast, discouraging elements, such as ambiguous images, such as pictures of toilets, and visuals evoking negative emotions, such as pictures showing internal organs, were identified as barriers to engagement. These visuals may confuse audiences or evoke feelings of disgust, which can deter individuals from participating in screening. The findings suggest that screening promotion materials should incorporate clear, informative visuals that directly relate to the screening process, such as test kits and health care professionals. Conclusions: The study provides practical recommendations for designing effective, culturally relevant promotional materials that balance informational content with emotional appeal, improving the likelihood of increasing bowel cancer screening uptake.
This brief report examines the association between health information literacy and digital self-efficacy (DSE) in patients with multiple sclerosis or epilepsy (pwMS/E). The focus is specifically on critical and risk-conscious aspects of health information literacy. The study used survey data (N = 287) collected from pwMS/E. The analysis comprises a principal component analysis and a regression analysis. In a model controlling age, gender and subjective anxiousness and/or depression, a high level of health information literacy was associated with higher DSE. The model explained over one-third of the variance in DSE. The found association between health information literature and DSE in a Finnish sample of pwMS/E increases the generalizability of the findings of the previous review study. Chronically ill patients with adequate health information literacy are confident in their ability to manage their illness, including on digital platforms.
Background: Millions of United States residents made use of public health websites during the coronavirus disease 2019 (COVID-19) pandemic to obtain information about vaccines and determine vaccine eligibility. Objective: For public health websites to be effective, they must be usable. This study aimed to evaluate the usability of government websites for vaccine information, by examining whether these platforms helped users determine COVID-19 vaccine eligibility accurately and satisfactorily, as well as how health literacy (HL) plays a role in accurate eligibility judgments and satisfaction with the media. Methods: A within-subject experiment was conducted (N = 39), where each participant used two websites and one embodied conversational agent system to determine their own eligibility for vaccination, as well as that of a fictitious persona as a standardized task. The website conditions in the study included the Centers for Disease Control (CDC) website, as well as vaccines.gov and mass.gov. The accuracy of participant-estimated eligibility and usability were further analyzed for association with HL. Key Results: Participants' estimate of vaccine eligibility was generally inaccurate for all website conditions, with an overall rate of 53.8% for correct responses. Participants with low HL had more incorrect responses and confusion, and HL was found to be a significant predictor of eligibility correctness when they were determining their own vaccine eligibility using the CDC website. Participants also reported having a significantly higher ability to find information and were more satisfied when interacting with the embodied conversational agent system, compared to the websites. Conclusions: Government websites—particularly the CDC website—were found to lack usability, especially for those with low HL. High error rates and low satisfaction underscore the need for simplification of public health site content and design and motivate the development of novel education methods for public health communication.
Background: Digital mental health (dMH) treatments have garnered much attention for increasing access to treatment, yet real-world engagement with these treatments remains a challenge. In upscaling these treatments, we need to ensure that they are equitable and do not exclude groups who already experience inequities in health care, such as people with lower health literacy. Objective: To co-develop recommendations for the design and delivery of dMH treatments for people with a variety of health literacy levels. Methods: Drafted recommendations were based on a thematic analysis of 357 free-text comments (likes, dislikes/other suggestions) from 213 people (n = 80 lower, and n = 133 higher health literacy) who had completed unguided internet-delivered cognitive behaviour therapy (iCBT) for depression and anxiety, as part of a trial. The initial set of drafted recommendations were iteratively modified and refined based on a review by a multidisciplinary project team with professional and lived-experience expertise (n = 9) and focus group consultations with people with relevant lived experience (n = 8). Key Results: The co-development process resulted in seven final recommendations: (1) Focus on informative and practical content; (2) Prioritize accessibility and ease of use; (3) Structure content in a progressive, layered way; (4) Enhance interactivity and engagement; (5) Employ strategies to enhance motivation and accountability; (6) Consider participants' emotional wellbeing; (7) Incorporate diverse modes of delivering content. Most recommendations were based on comments from people with lower and higher health literacy. Conclusions: These recommendations advance both research and practice by outlining a flexible and practical framework for dMH treatment developers and service providers to meet the preferences and needs of people with diverse health literacy strengths and needs. Further research is needed to determine the feasibility and impact of implementing these recommendations across different dMH treatment delivery formats, settings, and populations.
Background: Despite recommendations that medical schools incorporate health literacy (HL) into curricula and identification of consensus areas of HL competence, high-quality data are needed for curricular characteristics and structured evaluation that foster sustained HL competency adoption. Objective: This study aimed to develop and evaluate a comprehensive longitudinal medical school HL curriculum using qualitative and quantitative assessments. We sought to ground this in existing theory and provide evidence for generalizable use and further theory refinement. Methods: Across three medical student cohorts, HL was integrated into a 14-month pre-clinical professional development course. The longitudinal curriculum was informed by consensus-derived HL competencies and Bloom's Taxonomy. Student self-assessment and reflection data were linked across three timepoints and analyzed using mixed methods: an inductive approach identified key qualitative themes; exploratory factor analysis (EFA) identified prevalent factors within self-assessments; and analysis of variance identified differences across timepoints. Key Results: Three qualitative themes emerged from student reflections: emotions associated with a backward reading exercise; shifts in awareness of HL as a patient challenge; and plans to continue using HL practices. Among 336 students with quantitative data across all timepoints, EFA identified three factors: foundations, shame-free environment, conveying information. Over the curriculum, students demonstrated significant (p < .05) improvements in each factor. Conclusions: Our longitudinal HL curriculum, grounded in existing competencies and conceptual framework, elicited positive changes related to medical student HL competencies. Qualitative data demonstrating motivation and intention to continue applying HL practices were augmented by quantitative data showing increased adoption of self-reported behaviors over curricular timepoints. This study fulfills multiple features of a conceptual framework for HL curricula in health professions education, including sequenced, interactive sessions, multiple instruction modes, reflection, integration of knowledge and skill education, and varied assessment methods. Our findings can be used by investigators, institutions, and professional accreditation organizations to broadly enhance HL education.
Background: Community engagement is key to developing culturally responsive public health interventions that resonate with diverse populations and promote health equity. Brief Description of Activity: We applied an adapted version of Boot Camp Translation (BCT), a community-based participatory approach, to develop culturally and locally relevant messaging and materials for diverse populations. This adapted BCT approach focuses on three core themes: (1) Listen, (2) Empower, and (3) Co-Create, or LEC. The LEC method helps community leaders and champions learn from community members about barriers and gaps in health care (listen), share health information in a collaborative way (empower), and develop messages and materials that resonate with and motivate community members to take control of their own health (co-create). Implementation: LEC follows a 3 to 4 month process: an in-person session with expert presentations and group discussions, followed by two virtual meetings to share and refine co-created messages and materials. Results: The LEC approach was successfully conducted in diverse communities, engaging participants in preferred venues like churches, clinics, and tribal centers over 3 to 4 months. Tailored messages resonated with cultural values, while common themes included family and faith. Preferred materials were fact sheets, pamphlets, posters, videos, and visual stories. Participant evaluations showed high satisfaction, comfort sharing opinions, and improved understanding of how to take care of one's health. Lessons Learned: The LEC method fosters collective responsibility between community members and researchers to collaboratively address health needs. To support implementation, we offer best practices for LEC application, and customizable materials and guidance tailored to community preferences. This flexible, adaptable approach may enhance effectiveness, relevance, and sustainability of public health efforts across diverse settings.
Hispanic and Latino/a/e individuals are more likely to have lower levels of health literacy compared to other ethnic and racial groups. Additionally, 32% of this population also has limited English proficiency. There is a need to develop culturally valid instruments in Spanish to assess health literacy in this population. The Health Literacy Skills Instrument Short Form (HLSI-SF) was developed and validated in English by RTI International, but not in Spanish. Our aim was to culturally adapt the HLSI-SF to be used for Hispanic and Latino/a/e individuals living in the United States. We followed the Patient-Reported Outcome Consortium guidelines for cross-cultural adaptation of measures for content and linguistic validity. This included two forward-translations, reconciliation, two back-translations, revision and harmonization, cognitive interviews (total of six), revision, external expert review, and final version. We involved an expert panel of health professionals and community representatives throughout the process. The panel (n = 4) all self-identified as Hispanic or Latino/a/e and were fluent in English and Spanish. To evaluate the adapted HLSI-SF measure, we conducted cognitive interviews through six online focus groups involving 22 Hispanic and Latino/a/e community members, followed by a psychometric assessment using a sample of 726 Hispanic and Latino/a/e individuals with Spanish as their primary language. Focus group-based cognitive interviews revealed that while most items on the adapted HLSI-SF measure performed well, some participants had difficulties with a few items, which may suggest limited health knowledge. Psychometric analyses revealed that all but the Nutrition Label and Calories items performed well. Further validation of the HLSI-SF is needed to produce a valid and reliable instrument to measure health literacy in Hispanic and Latino/a/e populations in the U.S. [HLRP: Health Literacy Research and Practice. 2025;9(3):e83-e92.].
Advancing Health Literacy Franklin County was initiated in June 2021 with a goal of building a sustainable health literate community in Franklin County, Ohio, USA. The project was a collaboration among public health departments, health care organizations, an academic institution, and community organizations and included capacity-building over a 2-year period. Project evaluation included social network analysis mapping of organizational relationships over two project time periods to document change in this area. This brief report describes the social network analysis mapping as a project outcome, a valuable approach to advancing organizational health literacy and health equity, and a practical tool for other health literacy projects as sustainable relationships and networks are important in health literacy research and practice. [HLRP: Health Literacy Research and Practice. 2025;9(3):e78–e82.]
This study aimed to explore the barriers to cardiac rehabilitation (CR) participation across individuals with different levels of health literacy. A cross-sectional study was conducted among individuals referred to a CR program. Participants completed online surveys assessing CR barriers using the Cardiac Rehabilitation Barriers Scale and health literacy using the Brief Health Literacy Screening Tool. Descriptive statistics and comparisons were performed. Among 881 individuals invited, 400 responded, with varying levels of health literacy: 22(6%) limited, 305(76%) marginal, and 72(18%) adequate. The greatest barriers included family responsibilities, lack of energy, and a preference for managing health alone. However, distinct patterns emerged based on health literacy levels, with individuals citing different barriers. Although no significant differences were observed in CR barriers based on health literacy, understanding individual-specific challenges is crucial for intervention development. Addressing common barriers such as family responsibilities and logistical challenges could enhance CR engagement and adherence. [HLRP: Health Literacy Research and Practice. 2025;9(2):e72–e77.]
BACKGROUND:In recent years, parents have had more opportunities to use applications (apps) to access health care information. OBJECTIVE:In this study, we aimed to evaluate whether the use of an app that provides health care information on children improves parents' health literacy. METHODS:This open-label, nonrandomized, parallel-controlled trial was conducted at two health centers in Japan. We recruited parents of 1.5-year-old children and introduced the Oshiete! Doctor app to the intervention group. The primary outcome was a change in the parents' health literacy scores (HLSs). KEY RESULTS:A total of 200 parents were included in this study. The mean HLSs slightly improved in both groups, with greater improvement observed in the intervention group than in the control group. However, the difference was not statistically significant. In the intervention group, participants with higher app ratings showed greater improvement in their HLSs after the intervention. CONCLUSIONS:The introduction of an app that provides health care information on children did not show a statistically significant improvement in parents' health literacy. In the intervention group, participants with higher app ratings showed greater improvement in their HLSs after the intervention. Future research on apps and parental health literacy should also consider the frequency of app use. Larger, longer-term studies are needed. [HLRP: Health Literacy Research and Practice. 2025;9(2):e64-e71.].
