Background: Health literacy is a critical determinant of health outcomes, yet considerable variability exists in how it is measured across intervention studies. This scoping review article systematically mapped health literacy measurement tools and implementation reporting practices in United States-based interventions published between 2014 and 2024, with particular attention to validated and nonvalidated instruments and their application across diverse populations and settings. Methods: Following Joanna Briggs Institute guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, we searched Ovid MEDLINE in January 2025 for studies describing health literacy interventions focusing on health care providers, patients, educators, or community organizations in the U.S. Two independent reviewers screened records and extracted data using the Population-Concept-Context framework. Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate reporting of Reach, Effectiveness, Adoption, Implementation, and Maintenance dimensions. Key Results: Of 117 included studies, most targeted health care patients, with strong representation of racial and ethnic groups but limited inclusion of non-English speakers. Health literacy measurement was reported in 71 studies, with only 49 employing validated instruments. The Newest Vital Sign, eHealth Literacy Scale, and RE-AIM were most frequently used. Nearly all studies reported effectiveness with statistically significant results, predominantly measuring behavioral rather than clinical outcomes. RE-AIM analysis revealed substantial reporting gaps, particularly in demographic details, implementation fidelity, cost documentation, and maintenance planning. Only 18% of studies reported fidelity and fewer than 10% described sustainability strategies. Discussion: While health literacy intervention research has grown substantially, significant inconsistencies in measurement practices and implementation reporting limit comparability and translation into practice. The field requires greater standardization in measurement approaches, more comprehensive demographic reporting to assess equity impacts, and systematic application of implementation science frameworks from intervention inception. Improved reporting standards are essential to accelerate translation of health literacy research into sustainable, equitable practice.
Background: Several factors affect Quality of Life (QoL) such as health literacy, health behaviors, and mental health. Objective: This quantitative study examined the relationships between health literacy (HL), health behaviors (HB), mental health (MH), and QoL among Thailand's working-age population. Methods: A total of 360 individuals were selected using multistage sampling. Seven of 13 health regions were randomly chosen, followed by random selection of one province, district, and agency per region. Participants age 15 to 59 years were purposively recruited. Data were collected from December 2024 to January 2025 by using four questionnaires consisting of HL, HB, MH, and QoL (rating scale 1 to 5). Structural equation modeling (SEM) was used for data analysis. Key Results: Most participants demonstrated excellent health literacy (78.06%) and QoL (48.89%), with good HB (Mean = 3.82) and MH (Mean = 3.95). SEM showed HB and MH had significant direct positive effects on QoL (β = 0.315, p < .001; β = 0.860, p < .001), while HL exerted significant direct positive effects on both HB (β = 0.396, p < .001) and MH (β = 0.391, p < .001). HL indirectly influenced QoL (β = 0.464, p < .001) through these mediating variables. The model explained 92% of QoL variance and demonstrated excellent fit with empirical data (χ2 = 94.905, df = 76, χ2/df = 1.249, p = .070, RMSEA (root mean square error of approximation) = 0.026, RMR (root mean square residual) = 0.030, GFI (goodness-of-fit index)= 0.972, NFI (normed fit index) = 0.975, TLI (Tucker-Lewis Index) = 0.990, CFI (comparative fit index) = 0.995). A significant sequential pathway was observed (HL → HB → MH → QoL), with no significant direct path from HL to QoL. Conclusion: These findings suggest two potential pathways for improving QoL among working-age Thais: directly enhancing MH and HB to prevent illness or promoting HL to indirectly improve health outcomes. Health care providers should develop programs targeting these factors, with particular emphasis on MH given its stronger influence.
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.
