Predictors of Diabetes Health Literacy and Numeracy Among Urbanized Older Adults in Malaysia

@#Introduction: Diabetes health literacy and numeracy are health indicators of increasing attention to empower diabetic self-management. This study aimed to explore the predictors of diabetes health literacy and numeracy among urbanized older adults. Methods: A total of 408 older adults with type 2 diabetes mellitus, aged 50 years and older were recruited using stratified random sampling from eight health clinics in Petaling district. A pre-tested questionnaire was used to measure knowledge, attitude, self-efficacy, self-care behavioral skills, diabetes health literacy and numeracy related to diabetes mellitus, as well as the sociodemographic background. Multivariable linear regression was used to understand and rank the predictors of diabetes health literacy and numeracy among the respondents. Results: The total mean score for diabetes health literacy was 53.74 ± 0.60, which was significantly predicted by age (β = -0.21, p=0.01), secondary (β =12.21, p<0.001) and tertiary (β = 16.37, p<0.001) education levels, non-Malays (β = -5.83, p<0.001), being employed (β = -2.77,p=0.02), have other comorbidities (β = -3.02, p=0.003), diabetes related self-efficacy (β = -0.37, p=0.02) and self-care behavioral skills (β =0.36, p<0.001). Meanwhile, the total mean score for diabetes health numeracy was 1.50 ± 0.13 and was significantly predicted by age (β=-0.15, p<0.001), secondary (β=1.09, p=0.002) and tertiary (β=2.24, p<0.001) education levels, and attitude towards diabetes (β=0.16, p<0.001). Conclusion: Very low diabetic numeracy was observed, which was predicted by increased age, low education and low attitude score towards managing diabetes. Hence promoting diabetic numeracy should be targeted among older adults with identified risks.

Differences in decisions affected by cognitive biases: examining human values, need for cognition, and numeracy

Abstract A better understanding of factors that can affect preferences and choices may contribute to more accurate decision-making. Several studies have investigated the effects of cognitive biases on decision-making and their relationship with cognitive abilities and thinking dispositions. While studies on behaviour, attitude, personality, and health worries have examined their relationship with human values, research on cognitive bias has not investigated its relationship to individual differences in human values. The purpose of this study was to explore individual differences in biased choices, examining the relationships of the human values self-direction, conformity, power, and universalism with the anchoring effect, the framing effect, the certainty effect, and the outcome bias, as well as the mediation of need for cognition and the moderation of numeracy in these relationships. We measured individual differences and within-participant effects with an online questionnaire completed by 409 Brazilian participants, with an age range from 18 to 80 years, 56.7% female, and 43.3% male. The cognitive biases studied consistently influenced choices and preferences. However, the biases showed distinct relationships with the individual differences investigated, indicating the involvement of diverse psychological mechanisms. For example, people who value more self-direction were less affected only by anchoring. Hence, people more susceptible to one bias were not similarly susceptible to another. This can help in research on how to weaken or strengthen cognitive biases and heuristics.

Abriendo espacios de participación virtual multimodal a jóvenes durante la pandemia covid-19 / Opening multimodal virtual participation spaces for young students during the COVID-19 pandemic / Abrindo espaços virtuais multimodais de participação para estudantes durante a pandemia Covid-19

Resumen (analítico) Las y los estudiantes carecen de espacios para valorar sus experiencias de inclusión/exclusión escolar. La crisis sanitaria obligó a vincularnos virtualmente, sin conocer las posibilidades para el intercambio de significados digitales, representación de experiencias y movilización de relaciones interpersonales. Desde una perspectiva pedagógica, semiótica y social, este estudio analiza una sesión de un taller virtual con nueve estudiantes secundarios de tres escuelas chilenas, preguntándose sobre cómo se materializó la participación de las y los jóvenes. Con herramientas de la multimodalidad se analiza un corpus audiovisual de una cartografía virtual de espacios educativos. Se visibilizan los recursos disponibles para la participación virtual y las maneras en que fueron usados para compartir significados individuales y generar solidaridad co-construyendo relatos de inclusión/exclusión escolar.

Abstract (analytical) Students lack spaces that evaluate their experiences of inclusion/exclusion in school. The health cri-sis forced us to interact online and at first we were not aware of the resources available for the ex-change of digital meanings, representation of experiences and formation of interpersonal relation-ships. Using a pedagogical, semiotic and social approach, this study analyzes the results of an online workshop attended by nine secondary students from three Chilean schools. The aim was to identify the means and resources that facilitated student participation in online environments. Using multi-modal tools, an audiovisual corpus consisting of an Online Cartography of Educational Spaces is explored by the authors. The resources available for online participation were shared by participants. In addition, the article describes semiotic mechanisms for sharing individual meanings and developing solidarity by co-constructing stories about inclusion/exclusion in the classroom.

Resumo (analítico) Os alunos e alunas não têm espaços para avaliar suas experiências de inclusão/exclusão escolar. A crise de saúde pela Covid-19 obrigou as pessoas a termos uma interação virtual, sem conhecer os recursos disponíveis para a troca de significados digitais, a representação de experiências e o desenvolvimento das relações interpessoais. Do ponto de vista pedagógico, semiótico e social, este estudo analisa uma sessão de oficina virtual com nove alunos e alunas do ensino médio de três es-colas chilenas. A pesquisa foca em identificar os significados y recursos que auxiliam a participação dos e das estudantes. Utilizando ferramentas multimodais, foi analisado um corpus audiovisual de uma Cartografia Virtual de Espaços Educacionais. Assim, este estudo mostra os recursos disponíveis para a participação virtual e as formas como foram utilizados para compartilhar significados desde a experiência pessoal, além de promover a solidariedade através da co-construção de relatos de inclusão/exclusão escolar.

¿Ser o no sucesor? A qué aspira la juventud rural de Rio Grande do Sul / Ser ou não ser sucessor? O que almejam os jovens rurais do Rio Grande do Sul / To be or not to be a successor? The aspirations of the rural youth of Rio Grande do Sul

Resumen (analítico) Essa pesquisa identificou se os jovens e as jovens rurais que residem no Rio Grande do Sul/Brasil estão projetando seu futuro profissional no campo, pretendem ser sucessores nos estabelecimentos agropecuários familiares, além de apontar os fatores condicionantes para a tomada destas decisões. A pesquisa foi realizada a partir de questionário aplicado em 2018 e 2019. A amostra foi composta por 743 jovens, com idades de 13 a 21 anos, filhos de agricultores e estudantes do ensino médio. Constatouse que 47.9% dos e das jovens querem permanecer no campo e 45.2% querem ser sucessores. O processo sucessório tem sido comprometido pela limitação da participação dos e das jovens rurais nos processos gerenciais e na tomada de decisões nas propriedades. Conclui-se que o jovem valoriza significativamente o fato de ser sujeito atuante e autônomo na propriedade.

Abstract (analytical) This research focused on whether rural youths living in Rio Grande do Sul in Brazil are projecting their futures in agriculture and intend to be successors of family farming establishments, in addition to highlighting the conditioning factors that are used to make these decisions. The research involved the application of a questionnaire applied in 2018 and 2019. The sample consisted of 743 young people aged 13 to 21 years who are children of farmers and high school students at the time. It was found that 47.9% of the surveyed young people want to stay in the countryside and 45.2% want to be successors. The succession process has been compromised by limits on the participation of rural youth in management and decision-making processes on their family's properties. The authors conclude that these young people significantly value being active and autonomous subjects on their families' properties.

Resumo (analítico) Esta investigación identificó si los jóvenes rurales residentes en Rio Grande do Sul/Brasil están proyectando su futuro profesional en el campo, pretenden ser sucesores en los establecimientos de agricultura familiar, además de señalar los condicionantes para la toma de estas decisiones. La encuesta se realizó con base en un cuestionario aplicado en 2018 y 2019. La muestra estuvo conformada por 743 jóvenes, de 13 a 21 años, hijos de agricultores y estudiantes de secundaria. Se encontró que el 47.9 % de los jóvenes quiere quedarse en el campo y el 45.2 % quiere ser sucesor. El proceso de sucesión se ha visto comprometido al limitar la participación de la juventud rural en los procesos de gestión y en la toma de decisiones sobre las propiedades. Se concluye que el joven valora significativamente el hecho de ser un sujeto activo y autónomo en la propiedad.

Conocimientos sobre dibujo, escritura y numerales en la producción gráfica materno-infantil, Argentina / Knowledge about drawing, writing and numerals in mother-child graphic production, Argentina / Conhecimentos sobre desenho, escrita e números na produção gráfica maternoinfantil, Argentina

Resumen (analítico) Este estudio examina los conocimientos sobre las propiedades formales y la función referencial del dibujo, la escritura y los numerales desplegados por madres y sus niños y niñas (2 ½ años y 4 años) en una tarea de producción conjunta. Se construyó un sistema de codificación mediante el método comparativo constante; se analizó mediante pruebas no paramétricas. Las díadas del grupo de 2 ½ años conversaron sobre la función referencial de los tres sistemas, especialmente del dibujo. A los 4 años se incrementó el interés en la escritura, la consideración de las propiedades formales de la escritura y los numerales; así como las producciones infantiles independientes de dibujo y escritura. El estudio mostró a la producción gráfica como una interacción educativa en la familia que estimula la apropiación temprana de las representaciones externas.

Abstract (analytical) This study examines the knowledge of formal properties and referential function of drawing, writing and numerals displayed by mothers and their children (2 and a half years old and 4 years old) in a joint production task. A coding system was constructed using the constant comparative method and was analyzed using non-parametric tests. The results of the group with 2 and half year old children demonstrated the referential function of the three systems, especially the drawing. At the age of 4 children's interest in writing increased, as well as the consideration of the formal properties of writing and numerals and the children's independent production of drawing and writing. The study demonstrated that graphic production is an educational interaction in the family that stimulates the early appropriation of external representations.

Resumo (analítico) Este estudo examina o conhecimento sobre as propriedades formais e a função referencial de desenho, escrita e numerais que mães, filhos e filhas (2 anos e meio e 4 anos) apresentados em tarefa de produção conjunta. O método comparativo constante foi utilizado para a construção do sistema de codificação; se analisou mediante provas não paramétricas. As duplas do grupo de 2 anos e meio conversaram sobre a função referencial dos três sistemas, especialmente do desenho. No grupo de 4 anos aumentaram o interesse pela escrita, a consideração das propriedades formais da escrita e dos numerais e as produções independentes de desenho e escrita. O estudo mostrou a produção gráfica conjunta como uma interação educacional na família que estimula a apropriação precoce de sistemas de representação externa.

Health literacy levels in diabetes patients with poor glycemic status in communities of Shanghai / 复旦学报（医学版）

Objective To investigate the levels of literacy and numeracy in type 2 diabetes patients with poor glycemic status in communities of Shanghai,China,and to evaluate their associations with blood glucose level.Methods A total of 800 type 2 diabetes patients with recent HbA1c≥7.5％ or fasting plasma glucose level ≥10 mmol/L were recruited from 8 communities in Minhang district and Changning district of Shanghai,China,and were interviewed using a structured questionnaire during February 2015 and March 2016.Literacy and numeracy levels of all patients were evaluated using the validated Health Literacy Management Scale (HeLMS) and the 5-item version Diabetes Numeracy Test (DNT-5),respectively.Results The patients included in this study were observed to have higher levels of health literacy,with a median score of HeLMS being 116 [interquartile range (IQR),108-120] and a median correct rate of DNT-5 of 80％ (IQR,60％-100％).Age,educational level and occupation were significantly related with health literacy levels and numeracy.Sex and income were closely related with health literacy levels.HeLMS score was not significantly associated with HbA1c level (P =0.383),while the lower correct rate of DNT-5 was linked with a higher level of HbA1c.The median HbA1c level was 8.3％ (IQR 7.7％-9.4％) in the patients with the lowest tertile of DNT-5 correct rate,significantly higher than 8.2％ (IQR:7.5％-9.2％) in the medium and 8.0％ (IQR:7.5 ％-8.8 ％) in the highest tertile group (P =0.009).Conclusions Diabetes patients with poor glycemic status in communities of Shanghai have high levels of health literacy,which was significantly related with age,sex,educational level,occupation and income.Ability in numeracy may be a more important influence factor than health literacy for glycemic status of diabetes patients.

Public Perceptions on Cancer Incidence and Survival: A Nation-wide Survey in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to compare the public perceptions of the incidence rates and survival rates for common cancers with the actual rates from epidemiologic data. MATERIALS AND METHODS: We conducted a survey of Korean adults without history of cancer (n=2,000). The survey consisted of questions about their perceptions regarding lifetime incidence rates and 5-year survival rates for total cancer, as well as those of eight site-specific cancers. To investigate associated factors, we included questions about cancer worry (Lerman's Cancer Worry Scale) or cared for a family member or friend with cancer as a caregiver. RESULTS: Only 19% of Korean adults had an accurate perception of incidence rates compared with the epidemiologic data on total cancer. For specific cancers, most of the respondents overestimated the incidence rates and 10%-30% of men and 6%-18% of women had an accurate perception. A high score in "cancer worry" was associated with higher estimates of incidence rates in total and specific cancers. In cancers with high actual 5-year survival rates (e.g., breast and thyroid), the majority of respondents underestimated survival rates. However, about 50% of respondents overestimated survival rates in cancers with low actual survival rates (e.g., lung and liver). There was no factor consistently associated with perceived survival rates. CONCLUSION: Widespread discrepancies were observed between perceived probability and actual epidemiological data. In order to reduce cancer worry and to increase health literacy, communication and patient education on appropriate risk is needed.

Habilidades numéricas y salud: una revisión crítica / Numeracy and health: A critical review

A la hora de realizar juicios y tomar decisiones sobre la salud, debemos procesar y comprender información numérica. Por ejemplo, habitualmente recibimos información sobre el riesgo de padecer una enfermedad en probabilidades, porcentajes o fracciones. Sin embargo, muchas personas presentan deficiencias a la hora de comprender esta información. En este trabajo, presentamos una revisión crítica de la evidencia empírica sobre los efectos que tienen las habilidades numéricas en diversos aspectos del proceso que acontece cuando un paciente acude al médico, más concretamente en la percepción de los riesgos médicos y la eficacia de los tratamientos. También describimos los distintos marcos teóricos que pretenden explicar estos efectos y resaltamos algunas de sus limitaciones. Por último, discutimos las ventajas y los inconvenientes de los instrumentos de medida de las habilidades numéricas, y destacamos entre ellos el Berlin Numeracy Test. Concluimos que este test puede evaluar las habilidades numéricas satisfactoriamente en diversos contextos, y planteamos diversas cuestiones que permanecen abiertas, como la relación entre las habilidades numéricas y diversos constructos psicológicos como la inteligencia o la reflexión cognitiva.

When we make judgments and decisions about our health, we are frequently faced with numerical information. For example, we often receive information concerning the risk of suffering an illness in terms of probabilities, percentages or fractions. However, many people have difficulties in understanding this type of information. In this paper, we present a critical review of the existing empirical evidence that documents the influence of numeracy on various aspects of the process that occurs when patients visit their doctor, focusing on perceptions of medical risks and treatment efficacy. We also outline different theoretical frameworks that have attempted to explain the impact of numeracy, highlighting some of their limitations. Finally, we discuss the advantages and disadvantages of existing tools for measuring numeracy, drawing attention to the Berlin Numeracy Test. We concluded that this test can satisfactorily assess numeracy in a wide range of contexts. We also discuss a number of open questions, including the relationship between numeracy and other psychological constructs, such as intelligence or cognitive reflection.

Letramento em saúde de diabéticos tipo 2: fatores associados e controle glicêmico / Health literacy in type 2 diabetics: associated factors and glycemic control

Pacientes com diabetes mellitus requerem um autocuidado extenso, com tratamentos complexos e comportamentos de saúde adequados, sendo, essas habilidades, fator chave. Frente a tal complexidade surge a importância do letramento funcional em saúde. O objetivo do estudo foi analisar fatores associados ao letramento em saúde e sua relação com controle glicêmico em pacientes diabéticos. Este estudo foi realizado com 82 pacientes diabéticos tipo 2, atendidos em um ambulatório de endocrinologia de um hospital público, de ambos os sexos e com idade entre 19 e 59 anos, que responderam à versão abreviada e traduzida do Test of Functional Health Literacy in Adults (b-TOFHLA). Valores de glicemia de jejum e hemoglobina glicada foram coletados dos prontuários dos participantes. Foram realizadas correlações, comparações de médias e modelos de regressão linear. O letramento inadequado foi encontrado em 65,9% dos pacientes. Foram fatores associados à pontuação do b-TOFHLA, a idade e os anos de estudos. O letramento global não explicou o controle glicêmico, mas o numeramento apresentou associação com tal controle. Nossos resultados apontam para a necessidade de melhorar o numeramento em saúde dos pacientes para obter seu melhor controle glicêmico, principalmente naqueles com maior idade e menos anos de estudo.

Diabetes mellitus patients must concentrate on self-care, with complex treatments and adequate health behavior in which such habits are a key factor. Due to the complexity of this issue, the importance of literacy in health arises. The goal of the study was to analyze factors associated with literacy in health and its relation with glycemic control in diabetic patients. It involved a study with 82 type 2 diabetic patients of both sexes and aged between 19 and 59 attended in the outpatient endocrinology ward of a public hospital, who filled out an abbreviated and translated version of the Test of Functional Health Literacy in Adults (b-TOFHLA). Fasting glycaemia values and glycated hemoglobin were collected from the clinical history of the participants. Correlations, mean comparisons and linear regression models were tested. Inadequate literacy in health was encountered in 65.9% of the patients. The issues involved factors associated with the b-TOFHLA point scores were age and years of schooling. Global literacy did not explain the glycemic control, but the level of numeracy presented an association with this control. The results point to the need to improve the numeracy in health of the patients to obtain enhanced glycemic control, mainly in those with more advanced age and less years of schooling.

Oral Health Literacy Among Carers Of Special Needs Children In Kuala Terengganu, Malaysia

Oral health literacy (OHL) is important in empowering people to improve their general and oral health.Carers’ OHL may be associated with their ability to deliver good oral healthcare to their children. The aimof this pilot study was to assess the OHL among carers of special needs children. This is a descriptivecross-sectional study of carers in four Community-Based Rehabilitation Centre. Data were collectedthrough a structured face-to-face interview of 40 carers. Oral Health Literacy Malay Version (OHLI-M)was measured using text passages and prompts with a total of 57 items. These items were used toassess comprehension and numerical ability of carers based on domains namely, accessing dental care,understand appointment and following medication instructions. The results showed that majority of theparticipants had ‘marginal’ and ‘adequate’ OHL level of 32.5% and 52.5%, respectively. Only four (10%)participants had ‘inadequate’ OHL level. The ‘reading comprehension’ and ‘numeracy’ sections’ meanscores were 37.54 (95% CI 35.7-39.4) and 38.17 (95% CI 34.8-41.6). The total OHL mean score was75.7 (95% CI 71.2-80.2). In conclusion, majority of the carers of special needs children in this sample hadmoderate OHL. Such information is important to develop more appropriate intervention programmes forcarers to match their OHL.