Health literacy and risk of viral hepatitis among Chinese school children.

INTRODUCTION: Poor literacy is associated with hepatitis morbidity and mortality. Adolescents are especially at risk of hepatitis C. This study investigated viral hepatitis literacy, risk, and influencing factors among Chinese middle and high school students. METHODOLOGY: A supervised self-administered survey was conducted with school children from six schools in Shantou, China. Data on demographics, health literacy, and risk of viral hepatitis were analyzed. RESULTS: A total of 1732 students (from three middle and three high schools) participated in the study. Their major information resources were the internet (39.5%, 685/1732), television (28.8%, 498/1732), family (27.7%, 479/1732), and school (21.2%, 368/1732). The mean literacy score on the manifestations and risk factors of hepatitis was 3.4 ± 2.2 and 4.0 ± 2.3 (out of 8), respectively. Multiple linear regression models showed being female and in high school, having parents with higher education levels, and school or clinicians as an information resource were independent positive predictors, whereas poor awareness of risk factors was a negative predictor for health literacy. CONCLUSIONS: We report the risk of hepatitis among Chinese middle and high school students due to limited literacy and poor attitudes towards health-risk behaviors. Health education in school is recommended for preventable health risks among Chinese adolescents.

HIV and AIDS prevention: knowledge, attitudes, practices and health literacy of older persons in the Western Cape and KwaZulu-Natal Provinces, South Africa and in Lesotho.

BACKGROUND: Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years. METHODS: A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants' KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level. RESULTS: The baseline survey comprised 1163 participants. The median age was 63 years (range 50-98 years); 70% were female, and 69% had ≤ 8 years' education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2-2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5-2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4-3.4); (High school: AOR = 4.4; 95% CI = 2.7-7.0); (University/college: AOR = 9.6; 95% CI = 4.7-19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention. CONCLUSIONS: The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.

Accelerating digital health literacy for the treatment of growth disorders: The impact of a massive open online course.

Background: Growth hormone deficiency (GHD) is a rare disorder characterized by inadequate secretion of growth hormone (GH) from the anterior pituitary gland. One of the challenges in optimizing GH therapy is improving adherence. Using digital interventions may overcome barriers to optimum treatment delivery. Massive open online courses (MOOCs), first introduced in 2008, are courses made available over the internet without charge to a large number of people. Here, we describe a MOOC aiming to improve digital health literacy among healthcare professionals managing patients with GHD. Based on pre- and post-course assessments, we evaluate the improvement in participants' knowledge upon completion of the MOOC. Methods: The MOOC entitled 'Telemedicine: Tools to Support Growth Disorders in a Post-COVID Era' was launched in 2021. It was designed to cover 4 weeks of online learning with an expected commitment of 2 h per week, and with two courses running per year. Learners' knowledge was assessed using pre- and post-course surveys via the FutureLearn platform. Results: Out of 219 learners enrolled in the MOOC, 31 completed both the pre- and post-course assessments. Of the evaluated learners, 74% showed improved scores in the post-course assessment, resulting in a mean score increase of 21.3%. No learner achieved 100% in the pre-course assessment, compared with 12 learners (40%) who achieved 100% in the post-course assessment. The highest score increase comparing the pre- and the post-course assessments was 40%, observed in 16% of learners. There was a statistically significant improvement in post-course assessment scores from 58.1 ± 18.9% to 72.6 ± 22.4% reflecting an improvement of 14.5% (p < 0.0005) compared to the pre-course assessment. Conclusion: This "first-of-its-kind" MOOC can improve digital health literacy in the management of growth disorders. This is a crucial step toward improving the digital capability and confidence of healthcare providers and users, and to prepare them for the technological innovations in the field of growth disorders and growth hormone therapy, with the aim of improving patient care and experience. MOOCs provide an innovative, scalable and ubiquitous solution to train large numbers of healthcare professionals in limited resource settings.

Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co-creation of a hospital-based health literacy plan.

BACKGROUND: People with literacy needs can experience many challenges in accessing, understanding and using health services and health information. Such challenges can adversely impact patient-provider interactions and ultimately, health outcomes. Healthcare providers need to be aware of health literacy (HL) to address the demands of healthcare systems, improve their interactions with communities and patients and promote patient engagement for improved health outcomes. METHODS: This paper reports on a process of patient and public involvement (PPI) with participants in an adult literacy programme acting as PPI contributors to identify priority areas for a local hospital HL action plan and to develop a protocol for a PPI process with other groups. A qualitative community-based participatory research study design informed by principles of PPI was undertaken, drawing on the tools of participatory and visual methods, open discussion and workshop format to facilitate a process of co-creation. Three workshops with six PPI contributors took place to identify issues to be included in the hospital action plan. PPI contributors identified issues and grouped these into priority areas using discussion and ranking procedures. RESULTS: Key areas prioritised for HL action by the PPI contributors were: verbal communication, emphasising the patient's right to understand, and improved understanding of medication use. These were incorporated into the action plan. The workshop format and process were deemed acceptable to the group and input on improvements will be incorporated into further work in this area. CONCLUSION: PPI acts as a lever in the knowledge translation process. Genuine engagement with service users can meaningfully contribute to relevant and sustainable changes to services as well as foster the empowerment of service users. PATIENT OR PUBLIC CONTRIBUTION: Members of the public with literacy needs actively participated in the co-creation of a HL action plan for a local hospital and in the development of a protocol for a patient and public process for HL research.

The role of digital literacy in achieving health equity in the third millennium society: A literature review.

Healthcare in the third millennium is largely delivered through systems involving the use of the technological devices and services, foremost among them telemedicine. For the adequate delivery of digital medicine services, however, it is necessary for users to be digitally literate, that is, able to consciously make use of technology. In order to understand how relevant digital literacy is in determining the effectiveness of e-Health services, we performed a traditional literature review on 3 major databases by combining the terms "Digital Literacy" and "Computer Literacy" with the terms "Telemedicine" and "Telehealth". Starting from an initial library of 1,077 papers, we selected 38 articles. At the outcome of the search, we found that digital literacy is a pivotal element in conditioning the effectiveness of telemedicine and digital medicine services in general, however, with some limitations.

[Providing Health-Literacy-Level-Appropriate Health Education to Older Adults in the Post-Pandemic Era].

The rapidly changing and high-risk nature of communicable diseases for older adults require individuals in this age group to appropriately change their lifestyle and healthcare habits and engage in self-care more actively and seriously. Good self-health management relies on good health literacy in order to be able to read, understand, and apply relevant health information; to communicate clearly with healthcare providers; and to take health-related decisions and actions. The results of research indicate the health literacy of over 50% of older adults in Taiwan to be inadequate, which may be expected to negatively impact on related health outcomes. After introducing the content, determinants, and impacts of health literacy, the author suggests strategies to improve health literacy in older adults in five activity domains based on current theories and research findings. These domains include: formulate public policies for health literacy, adjust the orientation of health services, construct a friendly healthy information environment for health literacy, strengthen community health literacy education resources, and promote gerontological education and shared decision-making in health care.

Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system.

The COVID-19 pandemic disproportionately affected Black communities in Canada in terms of infection and mortality rates compared to the general population. Despite these facts, Black communities are among those with the highest level of COVID-19 vaccine mistrust (COVID-19 VM). We collected novel data to analyze the sociodemographic characteristics and factors associated with COVID-19 VM among Black communities in Canada. A survey was conducted among a representative sample of 2002 Black individuals (51.66% women) aged 14-94 years (M = 29.34; SD = 10.13) across Canada. Vaccine mistrust was assessed as the dependent variable and conspiracy theories, health literacy, major racial discrimination in healthcare settings, and sociodemographic characteristics of participants were assessed as independent variables. Those with a history of COVID-19 infection had higher COVID-19 VM score (M = 11.92, SD = 3.88) compared to those with no history of infection (M = 11.25, SD = 3.83), t (1999) = -3.85, p < 0.001. Participants who reported having experienced major racial discrimination in healthcare settings were more likely to report COVID-19 VM (M = 11.92, SD = 4.03) than those who were not (M = 11.36, SD = 3.77), t (1999) = -3.05, p = 0.002. Results also showed significant differences for age, education level, income, marital status, provinces, language, employment status, and religion. The final hierarchical linear regression showed that conspiracy beliefs (B = 0.69, p < 0.001) were positively associated with COVID-19 VM, while health literacy (B = -0.05, p = 0.002) was negatively associated with it. The mediated moderation model showed that conspiracy theories completely mediated the association between racial discrimination and vaccine mistrust (B = 1.71, p < 0.001). This association was also completely moderated by the interaction between racial discrimination and health literacy (B = 0.42, p = 0.008), indicating that despite having a high level of health literacy, those who experienced major racial discrimination in health services developed vaccine mistrust. This first study on COVID-19 VM exclusively among Black individuals in Canada provides data that can significantly impact the development of tools, trainings, strategies, and programs to make the health systems free of racism and increase their confidence in vaccination for COVID-19 and other infectious diseases.

[The Role of Nurses in Bridging the Health Literacy Gap: Empowering Patients in the Post-Pandemic Era].

Health literacy (HL) is an essential ability used by people throughout life to access, understand, appraise, and apply health related information and services and is widely recognized as a key determinant of health. HL has been the focus of increasing international attention in the 21st century, with the World Health Organization identifying HL as a 2030 sustainable development target (World Health Organization, 2016). "Strengthening health communication and improving HL nationwide" is also an issue targeted in a Taiwan government white paper for improvement by 2025. Key related actions and strategies noted in this paper include investigating the HL of each life course; disseminating accurate, easy-to-access, and implementable health and safety information; improving the public's awareness and use of mobile tools; using multiple marketing models (public, organization, interpersonal communication); combining cloud technology to develop a health management system; setting up websites; providing cloud care; and developing other e-media (Ministry of Health and Welfare, 2016). The COVID-19 pandemic has greatly challenged the global healthcare system as well as individual health. Due to the difficulties and uncertainties associated with emerging diseases, updating regularly changing information in a timely manner is not easy. Ensuring public access to and application of updated information is a key challenge to improving public HL. Abel & McQueen (2020) pointed out that "critical health literacy", the ability of individuals to reflect on complex health issues and critically evaluate available information, will be the key to promoting and enhancing healthy behaviors in response to emerging diseases. Taiwan is rapidly moving toward becoming a super-aged society, at which time frail older adults, individuals with dementia, and individuals with disabilities and multiple chronic diseases are expected to be the primary targets of healthcare system services. During the pandemic, many individuals in vulnerable groups died quickly due to COVID-19-related severe illnesses, leaving their families with insufficient time to respond and adjust. This experience highlights the importance of palliative and end-of-life care communication with clients and of permitting family members to grieve. In addition, disease control measures such as isolation, wearing masks, and reducing visits to patients have also affected communication between people, widening the distance between patients, their families, and healthcare professionals. This experience has made us reflect on how to better use online and mobile tools to support self-care for patients and their families. In this issue, Professor Li first expounds on promoting HL in the elderly through the use of health education strategies such as formulating public policies related to HL, adjusting the orientation of health services, constructing a friendly environment for HL information dissemination, strengthening community resources for HL education, and promoting geriatric learning and shared decision-making. Professor Wu encourages nurses in long-term care facilities to apply the U-R-PEACE strategy to promote understanding, respect, planning, expression, act, care, and education in a manner that facilitates effective palliative care communication with patients and their families as early as possible. Because dementia care relies heavily on family caregivers, Professor Luo suggests using family-caregiver-created and managed Facebook groups to share health information and facilitate social support, shedding light on how to use social media to effectively empower caregivers. Interactions between patients and healthcare professionals are critical to effective healthcare delivery. The unequal power dynamic between physicians and patients may lead to communication conflicts, especially as generational replacement progresses and public health awareness improves. Facing the differences between these two interest groups, Professor Ye suggest nurses handle conflicts proactively by increasing their emotional drive to address disagreements, enhancing their cognitive abilities to handle interpersonal dynamics, and engaging actively in communicative measures.

Assessing the Readability of Covid-19 Testing Messages on the Internet.

The COVID-19 pandemic first became evident at the end of 2019, and because of the many unknown aspects of this emerging infectious disease, the internet quickly became a source of information for consumers. It is important for any vital information to be written unambiguously, and at a level that can be understood by all people regardless of education levels. The purpose of this study was to assess the readability of 50 sources of COVID19 testing information online. Only 6 websites out of 50 received an appropriate readability score on more than one assessment. One-sample, one-tailed t-tests (α = 0.05, df = 49) were used to see if the websites with information on COVID-19 testing are being written at appropriate reading levels. The resulting p-values indicate that each p-value recorded is substantially below 0.05, it is very unlikely that websites on this topic are being written at the recommended levels. Even the optimal messages on COVID-19 reflect a confusing and rapidly changing public health crisis, however if messages are kept simple and clear, individuals will have the best possible chance of optimizing behavioral mitigation strategies. These are compelling reasons for informational hosts to take necessary steps to ensure that messages are written in as simple terms as possible. To this end, it is suggested that internet sites dispersing COVID-19 testing information build in text analysis methods for all published messages, particularly those meant to inform best health practices in the time of a pandemic.

Critical health literacy in pandemics: the special case of COVID-19.

In the current COVID-19 pandemic the active participation of the public is of central importance, however, certain factors found in this new pandemic disease complicates the participation. Addressing these complications needs public health and health promotion experts to understand the role of critical health literacy in a pandemic. We present the case for a definition of critical health literacy in a pandemic, CHL-P. We suggest that CHL-P can help professionals to support individuals and communities as agents for effectively dealing with the unique features of this pandemic.

Health literacy and COVID-19-related beliefs and behaviors: a longitudinal study of the Japanese general population.

Since the outbreak of novel coronavirus disease-2019 (COVID-19), health communication has played a critical role in the process of disease prevention. Based on the concepts of health literacy and protection motivation theory, this study longitudinally examined the relationship between general health literacy measured immediately before the COVID-19 outbreak, and COVID-19-related information utilization, health literacy, beliefs and protective behaviors during the subsequent year in the Japanese general population. The participants were 767 Japanese residents who completed self-administered questionnaire surveys in January 2020 and February 2021. Based on the hypotheses, we constructed and tested a path model to predict the adoption of protective behaviors. Higher health literacy in 2020 was significantly related to higher COVID-19-related health literacy in 2021, which, in turn, was related to the adoption of recommended protective behaviors both directly and indirectly through threat and coping appraisal. Coping appraisal, but not threat appraisal, significantly differed by health literacy level. Generic health literacy skills for accessing, understanding and applying health information may enable people to better adapt to specific health risks. Our findings provide guidance for future health literacy education and health risk communication in populations with different health literacy levels.

The mediating effect of health literacy on COVID-19 vaccine confidence among a diverse sample of urban adults in Boston and Chicago.

BACKGROUND: A high rate of COVID-19 vaccination is critical to reduce morbidity and mortality related to infection and to control the COVID-19 pandemic. Understanding the factors that influence vaccine confidence can inform policies and programs aimed at vaccine promotion. We examined the impact of health literacy on COVID-19 vaccine confidence among a diverse sample of adults living in two major metropolitan areas. METHODS: Questionnaire data from adults participating in an observational study conducted in Boston and Chicago from September 2018 through March 2021 were examined using path analyses to determine whether health literacy mediates the relationship between demographic variables and vaccine confidence, as measured by an adapted Vaccine Confidence Index (aVCI). RESULTS: Participants (N = 273) were on average 49 years old, 63 % female, 4 % non-Hispanic Asian, 25 % Hispanic, 30 % non-Hispanic white, and 40 % non-Hispanic Black. Using non-Hispanic white and other race as the reference category, Black race and Hispanic ethnicity were associated with lower aVCI (-0.76, 95 % CI -1.00 to -0.50; -0.52, 95 % CI -0.80 to -0.27, total effects from a model excluding other covariates). Lower education was also associated with lower aVCI (using college or more as the reference, -0.73 for 12th grade or less, 95 % CI -0.93 to -0.47; -0.73 for some college/associate's/technical degree, 95 % CI -1.05 to -0.39). Health literacy partially mediated these effects for Black and Hispanic participants and those with lower education (indirect effects -0.19 and -0.19 for Black race and Hispanic ethnicity; 0.27 for 12th grade or less; -0.15 for some college/associate's/technical degree). CONCLUSIONS: Lower levels of education, Black race, and Hispanic ethnicity were associated with lower scores on health literacy, which in turn were associated with lower vaccine confidence. Our findings suggest that efforts to improve health literacy may improve vaccine confidence, which in turn may improve vaccination rates and vaccine equity. CLINICAL TRIALS NUMBER: NCT03584490.

Diagnostic accuracy of eHealth literacy measurement tools in older adults: a systematic review.

BACKGROUND: In Canada, virtual health care rapidly expanded during the COVID-19 pandemic. There is substantial variability between older adults in terms of digital literacy skills, which precludes equitable participation of some older adults in virtual care. Little is known about how to measure older adults' electronic health (eHealth) literacy, which could help healthcare providers to support older adults in accessing virtual care. Our study objective was to examine the diagnostic accuracy of eHealth literacy tools in older adults. METHODS: We completed a systematic review examining the validity of eHealth literacy tools compared to a reference standard or another tool. We searched MEDLINE, EMBASE, CENTRAL/CDSR, PsycINFO and grey literature for articles published from inception until January 13, 2021. We included studies where the mean population age was at least 60 years old. Two reviewers independently completed article screening, data abstraction, and risk of bias assessment using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We implemented the PROGRESS-Plus framework to describe the reporting of social determinants of health. RESULTS: We identified 14,940 citations and included two studies. Included studies described three methods for assessing eHealth literacy: computer simulation, eHealth Literacy Scale (eHEALS), and Transactional Model of eHealth Literacy (TMeHL). eHEALS correlated moderately with participants' computer simulation performance (r = 0.34) and TMeHL correlated moderately to highly with eHEALS (r = 0.47-0.66). Using the PROGRESS-Plus framework, we identified shortcomings in the reporting of study participants' social determinants of health, including social capital and time-dependent relationships. CONCLUSIONS: We found two tools to support clinicians in identifying older adults' eHealth literacy. However, given the shortcomings highlighted in the validation of eHealth literacy tools in older adults, future primary research describing the diagnostic accuracy of tools for measuring eHealth literacy in this population and how social determinants of health impact the assessment of eHealth literacy is needed to strengthen tool implementation in clinical practice. PROTOCOL REGISTRATION: We registered our systematic review of the literature a priori with PROSPERO (CRD42021238365).

Assessment of health literacy among migrant populations in Southern Spain: A cross-sectional study.

AIM: The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy. DESIGN: A cross-sectional descriptive study. METHODS: Health literacy was measured in a total of 278 immigrants using HLS-EU-Q16. An inferential descriptive and multiple regression analysis was carried out. RESULTS: 65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r = .398), age (r = .178p) and perceived social status (r = .151). Participants with shorter length of stay (ß = .405 1), without health sciences education (ß = .205) and low education level (ß = .182) had limited health literacy.

Readability and topics of the German Health Web: Exploratory study and text analysis.

BACKGROUND: The internet has become an increasingly important resource for health information, especially for lay people. However, the information found does not necessarily comply with the user's health literacy level. Therefore, it is vital to (1) identify prominent information providers, (2) quantify the readability of written health information, and (3) to analyze how different types of information sources are suited for people with differing health literacy levels. OBJECTIVE: In previous work, we showed the use of a focused crawler to "capture" and describe a large sample of the "German Health Web", which we call the "Sampled German Health Web" (sGHW). It includes health-related web content of the three mostly German speaking countries Germany, Austria, and Switzerland, i.e. country-code top-level domains (ccTLDs) ".de", ".at" and ".ch". Based on the crawled data, we now provide a fully automated readability and vocabulary analysis of a subsample of the sGHW, an analysis of the sGHW's graph structure covering its size, its content providers and a ratio of public to private stakeholders. In addition, we apply Latent Dirichlet Allocation (LDA) to identify topics and themes within the sGHW. METHODS: Important web sites were identified by applying PageRank on the sGHW's graph representation. LDA was used to discover topics within the top-ranked web sites. Next, a computer-based readability and vocabulary analysis was performed on each health-related web page. Flesch Reading Ease (FRE) and the 4th Vienna formula (WSTF) were used to assess the readability. Vocabulary was assessed by a specifically trained Support Vector Machine classifier. RESULTS: In total, n = 14,193,743 health-related web pages were collected during the study period of 370 days. The resulting host-aggregated web graph comprises 231,733 nodes connected via 429,530 edges (network diameter = 25; average path length = 6.804; average degree = 1.854; modularity = 0.723). Among 3000 top-ranked pages (1000 per ccTLD according to PageRank), 18.50%(555/3000) belong to web sites from governmental or public institutions, 18.03% (541/3000) from nonprofit organizations, 54.03% (1621/3000) from private organizations, 4.07% (122/3000) from news agencies, 3.87% (116/3000) from pharmaceutical companies, 0.90% (27/3000) from private bloggers, and 0.60% (18/3000) are from others. LDA identified 50 topics, which we grouped into 11 themes: "Research & Science", "Illness & Injury", "The State", "Healthcare structures", "Diet & Food", "Medical Specialities", "Economy", "Food production", "Health communication", "Family" and "Other". The most prevalent themes were "Research & Science" and "Illness & Injury" accounting for 21.04% and 17.92% of all topics across all ccTLDs and provider types, respectively. Our readability analysis reveals that the majority of the collected web sites is structurally difficult or very difficult to read: 84.63% (2539/3000) scored a WSTF ≥ 12, 89.70% (2691/3000) scored a FRE ≤ 49. Moreover, our vocabulary analysis shows that 44.00% (1320/3000) web sites use vocabulary that is well suited for a lay audience. CONCLUSIONS: We were able to identify major information hubs as well as topics and themes within the sGHW. Results indicate that the readability within the sGHW is low. As a consequence, patients may face barriers, even though the vocabulary used seems appropriate from a medical perspective. In future work, the authors intend to extend their analyses to identify trustworthy health information web sites.

The effects of parent's health literacy and health beliefs on vaccine hesitancy.

Parental vaccine hesitancy is a key factor influencing children's vaccination against infectious diseases such as the COVID-19. The current study aims to investigate how parent's health literacy and health belief affect parental hesitancy toward the COVID-19 vaccination, and navigate effective measures to help parents make vaccination decision for children. A mixed-mode web survey was conducted among parents of children aged 3-11 years. Parental vaccine hesitancy, health literacy, and health beliefs were assessed. Parallel mediation model examined whether the association between parent's health literacy and vaccine hesitancy was mediated by health beliefs. In total, 11.3% of the 346 participants reported vaccine hesitancy. Hesitant parents were more likely to be he mother (Father: 4.5%; Mother: 12.9%) and with children having allergic issues (Allergic: 18.3%; Non-allergic: 9.8%). Meanwhile, parents with lower health literacy were more likely to show hesitancy towards vaccinating their children (ß = -6.87, 95% CI = [-10.50, -3.11]). This relationship was partially mediated by more perceived barriers in vaccination (ß = -2.53, 95%CI = [-4.09, -1.02]), but not other health beliefs. In other words, parents with better health literacy may perceive fewer barriers in making vaccination decision for their children, thus being less hesitant. Accordingly, healthcare professionals and policy makers could design education service to promote parents' health literacy, and remove the perceived barriers as well as increase their confidence in following the COVID-19 vaccine guidance for children.

Relationship between health literacy and COVID-19 knowledge: A cross-sectional study.

Background: Health literacy (HL) is a protective factor for some chronic diseases. However, its role in the Coronavirus Disease 2019 (COVID-19) pandemic has not been clarified. This study aims to explore the association between HL and COVID-19 knowledge among residents in Ningbo. Methods: A total of 6,336 residents aged 15-69 years in Ningbo were selected by multi-stage stratified random sampling method. The "Health Literacy Questionnaire of Chinese Citizens (2020)" was used to evaluate the relationship between COVID-19 knowledge and HL. Chi-square test, Mann-Whitney U test and logistic regression were used to analyze the data. Results: The HL and COVID-19 knowledge levels of Ningbo residents were 24.8% and 15.7%, respectively. After adjusting for confounding factors, people with adequate HL were the more likely to have adequate COVID-19 knowledge compared with those with limited HL (OR = 3.473, 95% CI = 2.974-4.057, P <0.001). Compared with the limited HL group, the adequate HL group had a higher rate of COVID-19 knowledge, a more positive attitude, and a more active behavior. Conclusion: COVID-19 knowledge is significantly associated with HL. Improving HL may influence people's knowledge about COVID-19, thereby changing people's behaviors, and finally combating the pandemic.

Experiences of Every Mind Matters, Public Health England's adult mental health literacy campaign: a qualitative interview study.

BACKGROUND: Every Mind Matters (EMM) is a publicly funded health campaign, launched in England in 2019, to equip adults to look after their mental health, and that of others, by offering online information about common problems: anxiety, low mood, sleep, and stress. This study is one component of an independent evaluation of EMM conducted by the NIHR Mental Health Policy Research Unit. Its aim is to explore individuals' experiences of the EMM campaign and website. METHODS: Four researchers, including three with lived experience of using mental health services, conducted 20, one-off, semi-structured, online interviews with a range of adult participants, including a sample of EMM users and a purposively recruited sub-sample known to have severe or long-term mental health conditions. A codebook thematic analysis was undertaken, and four main themes were identified. FINDINGS: There was an expectation from the name Every Mind Matters that its advice would address everyone. Almost all participants had experience of mental distress and looked to EMM for help with a current problem for themselves. All participants were complimentary about the EMM website and found it to be user-friendly (theme 1) and personalised (theme 2) especially the interactive feature Your Mind Plan quiz which responds with suggested actions to improve wellbeing and follows up with reminder emails. A few participants found the website information and/or Mind Plan suggestions to be life changing. Some participants wanted EMM to better acknowledge the contexts in which they live (theme 3) such as the limitations of health conditions and health services, and difficulties of crowded housing, social policy, and climate change. Many participants would like EMM to do more (theme 4), offer more interactivity, more choice, more information about available treatments, and more stratified advice to cover more severe mental health conditions. CONCLUSION: EMM is available to all, including people with common or severe mental disorders. In the context of overwhelmed mental health services, people with severe mental illness expect more from EMM than advice about common problems. EMM could build on its success by extending its remit to address a wider range of needs so that everyone is included.

Recognising Basic Health Literacy Capabilities: An Explorative Study on the Relevance of Health-Related Information in the Support of People with Profound Intellectual and Multiple Disabilities.

Background: People with profound intellectual disabilities represent a vulnerable and heterogeneous population whose health-related needs and questions often remain unheard. One reason for this is that they are usually unable to participate in verbal communication. However, there is also a lack of suitable approaches to communicate health-related information to them according to their capabilities. The research presented in this paper addresses this gap. Methods: Following grounded theory methodology, we used a multimethod approach. Based on a theoretical analysis, a Delphi study (n = 14) was conducted as a starting point to map the research field. In a second step, these findings were incorporated into an online survey targeting disability care professionals (n = 111). Three field studies supplemented the data, encompassing a variety of ethnographic methods. Results: People with PIMD have basic health-related capabilities that can improve their health literacy. Nevertheless, their support environments have to take over many health literacy-related requirements by proxy or substitution. One of the most important tasks is to engage health information in an individualised way. Conclusions: The findings underline the importance of focusing on more basic capabilities and intersubjective approaches in health literacy research and practice, especially regarding new perspectives on the inclusion of previously marginalised populations (such as people with PIMD).