COVID-19 Vaccine Videos: Health Literacy Considerations.

BACKGROUND: Multimedia videos are important tools to inform uptake of the COVID-19 vaccine. Video design using health literacy guidelines may help optimize video usefulness. Many health organizations (HO) (provides information) and health care (HCO) (provides direct health care) organizations have used YouTube to deliver videos about COVID-19 vaccines. OBJECTIVE: We examined HO and HCO COVID-19 vaccine videos shown on YouTube for health literacy guidelines (quality, understandability and actionability). METHODS: The top 30 most viewed COVID-19 vaccine videos posted by HO and HCO were analyzed using the Global Quality Score (GQS) and the Patient Education Assessment Tool for evaluating audiovisual formats (PEMAT-AV). KEY RESULTS: GQS scores averaged 3.12 (standard deviation [SD] .789), which is equivalent to 80%. Using PEMATAV, there was a relationship between actionability and quality (r(28) = .453, p < .05) for HO; for HCO, there was a relationship between usability and quality (r(28) = .455, p < .05). Odds ratio analysis showed quality in HO leading to higher odds of actionability (3.573, 95% confidence interval [CI] [1.480-14.569]) and quality in HCO videos leading to higher understandability (4.093, CI [1.203-17.865]). CONCLUSION: Few organizations applied all health literacy principles to video design. Video creation for mass media health campaigns by HO and HCO should include consideration of evidence-based health literacy measures (quality, understandability, actionability) to ensure intended results across viewers with different health literacy levels including communities who have been disproportionately affected by COVID-19. [HLRP: Health Literacy Research and Practice. 2023;7(2):e111-e118.].

Strengthening the Case for Universal Health Literacy: The Dispersion of Health Literacy Experiences Across a Southern U.S. State.

BACKGROUND: How individuals perceive their health literacy may differ based on demographic and individual characteristics. OBJECTIVE: The purpose of this study was to understand the dispersion of health literacy across demographics in the state of Georgia in 2021 and to determine which factors influence health literacy. METHODS: Study participants were age 18 years and older and completed an on-line Health Literacy Questionnaire (N = 520). The participant pool was stratified to mirror state-wide demographics of geography and race. Results were further collapsed into composite scales reflecting basic, communicative, and critical health literacy. Descriptive statistics, bivariate Pearson's correlations, and multiple regression analyses were used. A two-step cluster analysis was performed with the nine health literacy scales. KEY RESULTS: Rural county and no health insurance were negatively related to all three composite scales (rs = .093-.254, ps < .05). Demographic predictors accounted for 6.7% of the variance in basic (F[6, 439] = 5.287, p < .001), 10% in communicative (F[6, 438] = 8.154, p < .001), and 6% for critical (F[6, 439] = 4.675, p < .0010. In all scales, health insurance status was the strongest primary unique predictor (ßs = .236, .295, .181, ps <.05, respectively). In a two-step cluster analysis only health insurance status differentiated the health literacy level clusters (X2(3) = 9.43, 34.51, ps = 024, <.001 respectively). CONCLUSION: Lacking health insurance is the most consistent and largest contributor to low health literacy across the state of Georgia; population demographics are not. Health literacy policies and practices should be developed for universal application and not focus on specific populations. [HLRP: Health Literacy Research and Practice. 2022;6(3):e182-e190.] Plain Language Summary: In this study, demographics that are usually associated with low health literacy like age, sex, race, educational attainment, and type of county (rural or urban) were not associated with; the only significant factor was lack of health insurance. This relationship strengthens the case for universal health literacy precautions that go beyond population demographics.

Health Literacy and Intercultural Competence Training.

Intercultural competence (ICC) and health literacy (HL) are vital components of patient education. The purpose of this study was to determine if an educational intervention that combined ICC and HL was effective at changing second-year nursing students' self-efficacy, beliefs, and knowledge. A total of 157 second-year nursing students in two different programs participated in pre- and post-surveys consisting of the Transcultural Self-Efficacy Tool and Health Literacy Beliefs and Knowledge survey. Students attended a two-part lecture with a moderated panel on ICC and health literacy and began clinical fieldwork. Results were analyzed using Wilcoxon signed-rank test and Pearson correlation. There was a statistically significant difference in all ICC subscales after an educational intervention and clinical fieldwork (cognitive z = 7.681, p < .001; practical z = 7.319, p < .001; affective z = 6.533, p < .001). HL knowledge and belief measures showed statistically significant difference after the intervention (z = 3.037, p < .001). There was a statistically significant correlation between intercultural self-efficacy and HL beliefs (Pearson's r = .486, p < .001). Self-efficacy in ICC and beliefs and knowledge in HL increased over time for nursing students, indicating that it may be beneficial to train students about these two constructs simultaneously. [HLRP: Health Literacy Research and Practice. 2021;5(4):e283-e286.].

Strengthening Culturally Competent Health Communication.

Vulnerable refugee communities are disproportionately affected by the ongoing COVID-19 pandemic; existing longstanding health inequity in these communities is exacerbated by ineffective risk communication practices about COVID-19. Culturally and linguistically appropriate health communication following health literacy guidelines is needed to dispel cultural myths, social stigma, misinformation, and disinformation. For refugee communities, the physical, mental, and social-related consequences of displacement further complicate understanding of risk communication practices grounded in a Western cultural ethos. We present a case study of Clarkston, Georgia, the "most diverse square mile in America," where half the population is foreign born and majority refugee. Supporting marginalized communities in times of risk will require a multipronged, systemic approach to health communication including: (1) creating a task force of local leaders and community members to deal with emergent issues; (2) expanding English-language education and support for refugees; (3) including refugee perspectives on risk, health, and wellness into risk communication messaging; (4) improving cultural competence and health literacy training for community leaders and healthcare providers; and (5) supporting community health workers. Finally, better prepared public health programs, including partnerships with trusted community organizations and leadership, can ensure that appropriate and supportive risk communication and health education and promotion are in place long before the next emergency.

Teach-Back Training for Nursing Students: Knowledge and Beliefs After Training for Health Literate Communication.

ABSTRACT: For nurses to communicate effectively, they must understand how patients obtain, understand, and use health information to make health decisions, that is, their health literacy (HL) level. A gap in teaching HL communication skills exists in nursing curricula. This study explored nursing students' knowledge and beliefs about HL communication before and after an HL training. Analysis revealed a significant increase in knowledge after training (Mpre = 9.00, Mpost = 9.89), t(36) = 3.75, p < .001. Participants (84.6 percent) used teach-back technique with simulated patients and identified additional training as an aid to skill building.

The Relationship Between Refugee Health Status and Language, Literacy, and Time Spent in the United States.

BACKGROUND: There are 3 million refugees living in the United States today whose health and wellbeing may be diminished by not being able to understand and use health information. Little is known about these barriers to health in multiethnic refugee communities. OBJECTIVE: This present study examined (1) the relationship between English proficiency, health literacy, length of time in the US, and health status; and (2) differences in poor health status caused by limited English proficiency and low health literacy individually and in combination to better understand which barriers might be addressed by improving refugee health. METHODS: Refugees (N = 136) age 18 to 65 years were recruited using health clinics and refugee resettlement agencies. Survey questions included demographics, health status, health literacy, English language proficiency, social determinants of health, and barriers to getting health care. Interpreters were used as necessary. We used a cross-sectional study with purposeful sampling. KEY RESULTS: There is a high correlation (Pearson's r = 0.77) between health literacy and English proficiency; they were moderately correlated with health status (r = 0.40 and 0.37, respectively). Length of time in the US only modestly correlated with health status (r = 0.16). Health literacy and English proficiency taken individually were strong predictors of health status (health literacy odds ratio [OR] = 4.0; 95% confidence interval [1.6-9.9], English proficiency OR = 3.6, confidence interval [1.5-9.0]) but not significant. Their interaction, however, was significant and accounted for most of the effect (log odds for interaction = 1.67, OR = 5.1, p < .05). CONCLUSIONS: English proficiency and health literacy individually and in combination facilitate poor health and present health-related barriers for refugees. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population. [HLRP: Health Literacy Research and Practice. 2020;4(4):e230-e236.] PLAIN LANGUAGE SUMMARY: The combined effects of limited English proficiency and low health literacy can create significant barriers to good health outcomes in refugee populations. Length of time in the US for refugees may not correlate with health status despite studies that suggest a change in health over time for the larger immigrant population.

Health-Literacy Training for First-Year Respiratory Therapy Students: A Mixed-Methods Pilot Study.

BACKGROUND: Respiratory therapists (RTs) should communicate with patients in a way that leads to patients understanding their discharge plans and medical device instructions. The teach-back method is a patient-centered, health-literate technique that allows health care professionals to confirm patient understanding. The purpose of this mixed-methods pilot study was to measure the use of teach-back by first-year undergraduate RT students in a simulation-center experience after a 1-h teach-back skills training. METHODS: First-year RT students' health literacy knowledge and belief in communication skills were measured using a pre- and post- survey about their knowledge and beliefs. A 1-h health literacy and teach-back skills training lecture (ie, intervention) was delivered after the pre-testing. RT students were then assessed for teach-back use during a regularly scheduled simulation center experience. Their experiences were recorded in a semistructured interview immediately after the simulation-center experience. RESULTS: 14 of 20 RT students used teach-back in the simulation center. Knowledge scores increased from 8.278 to 8.944 postintervention, and the median scores for belief increased from 111 to 117 postintervention. There was a statistically significant postintervention increase in knowledge scores (P < .001) and in communication belief scores (P = .038). Thematic content analysis revealed 2 primary themes for teach-back use: to confirm patient understanding and to confirm proper use of medical devices. Teach-back was not used due to the discharge scenario used in the simulation center, due to the student forgetting and/or being nervous, due to how engaged the patient was, or due to individual communication style. CONCLUSIONS: Results from our pilot study indicate that RT students may benefit from a 1-h health literacy and teach-back skills training. Furthermore, we identified reasons why the teach-back method was not used and determined what communication training students perceived would be helpful. Our findings can be used to help improve and implement communication skills training in the RT curriculum.

Perception Versus Reality: The Use of Teach Back by Medical Residents.

BACKGROUND: Health care providers (HCPs) may ask patients if they understand their diagnosis or instructions during clinic visits; patients often simply say yes. However, many patients leave with little idea of their medication and discharge instructions. Teach Back (TB) is a patient-centered health-literate technique that allows HCPs to confirm patient understanding during clinic visits. OBJECTIVE: The purpose of this pilot study was to determine a relationship between perception and actual use of TB by medical residents in primary care outpatient clinics (providers, N = 16; clinic visits, N = 80) and, if the observed rate of TB was discordant with perception, did a TB skills training intervention have any impact on use of TB (clinic visit, N = 78). We were also interested in language used during TB and if use of TB was related to patient demographics or health literacy level. METHODS: Medical residents' perception was measured using the "Always Use Teach-Back Confidence and Conviction Scale" (N = 16). Clinic visits were audiotaped and scored for use of TB (pre-intervention, N = 80; post-intervention, N =78). The intervention was a 1-hour TB skills training course. Content analysis was performed to understand the use of TB language. KEY RESULTS: Despite the high level of confidence/conviction about TB (r[16] = .669, p <. 05) TB was only used twice out of 80 visits during pre-intervention clinic visits. During post-intervention, use of TB increased to 41 times by 10 residents (c2[1, N = 16] = 6.533, p <. 05). TB language after the intervention was more collaborative; there was a relationship between gender and use of TB. CONCLUSION: Results from our pilot study identified three important observations that may be critical to improving health-literate physician communication: residents believe they are using TB in the clinic for many patients; use of TB was discordantly low at 2.5%; and a single 1-hour skills training intervention dramatically increased TB use to 53%. Residents used patient-centered TB language after the training intervention. [HLRP: Health Literacy Research and Practice. 2019;3(2):e117-e126.]. PLAIN LANGUAGE SUMMARY: Medical residents believe they are using Teach Back to confirm patient understanding in the clinic 60% of the time when they actually used Teach Back only 2.5% of the time. After an educational intervention, they used Teach Back 53% of the time; Teach-Back language was collaborative and patient-centered, and all but two patients confirmed their medication and discharge plan.