Measuring General Health Literacy in Chinese adults: validation of the HLS19-Q12 instrument.

BACKGROUND: Health literacy measurement lays a solid foundation to identify associations with health outcomes and monitor population health literacy levels over time. In mainland China, most existing health literacy instruments are either knowledge-based or practice-based, making health literacy results incomparable between China and other countries. This study aimed to examine the reliability and validity of the 12-item Health Literacy Population Survey (HLS19-Q12) in a general population of Chinese adults. METHODS: A cross-sectional study was conducted to recruit primary carers of students from 11 schools in Zhengzhou, Henan Province, using convenience cluster sampling. Participants completed an online self-administered survey that collected information on key sociodemographics, health literacy (HLS19-Q12 and a comparison tool: Health Literacy Questionnaire (HLQ)), and health-related outcomes. Using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist as a guideline, we tested internal consistency, test-retest reliability, content validity, structural validity, concurrent predictive validity, and convergent validity of the HLS19-Q12. RESULTS: Overall, 14,184 participants completed the full survey. The HLS19-Q12 showed excellent internal consistency (Cronbach's α = 0.93), moderate test-retest reliability (intra-class correlation coefficient = 0.54), satisfactory content validity (based on the 12-matrix health literacy model), and strong structural validity (comparative fit index = 0.94, Tucker and Lewis's index of fit = 0.93, root mean square error of approximation = 0.095). Concurrent predictive validity results showed health literacy was associated with both health determinants and health-related outcomes. The HLS19-Q12 had weak to strong correlations (coefficients = 0.24 to 0.42) with the nine scales of the HLQ. Respondents had an average score of 81.6 (± 23.0) when using the HLS19-Q12, with 35.0% and 7.5% having problematic and inadequate levels of health literacy, respectively. CONCLUSIONS: The HLS19-Q12 is a reliable and valid instrument to measure health literacy in our sample. Further validation is needed with a more nationally representative sample of Chinese adults. The HLS19-Q12 could be used as a comprehensive, skills-based, and easy-to-administer health literacy assessment tool integrated into population surveys and intervention evaluations.

The well-being and work-related stress of senior school leaders in Wales and Northern Ireland during COVID-19 "educational leadership crisis": A cross-sectional descriptive study.

The COVID-19 pandemic caused far-reaching societal changes, including significant educational impacts affecting over 1.6 billion pupils and 100 million education practitioners globally. Senior school leaders were at the forefront and were exposed to particularly high demands during a period of "crisis leadership". This occupation were already reporting high work-related stress and large numbers leaving the profession preceding COVID-19. This cross-sectional descriptive study through the international COVID-Health Literacy network aimed to examine the well-being and work-related stress of senior school leaders (n = 323) in Wales (n = 172) and Northern Ireland (n = 151) during COVID-19 (2021-2022). Findings suggest that senior school leaders reported high workloads (54.22±11.30 hours/week), low well-being (65.2% n = 202, mean WHO-5 40.85±21.57), depressive symptoms (WHO-5 34.8% n = 108) and high work-related stress (PSS-10: 29.91±4.92). High exhaustion (BAT: high/very high 89.0% n = 285) and specific psychosomatic complaints (experiencing muscle pain 48.2% n = 151) were also reported, and females had statistically higher outcomes in these areas. School leaders were engaging in self-endangering working behaviours; 74.7% (n = 239) gave up leisure activities in favour of work and 63.4% (n = 202) sacrificed sufficient sleep, which was statistically higher for females. These findings are concerning given that the UK is currently experiencing a "crisis" in educational leadership against a backdrop of pandemic-related pressures. Senior leaders' high attrition rates further exacerbate this, proving costly to educational systems and placing additional financial and other pressures on educational settings and policy response. This has implications for senior leaders and pupil-level outcomes including health, well-being and educational attainment, requiring urgent tailored and targeted support from the education and health sectors. This is particularly pertinent for Wales and Northern Ireland as devolved nations in the UK, who are both implementing or contemplating major education system level reforms, including new statutory national curricula, requiring significant leadership, engagement and ownership from the education profession.

Adolescents' understanding of the Nepalese version of HLS-CHILD-Q15: qualitative pre-testing in ninth-graders.

INTRODUCTION: Research on health literacy is still at an early stage, lacking a dedicated measurement instrument for assessing children's and adolescents' health literacy. Such tools are necessary to generate the evidence required for informed intervention development. This study translated the validated German HLS-Child-Q15 into the Nepalese context, creating the HLS-Child-Q22-NEP. METHODS: The research team initially created the HLS-Child-Q22-NEP using an additional item pool. We conducted thirteen one-on-one cognitive interviews with adolescent students from community schools in three districts of Nepal during the pre-test. We employed verbal probing techniques and deductively analysed the interviews based on Tourneau's model, uncovering four main themes: (1) comprehension (with the two sub-categories: a) item comprehension and b) word comprehension); (2) retrieval; (3) judgement; and (4) response. RESULTS: Overall, participants responded positively to the HLS-Child-Q22-NEP. However, this study revealed comprehension challenges such as unfamiliarity, misunderstandings, and translation issues. Additionally, the study identified retrieval challenges and poor judgement, indicating limitations in the assessment. Participants experienced varying levels of difficulty with some items, emphasising the need for revised instructions. Subsequent revisions, guided by pretest insights, led to the development of the HLS-Child-Q24-NEP. CONCLUSION: The development of the HLS-Child-Q22-NEP is a significant step in addressing Nepali adolescents' lack of health literacy measurement. Despite its generally positive reception, this study encountered challenges in comprehending the scale, prompting enhancements, and developing the HLS-Child-Q24-NEP. Further research, both qualitative and quantitative, is necessary to evaluate the validity and reliability of the modified items.

Do demographic and socio-economic factors predict Sense of Coherence among university students?

INTRODUCTION: The COVID-19 pandemic and related containment measures have been threatful for psychological well-being, particularly for young people such as university students. Sense of Coherence (SoC) can help in coping with stressful and anxiety-provoking situations. AIM: The aim of this study is to describe the levels of SoC and to investigate the socio-economic, and demographic predictors in a sample of students attending Florence University, in the timespan between August, 17th and October, 3rd 2020. METHOD AND RESULTS: The cross-sectional online survey was completed by 2,996 students. Higher levels of SoC have been found among males and for respondents reporting a better socioeconomic condition. Regarding the dimensions of SoC, lower levels were reported for comprehensibility and manageability, higher for meaningfulness. CONCLUSIONS: These results reinforce the need to plan and implement health promotion interventions aimed to support and sustain university students in general and specifically those at higher risk of low level of SoC.

Online health information-seeking behaviour and mental well-being among Finnish higher education students during COVID-19.

Online health information-seeking behaviour has increased since the World Health Organization declared COVID-19 a global pandemic in March 2020. This study examined whether health-related information on COVID-19 searched on the internet was associated with mental well-being among higher education students. A cross-sectional internet survey was conducted among 18- to 34-year-old students in Finland (N = 2976; mean age 24.61 years and median 24) in the spring of 2020. The data were analysed using descriptive statistics, Pearson's chi-square tests, Kruskal-Wallis nonparametric H tests, and a two-way ANOVA. The results indicated that most students (86% of females, 82% of males) used the internet to search for information on COVID-19. Students' self-perceived abilities to determine the relevance of online information on COVID-19 were associated with mental well-being.

Predictors of well-being, future anxiety, and multiple recurrent health complaints among university students during the COVID-19 pandemic: the role of socioeconomic determinants, sense of coherence, and digital health literacy. An Italian cross-sectional study.

The pandemic deeply changed young adults' life. Lockdown period and the social restrictions dramatically affected university students' mental health. The aim of our cross-sectional study was to describe psychological well-being, future anxiety (FA), and health complaints (HCs) in a sample of 3,001 students of the University of Florence in the middle of the first two pandemic waves. We assessed the role of subjective social status, chronic diseases, sense of coherence (SoC), and digital health literacy (DHL) as predictors of psychological well-being, FA, and HCs. Students expressed high levels of FA and reported being disturbed by not being able to achieve their desired future goals. About 40% reported a low or a very low well-being and 19.1% experienced two or more subjective health complaints more than once a week. The likelihood of having a better mental health status significantly increased with increasing SoC and among males. Subjective Social Status proved to be a predictor for FA. Enhancing SoC could improve the health status of the university students during the pandemic and beyond.

Evaluating the effect of an adapted mental health literacy intervention on mental health related stigma among secondary students in Germany: results of a pre-post evaluation study.

BACKGROUND: Most mental health problems develop during youth, with about three quarter emerging before age 25. In adolescence, stigmatizing attitudes related to mental illness become more nuanced and consolidate into one's belief system. As the stigma of mental illness is still one of the leading barriers to help-seeking, intervention measures should explicitly address it before it becomes entrenched over time. Preventive measures, for example, based on promoting mental health literacy (MHL), can be used to address and tackle stigmatizing attitudes. The Canadian MHL-based intervention "the Guide" was translated and adapted for the use in German schools. The present study evaluates the effect of the German version of the Guide on attitudes towards mental illness among students in Germany. METHODS: The first-time application of the Guide (German version) was evaluated with a pre-post-evaluation study with an intervention and a control group. The evaluation data of 188 students (intervention group n = 106, control group n = 82) were statistically analyzed focusing on the outcomes social stigma, social distance, and self-stigma. RESULTS: The analysis showed that participants do not tend to hold stigmatizing attitudes even before the intervention. Nevertheless, the intervention was effective in reducing social stigma, but not in reducing social distance and self-stigma. Neither gender, pre-existing experience with mental illness, nor the delivery modality of the contact element within the intervention (speaker vs. video) seemed to influence the outcomes. CONCLUSIONS: The German version of the MHL-based intervention, the Guide, seems to be a suitable intervention to improve attitudes towards mental illness among students in Germany. More extensive research is necessary to confirm the findings and further explore factors that influence the program's effects on attitudes short- and long-term.

The effects of an adapted mental health literacy curriculum for secondary school students in Germany on mental health knowledge and help-seeking efficacy: results of a quasi-experimental pre-post evaluation study.

Background: Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention's effects on mental health knowledge and help-seeking efficacy among 10th grade students in Germany. Methods: 10th grade students (aged 14-17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention's effects. Results: Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge (f = 0.574, p < 0.001, partial η2 = 0.25) and a medium effect size for help-seeking efficacy (f = 0.311, p < 0.001, partial η2 = 0.09). Conclusion: The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10th grade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.

Coronavirus-related health literacy levels among school administrators and influencing factors.

Our study aimed to determine the level of coronavirus-related health literacy among school administrators and the factors that influence this. The sample of this cross-sectional study consisted of 402 school administrators serving in primary, secondary and high schools in Ankara. The data were collected between September 2021 and February 2022 using the descriptive characteristics questionnaire and the Coronavirus-Related Health Literacy Questionnaire (HLS-COVID-Q22). It was seen that 64.4% of the participants were male, 34.6% were 40 years old or younger and 35.6% were working in primary schools; 77.6% of the participants had a sufficient, 16.2% had a problematic and 6.2% had an inadequate level of coronavirus-related health literacy. Age, gender, chronic disease status, type of school they work in, level of knowledge about coronavirus, level of confusion due to knowledge about coronavirus, willingness to be vaccinated, believing that vaccines are safe/effective/compatible with their religious beliefs were found to affect coronavirus-related health literacy (p < 0.05). Gender, age, information satisfaction on coronavirus, confusion due to information on coronavirus and 'Overall, I believe that vaccinations are effective' explained 24.9% of HLS-COVID-Q22 variance (Adjusted R2 = 0.249, F = 13.080, p < 0.001). This study found the coronavirus-related health literacy level among school administrators to be sufficient. It found that their level of health literacy was affected by gender, age, chronic disease status, type of school they worked at, level of knowledge about coronavirus, level of confusion due to information about coronavirus, desire to be vaccinated and their thoughts about vaccines.

Vaccination as a social practice: towards a definition of personal, community, population, and organizational vaccine literacy.

BACKGROUND: A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines. METHODS: To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts. RESULTS: Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed. CONCLUSION: The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.

Gender differences in sense of coherence among university students during the COVID-19 pandemic in Turkey.

Non-pharmaceutical interventions (NPIs) implemented to mitigate the COVID-19 pandemic halted everyday life in higher education along with social and psychological impacts. The objective of our study was to explore the factors related to sense of coherence (SoC) from a gender perspective among university students in Turkey. This is a cross-sectional survey conducted online with a convenience sampling method as part of the international COVID-Health Literacy (COVID-HL) Consortium. SoC was measured by a nine-item questionnaire that was adapted to the Turkish language, including socio-demographic information and health status, including psychological well-being, psychosomatic complaints, and future anxiety (FA). 1595 students from four universities, of whom 72% were female, participated in the study. Cronbach's alpha for the SoC scale was 0.75. Based on the median split of the individual scores, levels of SoC showed no statistically significant difference according to gender. Logistic regression analysis indicated that higher SoC was associated with medium and high subjective social status, studying in private universities, high psychological well-being, low FA, and none/one psychosomatic complaint. While results were similar among female students, type of university and psychological well-being showed no statistically significant association with SoC among males. Our results indicate that structural (subjective social status) and contextual (type of university) factors, along with gender-based variations, are associated with SoC among university students in Turkey.

Digital health literacy and well-being among university students: Mediating roles of fear of COVID-19, information satisfaction, and internet information search.

Background: Digital health literacy (DHL) enables healthy decisions, improves protective behaviors and adherence to COVID-19 measures, especially during the era of the "infodemic", and enhances psychological well-being. Objective: We aimed to explore the mediating roles of fear of COVID-19, information satisfaction, and the importance of online information searching on the association between DHL and well-being. Methods: A cross-sectional web-based survey was conducted among 1631 Taiwanese university students, aged 18 years and above, from June 2021 to March 2022. The collected data include sociodemographic characteristics (sex, age, social status, and financial satisfaction), the importance of online information searching, information satisfaction, fear of COVID-19, DHL, and well-being. A linear regression model was utilized to investigate factors associated with well-being, followed by a pathway analysis to assess the direct and indirect relationship between DHL and well-being. Results: The scores of DHL and overall well-being were 3.1 ± 0.4 and 74.4 ± 19.7, respectively. Social status (B = 2.40, 95% confidence interval (CI) 1.73-3.07, p < 0.001), DHL (B 0.29, 95% CI 0.10-0.49, p < 0.001), importance of online information searching (B = 0.78, 95% CI 0.38-1.17, p < 0.001), and information satisfaction (B = 3.59, 95% CI 2.22-4.94, p < 0.001) were positively associated with well-being, whereas higher fear of COVID-19 scores (B = -0.38, 95% CI -0.55-(-0.21), p < 0.001) and female (B = -2.99, 95% CI -5.02-0.6, p = 0.004) were associated with lower well-being, when compared with lower fear scores and male, respectively. Fear of COVID-19 (B = 0.03, 95% CI 0.016-0.04, p < 0.001), importance of online information searching (B = 0.03, 95% CI 0.01-0.05, p = 0.005), and information satisfaction (B = 0.05, 95% CI 0.023-0.067, p < 0.001) were significantly mediated the relationship between DHL and well-being. Conclusion: Higher DHL scores show direct and indirect associations with higher well-being scores. Fear, importance of online information searching, and information satisfaction significantly contributed to the association.

Subjective social status and well-being of adolescents and young adults in Ghanaian schools: conditional process analysis.

BACKGROUND: With the growing concern and interest in the mental health and well-being of adolescents and young adults (AYAs) including those in schools, many studies have explored the bivariate relationship between subjective social status (SSS) and AYAs' subjective well-being (SWB). Acknowledging the spurious nature of this relationship, we assessed the relationship between SSS and SWB of AYAs in schools within Northern Ghana, focusing on the conditional indirect effect of monetary resource (MR) and sense of coherence (SoC). METHODS: We utilised a cross-sectional descriptive design to survey 1096 senior high school students from two regions in Ghana's Northern zone through a stratified sampling method. A questionnaire consisting of a number of calibrated standardized measures was used for the data collection. The data were processed using SPSS and PROCESS Macro and analysed using Hayes' conditional process analysis. RESULTS: The results revealed that students' MR significantly moderated the relationships between SSS and SoC as well as SSS and SWB. A significant moderated mediation effect of MR and SoC on the relationship between SSS and SWB was found. Particularly, AYAs who reported higher levels of MRl, SSS and SoC reported a better SWB. CONCLUSION: The findings underscore the relevance of providing sufficient financial support for students in secondary schools in Ghana; thus, highlighting the sheer relevance of economic capital as a leading factor for better well-being. The findings also place much emphasis on building students' personal coping mechanisms as a key variable in explaining how the students' SSS and MR translate into having positive mental health outcomes.

Improving adolescent health literacy through school-based health literacy intervention: a mixed-method study protocol.

BACKGROUND: Health-promoting actions might benefit from adolescent health literacy (AHL), however, there is scant research on it in Nepal. This study identifies adolescent students' health literacy (HL) needs and trials an intervention to improve their HL and intention to take health-promoting actions. METHODS: This study employs a pre-and post-test mixed-method intervention involving three phases. First, we will conduct a formative and summative evaluation to identify participants' HL needs and design an intervention using quantitative and qualitative methods. Second, the intervention will be administered to the intervention group. Finally, formative and summative post-tests will be conducted to assess the effectiveness of the intervention. We will select four community schools from Birendranagar municipality based on random sampling. In quantitative research, data will be collected from adolescents selected through a census with standardized scales such as the HLS-Child-Q15, self-efficacy, social support, and health-promoting actions. A framework analysis was conducted to analyze qualitative data collected from focus group discussions with purposively chosen adolescents and key informant interviews with Health and Physical Education teachers and school nurses. The difference in difference approach will be used to analyze the intervention's outcome, i.e., the participants' improved HL, and health-promoting actions. DISCUSSION: This is one of the first studies to explore HL in this group in Nepal. This study will provide the first insights into the overall level of AHL, potential AHL determinants, and the relationship between AHL and the intention to participate in health-promoting activities. The data can then be used to inform health promotion and health literacy initiatives.

A cross-sectional study of university students' pocket money variance and its relationship with digital health literacy and subjective well-being in Ghana.

Background: Mental health concerns of university students are gaining more attention since the emergence of the coronavirus disease. Consequently, scholars in education, health and psychology-related fields have attributed the dwindling subjective well-being (SWB) of students to their low levels of digital health literacy (DHL). However, little attention has been paid to an important variable like pocket money (PM) which might serve as a buffer against reduced levels of SWB. In this study, we explored the dynamics of PM and its linkage with DHL and SWB among university students in Ghana. Methods: With a cross-sectional design, a convenient sample of 1160 students was obtained from the University of Education, Winneba, Ghana. The COVID-DHL and WHO-5 Well-being instruments were used for the data collection for a 2 months period (February-March, 2021). Chi-square test, multivariate regression, simple linear regression, and PROCESS mediation analyses were performed with the use of SPSS software version 25. Results: The study found that while most of the students were financially supported by their parents (n = 715, 61.6%), a larger proportion of them reported that their PM was either less sufficient or not sufficient (n = 550; 76.9%). Findings revealed a positive relationship between PM and SWB (B = -36.419, p < 0.001; B = -13.146, p = 0.012; B = -10.930, p = 0.043), with this relationship mediated by DHL (B = -1.139, confidence interval [CI] [-2.073, -0.263] vs. -2.300, CI [-4.290, -0.532] vs. -8.366, CI [-14.863, -1.908]). Conclusions: Students with little to insufficient PM were vulnerable to mental health problems, although this could be buffered by the high DHL levels. In practical terms, not only should the PM of university students be increased, but the sources of PM should be complemented since the sufficiency level of PM was associated with the source of finance. More importantly, parents should be empowered through job creation so that sufficient levels of PM can be provided to university students.

Digital Health Literacy and Information-Seeking in the Era of COVID-19: Gender Differences Emerged from a Florentine University Experience.

Gender appears to be a strong predictor of online health information-seeking behaviour (OHISB), which is related to Digital Health Literacy (DHL). Gender differences in OHISB have been studied in different countries with different results, but no studies have investigated gender-specific OHISB among University students during the COVID-19 pandemic. We sought to investigate any gender differences in OHISB in the period between the first and second waves of the pandemic in Italian university students. A questionnaire developed by the global COVID-HL network, including existing and adapted validated scales and self-developed scales, was administered to 2996 University students in Florence. Gender differences were tested using the χ2 test or the Mann-Whitney U test. Male students reported a higher score in DHL than females (p < 0.001). However, female students seek COVID-19 information more often on different sources (for themselves and other people), on various topics, consider various aspects of information quality to be "very important'' (p < 0.05) and are more likely to be "often dissatisfied'' or "partly satisfied'' with information (p < 0.001). Our study confirmed gender as an important dimension to explain students' OHISB differences, which could help institutions promote gender-specific education programmes and provide gender-oriented health information.

Work-Related Stress of Polish School Principals during the COVID-19 Pandemic as a Risk Factor for Burnout.

BACKGROUND: The ongoing COVID-19 pandemic has influenced educational systems worldwide. School principals coped with numerous significant challenges regarding school management during the epidemiological crisis that could generate a lot of work-related stress. Thus, the presented study examines Polish school principals' perceived stress and its association with exhaustion and psychosomatic complaints as burnout risk indicators. Principals' gender and age as sociodemographic control variables were also considered in this paper. METHODS: A cross-sectional online study was conducted in eight provinces of Poland from June to December 2021. The study was part of a global COVID-HL school principal survey under the global COVID-Health Literacy Research Network. Two subscales of the Perceived Stress Scale (PSS-10) (perceived helplessness [PH] and perceived self-efficacy [PSE]) were considered independent variables in relation to school principals' mental and physical exhaustion and psychosomatic complaints. Regression models consisting of two equations were used to test the relationship between variables. The first equation consists of the control variables (age, gender), and in the second equation, the independent variables (PH and PSE) were included in addition to the control variables. RESULTS: Almost 50% of school principals experienced a lack of control that caused anger and stress. Mental and physical exhaustion during the pandemic was often or always felt by 30% of respondents. Nearly half of Polish school principals experienced psychosomatic complaints in the form of muscle pain and headaches. PH, to a greater extent than PSE, was associated with mental and physical exhaustion and psychosomatic complaints. With age, the level of psychosomatic complaints and mental and physical exhaustion decreases, but it was higher among women. Regression analysis revealed significant associations between exhaustion and mental health outcomes, even after controlling for demographic variables Conclusion: This study showed that almost half of Polish school principals indicated a high frequency of perceived stress during the pandemic. PH was more substantially associated with mental and physical exhaustion in younger female principals than PSE. Younger female school principals reported more exhaustion and psychosomatic complaints. This finding should be the baseline information for policymakers to improve the wellbeing of Polish school principals and prevent the risk of burnout.