The low health literacy in Latin America and the Caribbean: a systematic review and meta-analysis.

BACKGROUND: Health literacy (HL) impacts people's health and well-being. In Latin America and the Caribbean (LAC), there are no general estimates of the prevalence of low HL. This study aimed to estimate the prevalence of low HL among citizens of LAC and identify the tools used to measure it. METHODS: We included observational studies quantifying the prevalence of low HL in people living in LAC. We searched PubMed, CINAHL, EMBASE, ERIC, LILACS, PsycINFO, Redalyc, SciELO, Web of Science, PQDT, and the reference lists of the included studies in June 2023. Two reviewers independently conducted the selection, extraction, and risk of bias assessment using the JBI Critical Appraisal Tools. Meta-analysis of proportions using random effects models was used to summarize the prevalence of low HL estimated. This prevalence was measured in each study using different classification methods: word recognition items, reading and numeracy comprehension items, and self-reported comprehension items. RESULTS: Eighty four studies involving 23,914 participants from 15 countries were included. We identified 23 tools to assess HL, and most of the studies were carried out in health services. The pooled prevalence of low HL were 44.02% (95%CI: 36.12-52.24) for reading and numeracy comprehension items, 50.62% (95%CI: 41.82-59.39) for word recognition items, and 41.73% (95%CI: 31.76-52.43) for self-reported comprehension items. CONCLUSION: Despite the variability in the prevalence of low HL and a diversity of tools, the average of low HL is of concern. Almost half of the participants in the included studies have low HL. Most of the studies targeted users of healthcare services. Further research investigating the prevalence of low HL in the general population and actions focused on health education, communication, and information are necessary. TRIAL REGISTRATION: PROSPERO (CRD42021250286).

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy.

BACKGROUND: The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model. METHODS: A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable. RESULTS: Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services. DISCUSSION: Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Current status of electronic health literacy among pregnant women with gestational diabetes mellitus and their perceptions of online health information: a mixed-methods study.

BACKGROUND: Women diagnosed with gestational diabetes mellitus often rely on internet-based health information for managing their condition. This study aims to investigate the present state of electronic health literacy among women with gestational diabetes mellitus, analyze the influencing factors, and explore their experiences regarding accessing, comprehending, evaluating, and applying online health information pertinent to gestational diabetes mellitus. METHODS: A sequential explanatory mixed methods research design was adopted in this study. Initially, 235 women with gestational diabetes mellitus participated in a cross-sectional survey. The research tools included general information and the Chinese version of the electronic Health Literacy Scale (eHEALS). Descriptive analyses were conducted to describe the characteristics of the sample, and multiple linear regression analyses were used to explore the factors influencing electronic health literacy among women with gestational diabetes mellitus. Secondly, 11 women with gestational diabetes mellitus joined semi-structured in-depth interviews to obtain their perceptions about online health information. The data were analyzed using inductive content analysis to develop themes. RESULTS: The median score of eHEALS in the Chinese version among 235 women diagnosed with gestational diabetes mellitus was 29 (interquartile range [IQR], 26 to 32). Factors influencing electronic health literacy among these women included accessing health information from medical professionals (ß = 0.137, p = 0.029) and utilizing health information from applications (ß = 0.159, p = 0.013). From the qualitative phase of the study, four thematic categories emerged: reasons and basis for accessing health information from the Internet; address barriers to accessing and applying online health information; desires for a higher level of online health information services; outcomes of accessing and applying online health information. CONCLUSION: The electronic health literacy of women diagnosed with gestational diabetes mellitus remains suboptimal and warrants improvement. The sources of access to health information affect electronic health literacy in women with gestational diabetes mellitus. Moreover, women facing gestational diabetes encounter numerous impediments when attempting to access health-related information online, underscoring the necessity for enhanced online health information services to meet their needs.

Development and evaluation of a food literacy questionnaire for schoolchildren in France.

Food literacy is gaining importance in nutrition education programs for children. To date, food literacy assessment tools have been developed in many countries, however, none exist in France. The objectives of this study were to develop a questionnaire and to evaluate its measurement properties among French schoolchildren aged 8-11 years. The questionnaire was developed in three phases: i) item selection (literature review and adaptation or creation of items) and content validity (submission to an expert panel), ii) questionnaire development including a pre-test in a small sample of children (n = 41) and item reduction and dimensionality based on the responses of children who completed the questionnaire in 31 schools between December 2022 and March 2023, and iii) questionnaire evaluation in terms of reliability, validity and acceptability. In total, 1187 responses were included in the analysis. The mean age of the children was 9.6 ± 0.7 years (girls: 51.2%, boys: 48.8%). The development process resulted in a 25-item questionnaire with good acceptability and satisfactory estimated reliability (McDonald omega coefficient = 0.73). Factor evaluation revealed a three-dimensional structure encompassing food and nutrition knowledge, participation in food preparation activities and food habits. To our knowledge, this study was the first to assess food literacy for schoolchildren in France. Our questionnaire can contribute to assess the factors that make food literacy vary, especially regarding socioeconomic variables to target priority populations for nutrition education actions and to describe changes in food literacy scores from a longitudinal perspective.

Mediating roles of perceived stigma and mental health literacy in the relationship between school climate and help-seeking behavior in Indonesian adolescents.

OBJECTIVE: This study aimed to investigate whether perceived stigma and mental health literacy play mediating roles in the correlation between school climate and help-seeking behavior in Indonesian adolescents. METHODS: We used cross-sectional study design that recruited 760 Indonesian adolescents of age 16-19 years. We used convenience sampling from July to September 2019. Bivariate analysis was used to investigate the association of demographic characteristics with help-seeking behavior. Mediation analysis was employed to explore the mediating roles of mental health literacy and perceived stigma on the relationship between school climate and help-seeking behavior. RESULTS: Findings indicated that ethnicity, family income, and father's educational level were significantly associated (p < 0.05) with help-seeking behavior in Indonesian adolescents. Furthermore, perceived stigma and mental health literacy sequentially showed partial mediating roles in the relationship between school climate and help-seeking behavior (indirect effect: 0.004; 95% CI: 0.001, 0.010). Our mediating model indicated that a high level of school climate was associated with low perceived stigma (b = -0.11, p < 0.001) and high mental health literacy (b = 0.28, p < 0.001) and higher help-seeking behavior (b = 0.14, p < 0.001). CONCLUSION: Our study discovered novel insight of help-seeking behavior mechanism among adolescent by serial mediation test. Supportive school climate is necessary to achieve adequate help-seeking behavior. In addition, taking into account of student's perceived stigma and mental health literacy in promoting help-seeking behavior is also important.

Mechanisms of school-based peer education interventions to improve young people's health literacy or health behaviours: A realist-informed systematic review.

INTRODUCTION: Peer education interventions are widely used in secondary schools with an aim to improve students' health literacy and/or health behaviours. Although peer education is a popular intervention technique with some evidence of effectiveness, we know relatively little about the key components that lead to health improvements among young people, or components that may be less helpful. This review aims to identify the main mechanisms involved in school-based peer education health interventions for 11-18-year-olds. METHODS: Five electronic databases were searched for eligible studies during October 2020, an updated search was then conducted in January 2023 to incorporate any new studies published between November 2020 and January 2023. To be included in the review, studies must have evaluated a school-based peer education intervention designed to address aspects of the health of students aged 11-18 years old and contain data relevant to mechanisms of effect of these interventions. No restrictions were placed on publication date, or country but only manuscripts available in English language were included. RESULTS: Forty papers were identified for inclusion with a total of 116 references to intervention mechanisms which were subsequently grouped thematically into 10 key mechanisms. The four most common mechanisms discussed were: 1) Peerness; similar, relatable and credible 2) A balance between autonomy and support, 3) School values and broader change in school culture; and 4) Informal, innovative and personalised delivery methods. Mechanisms were identified in quantitative, qualitative and mixed methods intervention evaluations. DISCUSSION: This study highlights a number of key mechanisms that can be used to inform development of future school-based peer education health interventions to maximise effectiveness. Future studies should aim to create theories of change or logic models, and then test the key mechanisms, rather than relying on untested theoretical assumptions. Future work should also examine whether particular mechanisms may lead to harm, and also whether certain mechanisms are more or less important to address different health issues, or whether a set of generic mechanisms always need to be activated for success.

The association between undergraduate nursing students' health literacy and bullying and cyberbullying victimization.

BACKGROUND: Bullying and cyberbullying victimization are common among undergraduate nursing students. However, evidence regarding health literacy association with bullying and cyberbullying victimization is lacking. PURPOSE: To investigate the association between health literacy and bullying and cyberbullying victimization in undergraduate nursing students. METHODS: A cross-sectional design was used with a sample of undergraduate nursing students (N = 397). The students completed three data collection scales (Forms of Peer Victimization Scale, Florence Cyberbullying-Cybervictimization Scales, and Health Literacy Questionnaire) and a demographics questionnaire. Data analysis was performed using cluster analysis and independent samples t-test. RESULTS: The mean age of students was 20.93 (SD = 2.16). Cluster analysis revealed that there were two clusters; undergraduate nursing students in cluster 1 had lower scores on health literacy and higher scores on bullying and cyberbullying victimization. The t-test results showed that undergraduate nursing students with a history of bullying victimization had lower scores on health literacy scales than those who reported no exposure to bullying victimization (p < .05). The largest mean difference was found in the "social support for health" scale. CONCLUSION: The findings of this study provide evidence that health literacy is a key determinant of mitigating bullying and cyberbullying victimization in undergraduate nursing students.

'There's no waiting list, just press play': listeners' experiences of mental-health-related podcasts.

INTRODUCTION: The activity of podcasting has increased exponentially but little is known about the qualitative listener experiences of podcasts related to mental health. The aim of this study was to understand what listeners of mental health podcasts obtain from this medium. Participants were asked questions relating to mental health literacy, stigma and help-seeking behaviour. METHODS: The study gathered data, via an online survey (n=722). This article reports on the responses to open-ended questions: 'What do you take away from listening to mental health-related podcasts? What do you learn about yourself (or a loved one)? What do you find most useful about listening to mental health-related podcasts?' Inductive thematic analysis was utilised. RESULTS: Thematic analysis produced five core themes: accessibility, mental health literacy, potential pitfalls, reassurance and lived experiences. Accessibility of material and discussions featuring professionals and people with lived experience were reported key highlights. CONCLUSION: Results indicate that podcasts influence the development of mental health literacy, reduce stigma and increase help-seeking. Given the challenges with service access in underserved populations, there is a potential role for the use of podcasts in rural regions.

Self-Management Support Improves Diabetes Outcomes Without Exacerbating Inequities.

INTRODUCTION: Previous research has found an association between low health literacy and poor clinical outcomes in type 2 Diabetes Mellitus (T2DM) patients. We sought to determine if this association can be mitigated by a self-management support (SMS) program provided by trained health workers using a technology assisted menu driven program, called Connection to Health (CTH). METHODS: This study is a secondary analysis from a randomized trial of 2 similar versions of CTH implemented in 12 Northern California community health centers. As part of this, each participant completed a single validated question to assess health literacy. We used unadjusted and adjusted linear regression analyses to determine the extent to which baseline health literacy was predictive of prepost changes in hemoglobin A1c (HbA1c). RESULTS: Of 365 participants for whom prepost HbA1c data were available, HbA1c concentrations declined by an average of 0.76% (from 9.9% to 9.2%, 95% CI (0.53%-1.0%). Almost 114 (31.2%) of the participants had low health literacy, but there was no significant association between health literacy and the reduction in HbA1c concentrations in either the unadjusted or adjusted models, nor did baseline health literacy predict prepost changes in body mass index, medication adherence, exercise, or diet. DISCUSSION: The study found that implementing the CTH program in 2 versions via a randomized clinical trial improved HbA1c concentrations without increasing disparities between participants with high and low health literacy. This suggests CTH-like programs can enhance diabetes outcomes in community health centers without exacerbating inequities for those with low health literacy.

[Literacy in sexual and reproductive health as well as associated variables: multicenter study]. / Alfabetización en salud sexual y reproductiva así como variables asociadas: estudio multicéntrico.

OBJECTIVE: Limited Health Literacy implies an insufficient understanding of relevant health information, being associated with various variables. The objective of the study was to measure the prevalence of the level of Limited Sexual and Reproductive Health Literacy (AS-SR), its associated variables and the differences in scores between levels of AS-SR, universities and science of study in Chilean university students. METHODS: A multicenter and cross-sectional study, which applied a validated scale to measure levels of AS-SR, was carried out in a sample of 2,186 Chilean university students, categorizing it as high, medium high, medium low and low. The level of Limited AS-SR was obtained by adding the medium-low and low categories. Tests were carried out: descriptive, psychometric and reliability; association, logistic regression and differences between variables of interest. RESULTS: The prevalence of Limited AS-SR was 52.7%. The variables most associated with the level of Limited AS-SR were: low interest in information about health care (OR=2.819; 95% CI: 2.132-3.726), prevention (OR=2.564; 95% CI: 1.941-3.388), sexuality (OR=2.497; 95% CI: 1.807-3.452) and health promotion (OR=1.515; 95% CI: 1.239-1.853); certain sources of Information (OR=1.915; 95% CI:1.614-2.272); low economic income (OR=1.661; 95% CI: 1.361-2.026), among others. There were statistically significant differences in scores between categories of AS-SR levels, universities and study science. The scale had a reliability of 0.940. CONCLUSIONS: More than half of the students have Limited AS-SR, mainly associated with low interest in health information. The scale presents excellent psychometric indicators, being recommended for diagnoses of health situations.

OBJECTIVE: La Alfabetización en Salud Limitada implica una comprensión insuficiente de la información relevante en salud, asociándose con diversas variables. El objetivo del estudio fue medir la prevalencia del nivel de Alfabetización en Salud Sexual y Reproductiva (AS-SR) Limitada, sus variables asociadas y las diferencias de puntajes entre niveles de AS-SR, universidades y ciencia de estudio en universitarios chilenos. METHODS: Se realizó un estudio multicéntrico y transversal, que aplicó una escala validada para medir niveles de AS-SR, en una muestra de 2.186 estudiantes universitarios chilenos, categorizándola en alta, media-alta, media-baja y baja. El nivel de AS-SR Limitada se obtuvo mediante el sumatorio de categorías media-baja y baja. Se realizaron pruebas: descriptivas, psicométricas y fiabilidad; asociación, regresión logística y de diferencias entre variables de interés. RESULTS: La prevalencia de AS-SR Limitada fue del 52,7%. Las variables mayormente asociadas al nivel de AS-SR Limitada fueron: bajo interés en información sobre atención en salud (OR=2,819; IC 95%:2,132-3,726), prevención (OR=2,564; IC 95%: 1,941-3,388), sexualidad (OR=2,497; IC 95%: 1,807-3,452) y promoción de la salud (OR=1,515; IC 95%: 1,239-1,853); ciertas fuentes de Información (OR=1,915; IC 95%:1,614-2,272); bajo ingreso económico (OR=1,661; IC 95%: 1,361-2,026), entre otras. Existieron diferencias estadísticamente significativas de puntajes entre categorías de niveles de AS-SR, universidades y ciencia de estudio. La escala presentó fiabilidad de 0,940. CONCLUSIONS: Más de la mitad de los estudiantes poseen AS-SR Limitada, asociada principalmente al bajo interés en información en salud. La escala presenta excelentes indicadores psicométricos, siendo recomendable para diagnósticos de situación de salud.

Why is health literacy an essential component of health of individuals with chronic kidney disease / Pourquoi la littératie en santé est une composante essentielle de la santé des individus ayant une maladie rénale chronique.

Health literacy (HL) is the ability of individuals to access, understand and use health information to improve their health. It is a multidimensional and contextual concept, whose definition has been enriched over time. Considered both as a health risk factor and a skill to be developed by individuals, HL also depends on the healthcare system in which patients have to navigate, and on healthcare professionals' awareness of this concept. In order to promote shared decision-making and thus individual empowerment in the healthcare, HL should be at the core of the concerns of nephrology care teams.

La littératie en santé (LS) est la capacité d'un individu à accéder à des informations en santé, à les comprendre et à les utiliser pour améliorer son état de santé. Il s'agit d'un concept pluridimensionnel et contextuel dont la définition s'est enrichie au fil du temps. Considérée à la fois comme un facteur de risque pour la santé et une aptitude à développer chez les individus, la LS dépend également du système de santé dans lequel les patients doivent naviguer et de la sensibilisation des professionnels de santé à ce concept. Afin de favoriser la décision partagée et ainsi l'émancipation des individus en matière de santé, la LS devrait être au cœur des préoccupations des équipes de néphrologie.

Evaluation of the Quality and Readability of Online Information about Alzheimer's Disease in China.

Background: With the increasing popularity of the internet, a growing number of patients and their companions are actively seeking health-related information online. Objective: The aim of this study was to assess the quality and readability of online information about Alzheimer's disease (AD) in China. Methods: A total of 263 qualified AD-related web pages from different businesses, governments, and hospitals were obtained. The quality of the web pages was assessed using the DISCERN tool, and the readability of the web pages was assessed using a readability measurement website suitable for the Chinese language. The differences in readability and quality between different types of web pages were investigated, and the correlation between quality and readability was analyzed. Results: The mean overall DISCERN score was 40.93±7.5. The government group scored significantly higher than the commercial and hospital groups. The mean readability score was 12.74±1.27, and the commercial group had the lowest readability score. There was a positive correlation between DISCERN scores and readability scores. Conclusions: This study presents an evaluation of the quality and readability of health information pertaining to AD in China. The findings indicate that there is a need to enhance the quality and readability of web pages about AD in China. Recommendations for improvement are proposed in light of these findings.

Individual and family factors correlated with children's fruit consumption.

Background: Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors. Methods: A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively. Results: Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667). Conclusion: The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

The relationship between dental anxiety and oral health literacy with oral health-related quality of life.

BACKGROUND AND AIM: Dental anxiety is a prevalent issue in society, characterized by an uneasy sensation and anticipation of negative experiences in dental settings. In essence, dental anxiety, oral health literacy, and quality of life may have a relationship with each other, however, there is a shortage of evidence examining the interplay between these factors. Therefore, this study aimed to assess the relationship between dental anxiety and oral health literacy (OHL) with oral health-related quality of life (OHRQOL). METHODS: This is an analytical cross-sectional study conducted on 155 patients referred to the Department of Oromaxillofacial Diseases. Three questionnaires consisting of dental anxiety scale, oral health impact profile- 14, and oral health literacy adult questionnaire were used to measure anxiety, health literacy, and the quality of life-related to oral health. Scores were recorded and analyzed by IBM SPSS 24 software using independent samples T-test and ANOVA. Besides, the confirmatory modeling through the goodness of fit index of the model was applied. RESULTS: This study involved 155 participants, with a mean age of 38.44 ± 14 years. The majority were females, comprising 99 individuals (63.9%). In this study, 89 patients (57.4%) had dental anxiety. The mean OHL score in the examined participants was 9.88 ± 3.97. Both factors of anxiety (p < 0.001) and OHL (p = 0.012) had a significant effect on the OHRQOL. There was no significant difference in the mean OHRQOL among the three categories of OHL (p = 0.085). The confirmatory modeling showed that only the fourth (p = 0.065) and fifth (p = 0.146) questions of the OHL questionnaire had no significant effect on the total score of OHL. Besides, both factors of anxiety (p < 0.001) and OHL (p = 0.012) had a significant effect on OHRQOL. With an increase of one unit in anxiety, the OHRQOL score increases by 0.31 and for a one-unit increase in the OHL score, the OHRQOL score decreases by 0.66 units. CONCLUSION: In conclusion, it seems that considering various dimensions of oral and dental health can help patients to have reduced psychological anxiety. Notably, further multicenter studies assessing diverse variables related to dental anxiety, OHL, and OHRQOL, and considering more comprehensive study designs with longitudinal follow-up could help provide insights into how changes in dental anxiety and OHL over time affect OHRQOL.

Cancer Health Literacy and Its Correlated Factors in the United Arab Emirates-A Cross Sectional Study.

INTRODUCTION: Cancer Health literacy (CHL) is the health literacy related to cancer knowledge, prevention, treatment, screening, and access to services. It is an important indicator of people's adherence to screening and preventive measures, which helps to reduce the incidence and prevalence of cancer. The study assessed the CHL level and its association with relevant socio-demographic characteristics and sources of information among primary health care patients and visitors in the United Arab Emirates (UAE). METHODS: A cross-sectional study recruited survey participants who consented to respond to an interviewer-administered questionnaire. The assessment of CHL was done by using 15 questions. CHL level was measured as a median score and also categorized as poor/inadequate, moderate, good/excellent. Nominal logistic regression was used to analyze the relationship between CHL categories and participants' sociodemographic characteristics and CHL sources of information. RESULTS: Of the total 492 participants, 45.5% were young adults (30-39 years old), 32.9% were males, and 70.8% were UAE nationals. The overall median CHL score was 8.0 (IQR = 5.0-10). 33.7% of the participants had a poor/inadequate level of CHL, 49.6% had a moderate level and 16.7% had a good to excellent level of CHL. 76.9% of the participants knew the importance of early cancer screening tests, 72.7% acknowledged the metastatic capacity of cancer, and the protective factors of cancer, especially, in colon cancer (71.7%). A high proportion of participants received health information about cancer via the internet (50.7%), television (45.3%), social media (40.2%), and doctors (43.6%). Nationality other than UAE (aOR = 1.62, 95% CI = 1.03-2.56, P = .038), having university education (aOR = 2.20, 95% CI = 1.21-3.99, P = .010) compared to those with lower than high school, and having a family history of cancer (aOR = 2.42, 95% CI = 1.33-4.41, P = .004) were positively associated with CHL. Older age (aOR = .36, 95% CI = .17-.75, P = .007 for 50-59 years, and aOR = .29, 95% CI = .11-.82, P = .019) for 60-69 years, higher-income (aOR = .57, 95% CI = .33-.99, P = .047 for 10,000-19,999 AED; aOR = .53, 95% CI = .33-.88, P = .013 for ≥20,000) compared with those earning <10,000 AED were negatively associated with CHL. CONCLUSIONS: CHL among the resident UAE population was moderately adequate, therefore implementation of awareness campaigns seems to be warranted. Moreover, evaluation research targeting the CHL impact on cancer prevention practices and screening is also advocated.

Personal and organisational health literacy in the non-specific symptom pathway for cancer: An ethnographic study.

INTRODUCTION: People being investigated for cancer face a wealth of complex information. Non-specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner 'gut feeling', who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways. METHODS: This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowing and clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy. RESULTS: Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge. CONCLUSION: We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help-seeking post-discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtesting or inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors. PATIENT OR PUBLIC CONTRIBUTION: Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.-A. M.) was involved in data analysis and writing the manuscript.

Status of self-medication and the relevant factors regarding drug efficacy and safety as important considerations among adolescents aged 12-18 in China: a cross-sectional study.

The objective of this study was to investigate self-medication behavior among Chinese adolescents aged 12-18 years and explore the factors associated with whether adolescents prioritize drug efficacy or safety when engaging in self-medication behavior. In 2021, a questionnaire investigation was conducted in the Chinese mainland using a multi-stage sampling approach. After a statistical description, logistic regression was used to analyze the factors associated with considering drug efficacy and safety. The self-medication rate among Chinese adolescents aged 12-18 years was 96.61%. Of these, 65.84% considered drug safety to be essential, while 58.72% prioritized drug efficacy. Regression analysis showed that individuals with better healthcare were more likely to consider drug efficacy an important factor. Additionally, those with a healthier family lifestyle were more likely to prioritize efficacy. When individuals engage in self-medication, those residing in urban areas and possessing advanced preventive health literacy and ample family health resources tend to prioritize drug safety to a greater extent. Conversely, those with higher monthly household incomes and only children exhibit a decreased inclination towards prioritizing safety during self-medication. Self-medication is a frequently observed practice among Chinese adolescents aged 12-18. Several factors, such as demographic and sociological characteristics, health literacy, and family health status, have been found to be associated with the extent to which adolescents prioritize medication safety and efficacy when engaging in self-medication practices. Higher levels of health literacy and better family health status were positively correlated with considering both the efficacy and safety of drugs as important factors when self-medicating.

Relationship between perceived physical literacy and obesity-related outcomes in adolescents: the EHDLA study.

Purpose: The aim of the present study was to examine the relationship between perceived physical literacy and obesity-related outcomes among adolescents from Spain. Methods: This is a secondary cross-sectional analysis including a total sample of 845 Spanish adolescents (55.3% girls) aged 12-17 years from the Valle de Ricote (Region of Murcia) from the Eating Healthy and Daily Life Activities (EHDLA) project. Physical literacy was evaluated using the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). Body mass index was computed by taking the participants' body weight in kilograms and dividing it by the square of their height in meters, and body mass index (z score) and overweight/obesity and obesity were computed by the World Health Organization age- and sex-specific thresholds. Waist circumference was measured using a constant tension tape. Moreover, the waist-to-height ratio was calculated, and therefore, abdominal obesity was determined. Skinfold measurements were taken at the triceps and medial calf using calibrated steel calipers. Results: In general, the overall trend was downward (i.e., the higher the PPLI score the lower the obesity-related indicators), with the approximate significance of smooth terms being statistically significant for all models examined (p < 0.001). Adolescents with lower perceived physical literacy (PPL) showed the highest estimated marginal means of body mass index, body mass index z score, waist circumference, waist-to-height ratio, and skinfold (triceps and calf) and predictive probabilities of having excess weight, obesity, and abdominal obesity, while their counterparts with high PPL had the lowest. In addition, significant differences were observed for all the obesity-related indications between adolescents with low PPL and those with medium PPL (p-adjusted < 0.05 for all indicators), as well as with those with high PPL (p-adjusted < 0.05 for all indicators). Moreover, these significant differences were also shown for most indicators between adolescents with medium PPL and those with high PPL (except for obesity). Conclusion: Physical literacy could play a crucial role in maintaining more desirable obesity-related outcomes in adolescents. Adolescents with high perceived physical literacy showed lower obesity-related indicators (i.e., body mass index, body mass index z score, waist circumference, waist-to-height ratio, skinfolds), as well as a lower probability of having excess weight, obesity, and abdominal obesity.

Navigating Challenges and Seizing Opportunities in China's Era of Online Health Education.

The rapid growth of internet users in China presents opportunities for advancing the "Healthy China 2030" initiative through online health education. Platforms like "Shanghai Health Cloud" and "National Health Information Platform" improve health literacy and management, enhancing overall public health. However, challenges such as the digital divide and the spread of unverified health information hinder progress. Addressing these issues requires enhancing digital infrastructure, employing advanced technologies for information validation, and setting high standards for online health services. Integrated efforts from various sectors are essential to maximize the benefits of online health education in China.