Modifiable predictors of mental health literacy in the educational context: a systematic review and meta-analysis.

Mental health literacy is vital for well-being in educational settings, extending beyond academics to include social and emotional development. It empowers individuals, allowing them to recognize and address their mental health needs and provide essential support to their peers. Despite the acknowledged importance of modifiable factors, there is a noticeable research gap in those amenable to change through educational interventions. Thus, this systematic review aims to identify potentially modifiable predictors of mental health literacy in the educational context. A systematic search was conducted for quantitative studies published between 2019 and October 2023 using several databases following PRISMA guidelines. Studies needed to focus on potentially modifiable predictors of mental health literacy in the educational context. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS tool). In total, 3747 titles and abstracts were screened, 60 articles were assessed in full-text screening, and 21 were included in the review. Significant correlations between mental health literacy and modifiable predictors, including stigma toward professional help, self-efficacy, attitudes toward help-seeking, social support, positive psychological states, receiving mental health training, and psychological distress, were identified. By addressing these factors, educational institutions can cultivate community's adept in mental health, fostering an environment marked by empathy, understanding, and proactive engagement in addressing mental health issues. The implications serve as a foundation for future research, policy development, and implementing of practical strategies to enhance mental health literacy in diverse educational settings.

Effects of Digital Health Literacy Program on Sufficient Health Behavior Among Thai Working-Age People With Risk Factors for Noncommunicable Diseases.

BACKGROUND: Noncommunicable diseases (NCDs) account for more than 75% of deaths in Thailand, which is higher than the global average of 71%. OBJECTIVE: The aim of this study was to investigate the effects of the Digital Health Literacy (DHL) and Sufficient Health Behavior (SHB) Program on Thai working-age adults age 20 to 65 years with risk factors for NCDs (i.e., overweight and lacking physical activity), and compare the health literacy (HL) and SHB of participants living in urban and semi-urban areas at posttest. METHODS: Using the lottery method, this one-group pretest-posttest quasi-experimental design randomly selected 200 participants and assigned them to two equally sized groups. The data were gathered through surveys with an item discrimination power between .20 and .86 and a reliability of 0.94 and were statistically analyzed using t-test and F-test. KEY RESULTS: The DHL and SHB Program comprises six sessions over a 12-week period, and activities designed to enhance knowledge of NCDs, HL, health communication, and health behavior modification. It was conducted by health care workers from urban and semi-urban public hospitals via Zoom using various digital toolkits such as YouTube, animations, infographics, role-play videos, clips, and e-books. At the posttest, the participants had higher HL (t = 2.67, p = .001) and SHB (t = 3.36, p = .001). There was a difference in SHB scores (F = 4.640, p = .032) between those living in urban and those in semi-urban areas, but no difference in HL scores (F = 1.436, p = .232). CONCLUSIONS: The DHL and SHB Program improved HL and SHB in Thai working-age adults with risk factors for NCDs in both urban and semi-urban communities. [HLRP: Health Literacy Research and Practice. 2024;8(2):e93-e101.].

PLAIN LANGUAGE SUMMARY: This study describes the implementation of a Digital Health Literacy and Sufficient Health Behavior Program via Zoom by health care workers in urban and semi-urban hospitals to effectively improve health literacy and sufficient health behavior among Thai working-age populations with risk factors for noncommunicable diseases. The Program was preliminarily shown to be extendable to other health care settings covered by the Internet.

Causal Model of Herb Use Behavior Among Working-age Adults in Thailand.

Objectives: This study developed a causal relationship model of herb use from observational data and analyzed the direct and indirect effects of herb use on health according to the model. Methods: A cross-sectional study was conducted with 400 participants aged 26-59 years, selected through multistage random sampling. The instruments used for data collection included demographic information, herb use, health literacy (HL), perceived social support, societal values, and attitudes toward herb use. The conceptual model, hypothesized based on prior evidence, was tested using confirmatory factor analysis through structural equation modeling. Path coefficients were estimated using the maximum likelihood method. Results: The final model utilized empirical data, which showed that perceived social support had the most significant impact on herb use. This was followed by HL, positive attitudes toward herbal remedies, and societal values, with coefficients of 0.31, 0.18, and 0.16, respectively. When analyzing variables that indirectly affected herb use, it was clear that positive attitudes, perceived social support, and societal values significantly influenced herb use through HL, with influence coefficients of 0.08, 0.16, and 0.04, respectively. Together, these variables accounted for 68% of the variance in herb use. Conclusions: The findings from this study can be utilized to develop and implement strategies that guide the use of herbal products, ultimately aiming to improve human health.

Measuring Occupational Well-Being Indicators: Scale Construction and Validation.

The purpose of this study is to carry out the scale development of occupational well-being (OWB) (affective, professional, social, cognitive, psychological and psychosomatic well-being) in Laos. Using multiple sampling data, we developed a valid OWB scale with a large Laotian sample (n = 1745). The validity of the OWB-47 scale was analyzed using exploratory factor analysis (EFA). Cross-validity, the initial model, and confirmatory factor analysis (CFA) were performed using Stata 19 to assess the validity of the scale development. Consistent with the valid model, the CFA revealed a unidimensional structure in the OWB scale. The initial measurement of the OWB scale was significantly correlated with the measure of the six-dimensional model. Regarding the full model testing, the CFA model was developed to test the validity of the OWB-47 scale, suggesting the acceptability of the fit model.

Causal model of health literacy in dietary supplement use and sufficient health behavior among working-age adults.

Background: Sufficient health behavior (SHB) and health literacy in dietary supplement use (HL-DSU) are the key determinants of health status. However, the link between HL-DSU and SHB is not fully understood. Therefore, the objective of this research was to investigate the model and identify the size of its effect on HL-DSU and SHB among adults of working age. Methods: The study employed a cross-sectional survey design, with cluster random sampling used for the selection of 696 working-age adults ranging from 20-59 years. Data on their SHB, HL-DSU, awareness of dietary supplement advertising (DSA), and social support were collected from August to October 2021 through questionnaires employing a 5-point rating scale. Content validity was determined using item-objective congruence (IOC) values ranging from 0.6 to 1.0 obtained for each item on the questionnaire. The Cronbach's alpha values ranging from 0.93 to 0.96 indicated reliability, while the independent t-test, descriptive analysis, and structural equation modeling (SEM) were performed. Results: SHB is defined as the health-beneficial behaviors based on a balanced lifestyle, utilizing conceptual approaches resulting in positive health outcomes relating to fundamental goals in the use of dietary supplements and other contexts emphasizing sufficiency. The causal model was found to fit the empirical data with an acceptable goodness-of-fit value. The findings indicate that social support, awareness of DSA, and HL-DSU directly affect SHB (Beta of 0.33, 0.20, and 0.13, respectively, p < .05) and could predict 34% of SHB overall. HL-DSU is shown to be significantly and directly impacted by social support and awareness of DSA, with influence coefficients of 0.36 and 0.57, respectively. The variance of HL-DSU can be predicted by these two factors as 67%. Conclusion: The establishment of campaign activities to promote awareness regarding the advantage and disadvantages, as well as media literacy of supplementary food products in health centers and communities, should be the focus of healthcare providers.

Health literacy in dietary supplement use among working-age groups: systematic review and meta-analysis.

Background: Globally, dietary supplement use (DSU) is very popular against COVID19. This study aims to investigate the characteristics of research on health literacy (HL) in DSU and compare HL among working-age groups by reviewing related research between 2011 and 2021 in PubMed, SCOPUS, ClinicalKey, Google Scholar and ThaiJO. Methods: Twenty-five articles that met the inclusion criteria were selected for study and analyzed using Cohen's d. Results: The results showed that HL affected dietary supplement (DS) consumption behavior among working-age groups with an average effect size of 0.423 (95% CI = 0.249-0.598), followed by disclosure of DSU with an average effect size of 0.220 (95% CI = 0.087-0.353). No effect was found on awareness of dietary supplement advertisements. Conclusion: The discovery of such knowledge is a significant contribution to public health, leading to the development of interventions and policies for enhancing HL in DSU e.g. organizing knowledge-sharing workshops on DSU and building support networks across all sectors.

General health literacy scale for Thais and comparison between age groups.

Background: Health literacy (HL) has captured the world's interest since it was first defined by WHO in 1998. In Thailand, a number of HL scales for risk groups have been developed but none for the general population. Therefore, this research aimed to develop a general health literacy (GHL) scale for Thais and compare HL levels between groups, i.e. students, youth, adults, and older. Methods: In this mixed-methods study, a focus group was conducted with 20 health policy-makers. Data were collected from 4,000 participants from all regions of Thailand through questionnaires between 2018 and 2019. The participants were divided into 4 age groups: aged 7-14, 15-24, 25-59, and 60-75. All of them were selected using stratified random sampling. Data analysis was performed using CFA and ANOVA. Results: 1) The GHL Scale for Thais comprised 47 items, covering 5 domains i.e. access to health information and services, understanding of health information and service leading to practice, health information and service appraisal, communication and social support, and health self-management. The scale had high Cronbach's alpha values for all participants and different age groups (Cronbach's alpha = 0.95-0.97) and factor loadings ranging from 0.45 to 0.77. 2) Most Thai people (58.9%) had a fair level of HL, followed by high HL (24.3%) and low HL (16.8%). 3) The comparison of HL among age groups had different mean scores (P < .05) and low HL was found in adults (25.00%), older (18.60%), youth (12.60%), and students (11.40%), respectively. Conclusion: The GHL Scale for Thais can be used to screen people of all ages for potential health problems and develop strategies for promoting health resilience and preventing disease in each age group.

Effectiveness of a health literacy intervention based on transformative learning and incorporating positive psychology on health behavior and well-being of Thai families with NCDs risk.

BACKGROUND: Thailand has a higher global NCD mortality rate in comparison to the rest of the world, accounting for 75% and 71% of all deaths. WHO focused increasingly on health literacy (HL) in order to decrease NCDs. This study aimed to assess the effectiveness of an HL intervention utilizing transformative learning and positive psychology with mindfulness training in terms of changing levels of HL, health behavior (HB), and health outcomes.   Design and methods: The study was a randomized control trial from May to September 2019.  The participants were a rural Thai population with low levels of HL, living in an area with high levels of NCDs. The 200 participants were cluster randomly allocated to an eight-week intervention, and the control group. The data were collected by Likert questionnaires and physical exams, and analyzed via ANOVA.  Results: The intervention group mean scores for HL, psychological capital, HB, and family well-being increased from baseline to post-intervention, but decreased during the follow-up but were still significantly higher than the control group and baseline scores. The increases in HL and HB were matched by improvements in physiological measurement. The BMI scores of the intervention group decreased in each phase, while the control group scores remained largely unchanged. An intervention group had significantly lower fasting blood sugar than the controls at the intervention and in the follow-up. There was no interaction between social support and any other variables. CONCLUSIONS: This program demonstrated improvements in HL, HB and the well-being of Thai families at risk of NCDs in rural communities.

Mindfulness interventions reduce blood pressure in patients with non-communicable diseases: A systematic review and meta-analysis.

PURPOSE: Mindfulness based interventions (MBIs) are an emerging area of empirical study, not only in positive psychology, but also in clinical health care. This research aims to synthesize the evidence about whether MBIs reduce blood pressure (BP) in patients with non-communicable diseases (NCDs). METHODS: Relevant studies were identified via PubMed, the Cochrane Library, Embase and the CINAHL database between 2009 and 2019. The papers selected focused on mindfulness and the effect of these on the BP of patients with NCDs. The change in SBP and DBP were meta-analyzed, stratified by type of intervention (Breathing awareness meditation (BAM), Mindfulness Meditation (MM), and Mindfulness-based Stress Reduction (MBSR). RESULTS: Fourteen articles met eligibility criteria and were included in the final review. Among the studies using the type and duration of intervention, systolic BP was reduced after the mindfulness-based stress reduction for 8 weeks (-6.90 mmHg [95% CI: -10.82, -2.97], p < .050), followed by the breathing awareness meditation for 12 weeks (-4.10 mmHg [95% CI: -7.54, -0.66], p < .050) and the mindfulness-based intervention for 8 weeks (-2.69 mmHg [95% CI: -3.90, -1.49], p < .050) whereas diastolic BP was reduced after the mindfulness-based stress reduction for 8 weeks (-2.45 mmHg [95% CI: -3.74, -1.17], p < .050) and the mindfulness-based intervention for 8 weeks (-2.24 mmHg [95% CI: -3.22, -1.26], p < .050). CONCLUSION: MBIs can provide effective alternative therapies to assist in blood pressure reduction for patients with NCDs.

Learning programmes and teaching techniques to enhance oral health literacy or patient-centred communication for healthcare providers: A systematic review.

OBJECTIVE: To investigate the learning programmes and teaching techniques used in interventions to enhance oral health literacy (OHL) or patient-centred communication (PCC) for healthcare providers. MATERIALS AND METHODS: A systematic review of OHL and PCC were obtained from four electronic databases (PubMed, ScienceDirect, ProQuest and Scopus) was undertaken. These searches covered the period from January 2008 to December 2017. The quality assessment tool was the Joanna Briggs Institute Critical Appraisal tool for systematic reviews of effectiveness. RESULTS: The final review included nine studies amongst a total of 1475 studies. They showed three learning programmes (workshops, training and community-based rotation) and 17 related teaching techniques to promote OHL and PCC. The most commonly used learning programmes to enhance OHL and PCC for healthcare providers were workshops, and the teaching techniques included feedback and reflection. The intervention periods of the programmes took 20 minutes to half a day. The three studies did not have a follow-up, whilst the rest showed a follow-up range of 2 months to 3 years. Interestingly, there was one study, which applied double follow-ups to show the effectiveness of the programme. CONCLUSION: Either workshops or training programmes with a combination of teaching techniques were effective in terms of enhancing their OHL or PCC. The more frequent follow-up might increase the long-term effectiveness of the learning programme.

Multi-group Causal Model of Health Literacy and Behaviors on Family Well-being among Thai Adults at Risk of Non-Communicable Diseases (NCDs).

BACKGROUND: We aimed to develop a causal model of family well-being with health literacy (HL) as a mediator and to compare models between male and female spouses in urban and rural communities. STUDY DESIGN: A cross-sectional study. METHODS: The samples included 2000 spouses at risk of non-communicable diseases (NCDs) by stratified randomly sampled in 2018. Data were collected Likert questionnaires with reliability of 0.79-0.93, and analyzed via confirmatory factor analysis (CFA), and multi-group structural equation modeling (MSEM). RESULTS: A causal model for the overall group was consistent with the data. Causal factors had direct effects on health behavior including social norms, positive attitude toward health, psychological capital, and HL (ß=0.11, 0.14, 0.30, and 0.41, P<0.05 respectively). Health behavior and positive attitudes towards health had direct effects on family well-being (ß=0.36 and 0.42, P<0.05, respectively). All factors could predict health behavior and family well-being with variance of 70% and 50%. Invariance analysis of models showed no difference between male and female spouses. In addition, the mean comparison of latent variables showed that the positive attitudes towards health were lower in women than men. HL and positive attitudes towards health of spouses in urban were lower than in rural communities. CONCLUSION: Thai adult families in cities were at higher risk with NCDs. Therefore, health providers need to address HL and positive attitude toward health which were the main causal factors.

Health Literacy Scale and Causal Model of Childhood Overweight.

BACKGROUND: WHO focuses on developing health literacy (HL) referring to cognitive and social skills. Our objectives were to develop a scale for evaluating the HL level of Thai childhood overweight, and develop a path model of health behavior (HB) for preventing obesity. STUDY DESIGN: A cross-sectional study. METHODS: This research used a mixed method. Overall, 2,000 school students were aged 9 to 14 yr collected by stratified random sampling from all parts of Thailand in 2014. Data were analyzed by CFA, LISREL. RESULTS: Reliability of HL and HB scale ranged 0.62 to 0.82 and factor loading ranged 0.33 to 0.80, the subjects had low level of HL (60.0%) and fair level of HB (58.4%), and the path model of HB, could be influenced by HL from three paths. Path 1 started from the health knowledge and understanding that directly influenced the eating behavior (effect sized - ß was 0.13, P<0.05. Path 2 the health knowledge and understanding that influenced managing their health conditions, media literacy, and making appropriate health-related decision ß=0.07, 0.98, and 0.05, respectively. Path 3 the accessing the information and services that influenced communicating for added skills, media literacy, and making appropriate health-related decision ß=0.63, 0.93, 0.98, and 0.05. Finally, basic level of HL measured from health knowledge and understanding and accessing the information and services that influenced HB through interactive, and critical level ß= 0.76, 0.97, and 0.55, respectively. CONCLUSIONS: HL Scale for Thai childhood overweight should be implemented as a screening tool developing HL by the public policy for health promotion.

Multilevel Causal Analysis of Socio-Psychological and Behavioral Factors of Health Providers and Clients That Affect Health Behavioral Modification in Obesity.

UNLABELLED: The Comprehensive Lifestyle Intervention, which integrates behavioral therapy, is the main ideal management of the clients with obesity. Various socio-psychological factors can affect outcome of the program. THE PURPOSES: to determine the socio-psychological factors at the client and provider groups that affect health behavior modification (HBM) in obese clients, and to investigate the cross-level interaction of factors that affect HBM. The samples included 87 health providers and 412 clients using stratified random sampling. Hierarchical Linear Model was used to analyze in a questionnaire with reliability of 0.8-0.9. RESULTS: 1) for the clients: 1.1) Attitudes towards healthy behavior (AHB), health-related knowledge, and trust in the provider predicted self-efficacy at 49.40%; 1.2) AHB and support from the provider predicted self-regulation at 75.50%; and 1.3) AHB, trust in the provider and support from the provider predicted self-care at 26.6%. 2) for the health providers: 2.1) Health quotient (HQ), project management (PM), support from the team, and the team emotional quotient (EQ) predicted self-efficacy at 71.30%; 2.2) PM and HQ predicted self-regulation at 51.60%; and 2.3) PM, team EQ and HQ predicted self-care at 77.30%., 3) No cross-level interaction of factors between the clients and the providers was identified to affect HBM. CONCLUSION: the obese client's AHB is the factor that significantly influenced self-efficacy, self-regulation and self-care (3SELF). At the health provider level, both HQ and PM significantly influenced 3SELF. Behavioral.

The effects of behavioral modification based on client center program to health behaviors among obese university students.

The objectives of this research were to examine the effectiveness of Health Behavioral Modification based on the Client Center Program (HBMCCP) and to study behavioral change in relation to self - efficacy, self- regulation, self-care behaviors and body weight. The sample was 59 undergraduate students, who were selected by cluster random sampling. 29 participated in the HBMCCP for 8 weeks, and were followed up 4 weeks after the program, and 30 students in the control group. Data was collected 3 times, before, immediately after and 4 weeks after the program, by 6 scale - questionnaires which had high reliability of Cronbach's alpha-coefficient between .81 to.94. The stratified variables were psycho-social variables, being a positive attitude towards health behavior and social support. Data were analyzed by MANOVA and ANCOVA. Results showed that 1) Obese students in the experimental group with HBMCCP had self - efficacy, self- regulation and self-care behavior at immediately after and 4 weeks later program significantly higher scores than before the program (p<0.000). For body weights at immediately after program were significantly lower scores than before the program (p=0.02), 2) Obese students in the program had self - efficacy, self- regulation and self-care behavior scores at immediately after and 4 weeks after the program significantly higher than obese students in the control group (p=0.009) and significantly lower body weights than obese students in the control group (p=0.026), and 3) No three - way interaction among positive attitude towards health behavior, social support and the program was found, although there was a two- way interaction between positive attitude towards health behavior and the program (p=0.001) and effect size=0.272.

Effects of the comprehensive cardiac rehabilitation program on psychological factors and quality of life among coronary heart disease patients.

The Comprehensive Lifestyle Intervention, which integrates psychological and educational intervention, is a program to improve self-efficacy, self-regulation, self-care, body mass index and quality of life of the patients with coronary heart disease during early stages following hospitalization. The purpose of this study was to investigate the effects of the Comprehensive Cardiac Rehabilitation Program affecting psychological factors including self-efficacy, self-regulation, self-care, quality of life (QoL), and body mass index (BMI). This study was a quasi-experimental research with a repeated one group design. Eighty patients with coronary artery disease were recruited from either the Medicine or Surgical Ward at the Phramongkutklao Hospital where the patients joined the Comprehensive Cardiac Rehabilitation Program, which included attending exercising practice and receiving face-to-face counseling while being admitted to the hospital. Telephone counseling was thereafter performed one week after being discharged from the hospital, followed by undergoing individual or group counseling at the Cardiac Rehabilitation Clinic the following week. The follow-up period was performed within six weeks after hospitalization. Data was collected on two occasions before discharging from the hospital (pretest) and six weeks after (post-test) by using the self-efficacy, self-regulation, and self-care questionnaires, as well as the Short Form(SF) -36 (Thai version). The results indicated that by six weeks, 50%, 58.80%, 46.20%, and 72.50% of patients, respectively, had experienced increases with self-efficacy, self-regulation, self-care, and quality of life scores, while 12.50% of patients had decreased their body mass index in comparison with the pretest score. From the paired t-test, the self-efficacy, self-regulation and quality of life scores were statistically significant, having increased to the p<0.01 level; self-care was statistically significant, having increased to the p<0.05 level along with body mass index, which was statistically significant having experienced a decrease to the p<0.01 level.

3-Self behavior modification programs base on the PROMISE Model for clients at metabolic risk.

The objectives of this mixed methods research were 1) to study effects of the health behavior modification program (HBMP) conducted under the principles of the PROMISE Model and the CIPP Model and 2) to compare the 3-self health behaviors and the biomedical indicators before with after the program completion. During the program, three sample groups including 30 program leaders, 30 commanders and 120 clients were assessed, and there were assessments taken on 4,649 volunteers who were at risk of metabolic syndrome before and after the program conducted in 17 hospitals. The collected data were analyzed by the t-test and the path analysis. The research instruments were questionnaires used for program evaluation, structuralized interview forms, and questionnaires used for 3-self health behavior assessment. The findings were as follows: 1) During the program, the assessment result deriving from comparing the overall opinions toward the program among the three sample groups showed no difference (F=2.219), 2) The program management factors based on the PROMISE Model (positive reinforcement, optimism, context, and process or activity provision) had an overall influence on the product or success of the HBMP (p< 0.05) with size effects at 0.37, 0.13, 0.31 and 0.88 respectively. All of the factors could predict the product of the program by 69%. 3) After participating in the program, the clients' 3-self health behaviors (self-efficacy, self-regulation, and self-care) were significantly higher than those appeared before the participation (p< 0.05), and their biomedical indicators (BMI, blood pressure, waistline, blood glucose, lipid profiles, cholesterol, and HbA1c) were significantly lower than those measured before the program (p< 0.05).