Limited Awareness of Long COVID Despite Common Experience of Symptoms Among African American/Black, Hispanic/Latino, and Indigenous Adults in Arizona.

OBJECTIVES: Communities of color might disproportionately experience long-term consequences of COVID-19, known as Long COVID. We sought to understand the awareness of and experiences with Long COVID among African American/Black (AA/B), Hispanic/Latino (H/L), and Indigenous (Native) adults (18 + years of age) in Arizona who previously tested positive for COVID-19. METHODS: Between December 2022 and April 2023, the Arizona Community Engagement Alliance (AZCEAL) conducted 12 focus groups and surveys with 65 AA/B, H/L and Native community members. Data from focus groups were analyzed using thematic analysis to identify emerging issues. Survey data provided demographic information about participants and quantitative assessments of Long COVID experiences were used to augment focus group data. RESULTS: Study participants across all three racial/ethnic groups had limited to no awareness of the term Long COVID, yet many described experiencing or witnessing friends and family endure physical symptoms consistent with Long COVID (e.g., brain fog, loss of memory, fatigue) as well as associated mental health issues (e.g., anxiety, worry, post-traumatic stress disorder). Participants identified a need for Long COVID mental health and other health resources, as well as increased access to Long COVID information. CONCLUSION: To prevent Long COVID health inequities among AA/B, H/L, and Native adults living in AZ, health-related organizations and providers should increase access to culturally relevant, community-based Long COVID-specific information, mental health services, and other health resources aimed at serving these populations.

A pre-post evaluation of a digital intervention to improve psychosocial outcomes of caregivers of people living with cancer in Vietnam.

OBJECTIVES: To evaluate a co-designed intervention using digital resources "Vietnam Cancer Caring Coping" (V-CCC) on the health literacy, depression, and quality of life of caregivers supporting a cancer patient in oncology hospitals in Vietnam. METHODS: A pre-post quantitative evaluation with adult cancer caregivers across regional Oncology hospitals in Vietnam (Ho Chi Minh City, Da Nang, Can Tho, and Hue). Participants completed baseline and follow-up measures of health literacy (HLS-SF12) depression (PHQ-9) and Health-related Quality of Life (5Q-5D-5L). Participants accessed and reviewed V-CCC for a 2-week period. RESULTS: Two hundred and thirty-four caregivers completed pre and post-tests. Most participants were female (n = 143, 61%), married (n = 165, 70%), aged 18-44 (n = 155, 66%), lived rurally (n = 157, 67%). All health literacy scores of participants in post-intervention were significantly higher than that in pre-intervention across all domain's healthcare, disease prevention, and health promotion as well as the total score (p < 0.001). A significant reduction in the proportion of caregivers reporting PHQ-9 moderately severe/severe depression post-intervention was demonstrated (10.2 vs. 6.1%, respectively (p ≤ 0.001). No significant differences were observed pre and post-intervention across four 5Q-5D-5L health dimensions: mobility, self-care, usual activities, and pain/discomfort. Regarding anxiety/depression as measured by 5Q-5D-5L the proportion of participants who reported having moderate, severe, and extreme problems in pre- and post-intervention was statistically significant (32 vs. 24%), respectively (p = 0.0028). CONCLUSION: Co-designed digital resources can reduce health literacy inequities and improve psychological outcomes for cancer caregivers.

Quality and Readability of Noise-Induced Hearing Loss Prevention-Related Websites.

OBJECTIVE: This cross-sectional website analysis aimed to determine the readability and quality of English and Spanish websites pertaining to the prevention of noise-induced hearing loss. STUDY DESIGN: Cross-sectional website analysis. SETTING: Various online search engines. METHODS: We queried four popular search engines using the term "noise-induced hearing loss prevention" to reveal the top 50 English and top 50 Spanish websites for data collection. Websites meeting inclusion criteria were stratified based on the presence of a Health on the Net Code certificate (independent assessment of honesty, reliability, and quality). Websites were then independently reviewed by experts using the DISCERN criteria in order to assess information quality. Readability was calculated using the Flesch reading ease score for English and the Fernandez-Huerta formula for Spanish websites. RESULTS: Thirty-six English websites and 32 Spanish websites met the inclusion criteria. English websites had significantly lower readability (average = 56.34, SD = 11.17) compared to Spanish websites (average = 61.88, SD = 5.33) (P < .05). Spanish websites (average = 37, SD = 8.47) were also of significantly higher quality than English websites (average = 25.13, SD = 10.11). CONCLUSION: This study emphasizes the importance of providing quality and readable materials to patients seeking information about noise-induced hearing loss prevention. All of the English and Spanish websites reviewed were written at a level higher than the American Medical Association-recommended sixth-grade reading level. The study also highlights the need for evidence-based information online provided by experts in our field.

The influence of parental oral health literacy on children's oral health: a scoping review.

The aim of this review was to evaluate the association between parental oral health literacy and children's oral health outcomes. A comprehensive search was conducted across four electronic databases to identify articles that were published up to October 2023. The articles that met our predetermined criteria were then screened and assessed for eligibility. Updated Arksey and O'Malley's scoping review framework was followed. After identifying 2964 references, duplicates were removed, leaving 1992 titles. Following the screening of article titles and abstracts, 19 full-text articles underwent a thorough examination. The scoping review included 19 relevant studies. In most of the studies included, the status of oral health of children is linked to the caregiver's oral health literacy. Children of caregivers with low oral health literacy were found to exhibit deleterious oral health habits, including inadequate teeth brushing and the use of bottles at night-time. Dental caries was found to be more common in children whose parents had low oral health literacy. Striving for optimal oral health literacy in the community is a valuable and worthwhile effort. Equipping parents with the skills and knowledge to make appropriate decisions about their children's oral health could positively prevent dental caries and promote better oral health outcomes.

Effects of world stroke campaign on stroke literacy and knowledge in Taiwan.

OBJECTIVES: Stroke is a leading cause of death in Taiwan. Poor public knowledge of stroke may lead to delays in prehospital arrival, resulting in unfavorable prognoses. Studies have investigated public knowledge of stroke and highlighted the importance of stroke education, however, few such studies have been conducted in Taiwan. This study assessed the changes in public knowledge of stroke between 2012 and 2020 by conducting a survey during two World Stroke Day events. Furthermore, this study identified areas where educational efforts may have been insufficient. MATERIALS & METHODS: Questionnaires were distributed to the participants of 2012 and 2020 World Stroke Day events in Taiwan. In total, 328 and 336 questionnaires were completed, respectively. Stroke literacy and knowledge were analyzed between 2012 and 2020. Data were analyzed using the chi-square test or independent t-test. p < 0.05 indicates statistical significance. RESULTS: Hypertension was the most recognized risk factor for stroke in both years (p < 0.001), and recognition of most of the given risk factors significantly increased. In addition, recognition of more than half of the stroke warning signs significantly increased, awareness of the correct acute stroke response also increased (p < 0.001), and overall stroke literacy in Taiwan increased (p = 0.001). CONCLUSION: Stroke literacy and knowledge in Taiwan have improved significantly between 2012 and 2020, but many people still lack adequate stroke knowledge and awareness. Government health department must take this sort of intervention continually (campaigns) and novel approaches (e.g. board game…) to improve stroke literacy and knowledge in public health. REGISTRATION ID: N202109072, approved by the Joint Institutional Review Board of Taipei Medical University on 2021/11/02.

Science behind children's handwashing: action study of 9- to 10-years-old elementary school students in Japan.

Background: Hand washing instructions for children have been implemented in school education to establish good lifestyle habits. However, repeated hand washing through education from early childhood was common for both teachers and children. If this continues, children might assume they already know how to wash their hands, stop taking handwashing instructions seriously, and become increasingly lax about washing their hands. Purpose: This study aimed to develop a new handwashing education method for children. Methods: We applied the adenosine triphosphate (ATP) test to health education on hand washing in elementary schools. This study was conducted as part of a class for elementary school students in October 2023, in Hokkaido, Japan. The subjects were 157 third-grade (9-10 years old) elementary school students. After excluding absent pupils, 147 were included in the analysis. Results: Both pre- and post-education, ATP values after handwashing were lower than those before handwashing. Following the education, children's handwashing behavior improved, with an increase in the number of point washed and appropriate timing of handwashing. Conclusion: The new handwashing education program utilizing the ATP-test succeeded in promoting handwashing behavior among many children. Visualizing handwashing using ATP values was effective in motivating children.

Interpretation of immediately released health information: Informing patient medical education in breast oncology.

BACKGROUND: The Cures Act mandated immediately released health information. In this study, we investigated patient comprehension of mammography reports and the utility of online resources to aid report interpretation. METHODS: Patients who received a normal mammogram from February to April 2022 were invited to complete semi-structured interviews paired with health literacy questionnaires to assess patient's report comprehension before and after internet search. RESULTS: Thirteen selected patients via purposeful sampling completed interviews. Most patients described their initial understanding of the mammography report as "good" and improved to between "good" and "very good" after an internet search. Patients suggested "a little column on the side" for medical terminology, "an extra prompt" for making an appointment, or a recommendation for "good sites" to improve mammography reports. CONCLUSION: Patients varied in their ability to independently interpret medical reports and seek additional resources. While online resources marginally improved patient understanding, actionable and clear resources are needed.

The digital readiness of future physicians: nurturing the post-pandemic medical education.

BACKGROUND: The COVID-19 pandemic has accelerated the integration of digital technologies in the healthcare sector. Telemedicine has notably emerged as a significant tool, offering a range of benefits. However, various barriers, such as healthcare professionals' insufficient technological skills and competencies, can hinder its effective implementation. Scholars have examined the readiness of future physicians, with some studies exploring their readiness before or during the COVID-19 crisis. There is, however, a noteable gap in the literature concerning the post-pandemic period. This study aims to identify gaps in current medical education programs by examining two primary aspects: (1) technical readiness (encompassing general and health-related digital competencies) and (2) behavioural readiness, which includes prior experiences and future intentions related to telemedicine education and implementation among medical students and residents. METHODS: A cross-sectional study was conducted using a web-based questionnaire administered to medical students and residents at a major Northern Italian university. The survey responses were analyzed to ascertain whether their distributions varied across demographic variables such as gender and level of education. RESULTS: The most commonly owned technologies were laptops and smartphones, with smartphones perceived as the easiest to use, while desktop computers presented more challenges. Approximately 38% of respondents expressed apprehension about applying digital health information in decision-making processes. There was a significant lack of both personal and academic experience, with only 16% of students and residents having used telemedicine in a university setting. Despite this, 83% of participants expressed a desire for training in telemedicine, and 81% were open to experimenting with it during their academic journey. Moreover, 76% of respondents expressed interest in incorporating telemedicine into their future clinical practice. CONCLUSIONS: This study highlights the need for medical students and residents to receive specific education in digital health and telemedicine. Introducing curricula and courses in this domain is critical to addressing the challenges of digital healthcare.

Nurses' Experiences in Communicating With Immigrant Populations During COVID-19: Insights and Suggestions for Future Health Crises.

INTRODUCTION: When providing health information in a diverse society and during health crises, it is crucial that nurses can adapt their communication to immigrants, as this may have an impact on their health outcomes. This study seeks to identify how nurses experienced and assessed their communication and information work with immigrants during COVID-19 and to discuss measures to improve practice. METHOD: The study has an interpretive and explorative qualitative design, analyzing 10 semi-structured interviews with nurses from the municipal health service in Norway. RESULTS: Three themes were created as follows: multilingual infection control teams and cooperation with volunteers, challenges when providing COVID-19 information, and the nurses' suggestions for improvements in the event of a new pandemic or other health crisis. DISCUSSION: Nurses' cultural competence and their knowledge of immigrants' health literacy can help them understand how immigrants think and behave during illness. It is important that nurses use discretion during health crises.

Health and oral health literacy: A comprehensive literature review from theory to practice.

BACKGROUND: Health literacy (HL) refers to an individual's ability to access, understand, and apply health information to make informed decisions about their health. On the contrary, oral health literacy (OHL) focuses on an individual's ability to understand and utilize oral health information to maintain good oral health. AIM: This study presents a comprehensive literature review that explores the theoretical foundations and practical applications of HL and OHL. DESIGN: A comprehensive search was conducted using keywords on the following databases: PubMed, Google Scholar, and Cochrane Database of Systematic Reviews. RESULTS: The existing literature on various aspects of HL, including the most common used definitions of HL, conceptual frameworks, and consequences of limited health and OHL, was summarized. Additionally, the review discussed the significance of HL and OHL. Also, the relation between parent level of OHL and children's oral health was described. It further highlights modern approaches that have been shown in previous studies to improve the OHL of primary caregivers. CONCLUSIONS: Understanding the significance of HL and OHL is crucial in developing effective interventions that can address disparities and improve oral health outcomes for individuals of all backgrounds.

Comparing English- and Spanish-Reading Patients' Comprehension of the Drug Facts Label for a New Over-The-Counter Oral Contraceptive.

BACKGROUND: Health literacy is known to impact health outcomes in a multitude of ways and is impacted by language barriers. Lower health literacy is also associated with higher rates of unintended pregnancies. A progestin-only oral hormonal contraception product, norgestrel (Opill-Perrigo), was approved for over-the-counter (OTC) use in the United States in July 2023. OBJECTIVE: (s): The objective was to utilize a knowledge assessment survey to determine participants' comprehension of norgestrel from its drug facts label and compare the comprehension between primarily English- and Spanish-reading participants. METHODS: A 7-item knowledge assessment was developed and distributed to English and Spanish readers at one site within a network of federally qualified health centers. English-reading participants completed the English survey alongside use of an English copy of norgestrel's drug facts label. Spanish-reading participants completed the Spanish survey and were randomized in a 1:1 fashion to either receive an English or Spanish copy of norgestrel's drug facts label. RESULTS: The English-reading/English label (E/E) group had a higher level of comprehension of norgestrel's drug facts label compared to the Spanish-reading/English label (S/E) or Spanish-reading/Spanish label (S/S) groups. CONCLUSION: Differences exist in OTC label comprehension for norgestrel based on primary language able to be read. Advocacy for OTC labels to be readily available in languages other than English is imperative to mitigate unintended pregnancies associated with lower levels of health literacy.

Impact of research paradigms on low-income female caregivers and their children: an oral health literacy discourse.

Objective: Despite the vast knowledge gained through research and public health surveillance, dental caries prevalence among children from low-income households remains high. The aim of this literature review is to identify assumptions made within existing empirical, constructivist, and critical paradigms to determine how those assumptions impact knowledge and if these impacts have aided in perpetuating inequity or health disparities within this target population. Method: A literature search of EBSCOhost, PubMed, and Web of Science was conducted to retrieve articles from peer-reviewed journals published in the last 10 years, including qualitative, quantitative, and mixed methods studies. Qualitative methods included narrative research via interviews; quantitative designs included cross-sectional studies using surveys and various indices to assess oral health literacy (OHL) levels and oral health status. Exclusion criteria were non-English studies and studies that did not include female caregivers. Results: Nine primary research articles were selected for analysis. The positivist paradigm was dominant in 7 of 9 articles. Oral health social processes, such as the lack of value placed on oral health as a component of overall health by the broader medical community and the public, were not discussed as influencing factors on OHL. Discussion: Assumptions identified within the dominant paradigms were determined to perpetuate inequity or health disparities, confirming a link between caregivers' OHL levels and the oral health status of their children. It is critical that all health care professionals improve their understanding of factors affecting caregivers' OHL. Conclusion: Strategies that empower and advocate for women to improve their OHL should be developed.

Objectif: Malgré les vastes connaissances acquises par le biais de la recherche et des activités de surveillance de la santé publique, la prévalence des caries dentaires chez les enfants vivant dans des ménages à faible revenu demeure élevée. La présente revue de la littérature vise à cerner les suppositions des paradigmes empiriques, constructivistes et critiques existants afin de déterminer comment elles influent sur les connaissances, et si ces effets ont contribué à perpétuer les iniquités ou les disparités en matière de santé au sein de cette population cible. Méthodes: On a procédé à une recherche documentaire sur EBSCOhost, PubMed et Web of Science pour trouver des articles publiés au cours des 10 dernières années dans des revues à comité de lecture, y compris des études par cohortes qualitatives, quantitatives et mixtes. Les méthodes qualitatives comprenaient des recherches narratives réalisées au moyen d'entrevues. Les méthodes quantitatives comprenaient des études transversales faisant appel à des sondages, ainsi que divers indices visant à évaluer les niveaux de littératie en santé buccodentaire et la situation en matière de santé buccodentaire. Les critères d'exclusion s'appliquaient aux études non anglophones et aux études qui n'incluaient pas de femmes soignantes. Résultats: Neuf articles présentant des études originales ont été sélectionnés aux fins d'analyse. Le paradigme positiviste était dominant dans 7 des 9 articles. L'influence de certains processus sociaux de santé buccodentaire, tel que le manque de valeur accordée à la santé buccodentaire en tant qu'élément de la santé globale par la communauté médicale en général et par le public, sur la littératie en santé buccodentaire n'a pas été discutée. Discussion: On a établi que les suppositions définies dans les paradigmes dominants perpétuaient l'iniquité ou des disparités en matière de santé, ce qui confirme l'existence d'un lien entre le niveau de littératie en santé buccodentaire parmi les soignants et l'état de santé buccodentaire de leurs enfants. Il est essentiel que tous les professionnels de la santé renforcent leur compréhension des facteurs qui influent sur cette littératie chez les soignants. Conclusion: Il est nécessaire d'élaborer des stratégies propres à défendre les femmes et à leur donner les moyens d'améliorer leur littératie en santé buccodentaire.

Development and Outcomes of Returning Polycyclic Aromatic Hydrocarbon Exposure Results in the Washington Heights, NYC Community.

Report-back of research results (RBRR) is becoming standard practice for environmental health research studies. RBRR is thought to increase environmental health literacy (EHL), although standardized measurements are limited. For this study, we developed a report back document on exposure to air pollutants, Polycyclic Aromatic Hydrocarbons, during pregnancy through community engaged research and evaluated whether the report increased EHL. We used focus groups and surveys to gather feedback on the report document from an initial group of study participants (Group 1, n = 22) and then sent the revised report to a larger number of participants (Group 2, n = 168). We conducted focus groups among participants in Group 1 and discussed their suggested changes to the report and how those changes could be implemented. Participants in focus groups demonstrated multiple levels of EHL. While participant engagement critically informed report development, a survey comparing feedback from Group 1 (initial report) and Group 2 (revised report) did not show a significant difference in the ease of reading the report or knowledge gained about air pollutants. We acknowledge that our approach was limited by a lack of EHL tools that assess knowledge and behavior change, and a reliance on quantitative methodologies. Future approaches that merge qualitative and quantitative methodologies to evaluate RBRR and methodologies for assessing RBRR materials and subsequent changes in knowledge, attitudes, and behavior, may be necessary.

Nurses' health education competence and health literacy: A cross-sectional survey in Chinese county hospitals.

AIM: This study aims to assess the health education competence of nurses in China's county hospitals, examining its relationship with health literacy and other influencing factors, such as receipt of health education training, and acquisition of health knowledge. BACKGROUND: Nurses are pivotal in delivering health education, which is crucial for improving health outcomes. In rural China, the prevalent low health literacy, stemming from limited access to health guidance, necessitates an evaluation of nurses' health education competence in county hospitals. Understanding these competencies and their influencing factors is essential to enhance the health literacy of the Chinese population. DESIGN: A cross-sectional study. METHODS: The study surveyed 692 nurses from nine county hospitals in Shanxi Province, China, using convenience sampling. The analysis employed descriptive statistics, t-tests, ANOVA, Pearson's correlation, and hierarchical multiple linear regression. RESULTS: The study revealed a low level of health education competence among the surveyed nurses, with total health education scores averaging 3.77±0.60, and mean scores for knowledge, skills, and attitudes being 3.73±0.67, 3.77±0.64, and 3.89±0.64, respectively. The multiple regression models were significant (P<0.001), with R2 values ranging from 0.143 to 0.197. Key predictors included the incentive mechanism for health education, receipt of health education training, acquisition of health knowledge, and literacies in infectious disease prevention, scientific health concepts, and chronic disease prevention. CONCLUSIONS: This study assessed the health education competence of nurses in county hospitals in China and investigated the impact of various dimensions of health literacy on this competence. The findings indicate that the health education competence of nurses in these settings remains relatively low. Additionally, health education training and incentive mechanisms were found to significantly enhance nurses' health education competence in areas lacking medical resources.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Physicians are Unable to Consistently Predict Patient Health Literacy in a Breast Clinic.

INTRODUCTION: Health literacy (HL) is a patient's capacity to understand health information. Low HL is associated with worse cancer outcomes and adherence to treatment regimens. This study aimed to test physicians' ability to predict their patients' HL after an initial consultation to determine if routine HL screening is valuable. METHODS: From February 2023 through June 2023, patients seen at an academic breast clinic completed a validated, self-reported HL assessment. Surgical and medical oncologists estimated their patients' HL by answering the same HL questionnaire based on their perception of the patient visit. Patient and physician scores were compared using an intraclass correlation coefficient. Linear regression was used to evaluate associations between physicians' ability to predict HL and other variables. RESULTS: The cohort included 210 patient HL scores with corresponding physician scores for each. Most patients (75.7%) had adequate HL. There was moderate agreement between the patient and physician HL scores (intraclass correlation coefficient = 0.677, P < 0.01), meaning physicians could somewhat predict their patient's HL. Physicians were worse at predicting HL when patients had low HL. There was no difference in physicians' ability to predict HL based on patient age (P = 0.09) or race (P = 0.29). Additionally, we found no difference in the ability to predict HL based on the physician's specialty (P = 0.25). CONCLUSIONS: After an initial consultation, physicians cannot accurately predict patient HL, particularly in patients with lower HL. Given the impact of low HL on a patient's ability to make treatment decisions and adhere to treatment plans, using a validated tool to measure HL is necessary.

The relationship between health literacy and problematic internet use in Chinese college students: The mediating effect of subject well-being and moderating effect of social support.

BACKGROUND: The issue of problematic Internet use (PIU) amongst college students is emerging as a major concern for mental health. Factors such as health literacy, subjective well-being and the extent of social support may be critical in preventing PIU. However, the complex relationship between these factors has not been extensively explored in research. METHODS: A national cross-sectional study based on multistage random sampling was conducted in China in 2022. The subjects for this study were 7669 college students who completed a set of questionnaires assessing their health literacy, subjective well-being, PIU and social support. A structural equation model (SEM) was utilised for exploring the mediating effect of subjective well-being, and the PROCESS macro was used to test the moderating effect of social support. RESULTS: After controlling for demographic factors, a significantly negative correlation was found between health literacy and PIU, and subjective well-being partially mediated this relationship. In addition, social support was negatively related to PIU and could moderate the relationship between health literacy and subjective well-being and between subjective well-being and PIU. LIMITATIONS: This is a cross-sectional study, and the results cannot inform the causality between these variables. CONCLUSION: Results revealed that the relationship between health literacy and PIU was partially mediated by subjective well-being in college students. The correlation between health literacy and subjective well-being and between subjective well-being and PIU were moderated by social support. Thus, future interventions for college students' PIU should be facilitated by improving health literacy, subjective well-being and social support.

E-health literacy in stroke patients: Latent profile analysis and influencing factors.

AIMS: This study sought to explore latent categories of electronic health (e-health) literacy among stroke patients and analyse its influencing factors. DESIGN: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS: Between July and October 2020, 558 stroke participants from three tertiary care hospitals in Henan Province, China, were recruited using a convenience sampling method. A general information questionnaire and the Electronic Health Literacy Scale were used to collect their socio-demographic information and e-health literacy. Latent profile analysis was used to analyse latent categories of e-health literacy in stroke patients. Multiple logistic regression was used to analyse factors influencing latent categories of e-health literacy in stroke patients. RESULTS: Three latent categories of e-health literacy existed, including the low e-health literacy group, the low application-high decision-making group and the high literacy-low decision-making group. Multiple logistic regression showed that education level, presence of comorbidities, willingness to interact with people with mental illness, health information sources, frequency of Internet access, frequency of health information inquiry and willingness to receive remote care were predictors of the participants' latent categories of e-health literacy. CONCLUSION: Three latent categories of e-health literacy in stroke patients exist, and each latent category's characteristics should be considered while developing health education programmes. It is imperative that healthcare providers understand the requirement of creating tailored and efficient health education programmes for various categories of stroke patients to enhance their e-health literacy. IMPACT: It is imperative to improve Chinese stroke patients' overall e-health literacy. We categorized stroke patients' e-health literacy using advanced LPA. These findings hold implications for healthcare approaches, contributing to the enhancement of stroke patients' e-health literacy, enabling them to apply the acquired e-health information to manage and solve their own health issues. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Translation and cross-cultural adaptation of the Chinese version of the HLS-EU-Q47.

The development of health literacy in China is relatively slow, and there are fewer health literacy scales, which is difficult to measure. Therefore, this study aims to promote the development of health literacy in China through the translation and application of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). The scale was translated into Chinese, back-translated, culturally adapted and finally subjected to psychometric evaluation. A multi-stage stratified sampling method was used to select 2504 residents to test the reliability and validity of a questionnaire on health literacy. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the validity of the results, and the back consistency was calculated by Cronbach's alpha coefficient. The EFA revealed that health care, disease prevention and health promotion explained 78.68% of the total variance in health literacy. The scale and its subscales demonstrated strong internal consistency, with high Cronbach's alpha coefficients ranging from 0.947 to 0.983. CFA confirmed the three-factor model's goodness-of-fit for the Chinese population. The dimensions of healthcare, disease prevention and health promotion showed high convergent validity with an average variance extracted values ranging from 0.52 to 0.60 and composite reliability values ranging from 0.94 to 0.96. The reliable and valid Chinese version of the HLS-EU-Q47 (HLS19-Q47-CN) developed and evaluated in this study is an important tool for assessing health literacy levels in the Chinese population. Furthermore, as this tool has global applicability, it has the potential to assess health literacy levels across different countries, enabling practical international comparisons.