Characterizing Health Literacy Among Spanish Language-Preferring Latinos Ages 50-75.

BACKGROUND: Cultural background, language, and literacy are factors that may affect access, healthcare utilization, and cancer screening behaviors. OBJECTIVE: This study aimed to characterize health literacy among Spanish-preferring Hispanic/Latino individuals ages 50-75 and examine associations between sociodemographic characteristics, health beliefs, and health literacy. METHODS: Participants self-identified as Hispanic/Latino, preferring health information in Spanish, were ages 50-75 years old, at average risk for colorectal cancer (CRC), not up to date with CRC screening, and enrolled in a CRC screening education intervention trial. Sociodemographic characteristics, health beliefs, and health literacy (i.e., difficulty understanding written health information and confidence completing health forms) were assessed at baseline. Descriptive and logistic regression analyses were performed. RESULTS: Fifty-three percent of participants reported either sometimes having difficulty or always having difficulty with written health information, and 25% reported always asking for help or being not so confident in completing health forms. Univariate predictors of adequate health literacy for written health information were lower cancer worry and lower religious beliefs. Higher educational attainment predicted confidence in completing health forms. CONCLUSIONS: Findings highlight the need for interventions that address health beliefs and health literacy among Hispanic/Latino patients who have low confidence in completing written forms and difficulty understanding written information and reinforce the use of plain language and salient design features when developing patient education materials.

Addressing Health Literacy Needs in Rheumatology: Which Patient Health Literacy Profiles Need the Attention of Health Professionals?

OBJECTIVE: To identify and describe health literacy profiles of patients with rheumatic diseases and explore whether the identified health literacy profiles can be generalized to a broader rheumatology context. METHODS: Patients with rheumatoid arthritis, spondyloarthritis, and gout from 3 hospitals in different regions in The Netherlands completed the Health Literacy Questionnaire (HLQ). Hierarchical cluster analysis was used to identify patients' health literacy profiles based on 9 HLQ domains. A multinomial regression model with the identified health literacy profiles as the dependent variable was fitted to assess whether patients with a given disease type or attending a given hospital were more likely to belong to a specific profile. RESULTS: Among 895 participating patients, the lowest mean HLQ domain scores (indicating most difficulty) were found for "critical appraisal," "navigating the health system," and "finding good health information." The 10 identified profiles revealed substantial diversity in combinations of strengths and weaknesses. While 42% of patients scored moderate to high on all 9 domains (profiles 1 and 3), another 42% of patients (profiles 2, 4, 5, and 6) clearly struggled with 1 or several aspects of health literacy. Notably, 16% (profiles 7-10) exhibited difficulty across a majority of health literacy domains. The probability of belonging to one of the profiles was independent of the hospital where the patient was treated or the type of rheumatic disease. CONCLUSION: Ten distinct health literacy profiles were identified among patients with rheumatic diseases, independent of disease type and treating hospital. These profiles can be used to facilitate the development of health literacy interventions in rheumatology.

Health literacy profiles of adults with multiple chronic diseases: A cross-sectional study using the Health Literacy Questionnaire.

Health literacy is multidimensional, comprising functional, communicative, and critical thinking dimensions. Understanding health literacy is crucial for clinicians to develop effective health education strategies. In this study, we examined the multiple dimensions of health literacy in Vietnamese adults with chronic comorbidities. A cross-sectional sample of 600 patients, aged ≥18 years with a diagnosis of at least two chronic diseases (cardiovascular conditions, chronic kidney disease, or diabetes), completed the Health Literacy Questionnaire, an instrument assessing nine distinct domains. Descriptive and parametric tests were performed to analyze the health literacy levels for various demographic characteristics. Generalized linear models using backward modelling explored factors associated with higher health literacy. The lowest scoring domains were "Healthcare provider support" and "Appraisal of health information." In multivariate models greater health literacy was associated with those <65 years, having a postsecondary degree or higher level of education, greater income, urban residence, being cared for by spouses/children, and having fewer comorbidities. To improve health literacy, clinicians in primary and acute healthcare settings should build supportive relationships with patients and assist them with understanding and appraising health information.

Validation of the Short Assessment of Health Literacy in Portuguese-speaking adults in Portugal / Validación del Short Assessment of Health Literacy in Portuguese-speaking adults en Portugal

OBJECTIVE: To validate the Brazilian version of the Short Assessment of Health Literacy in Portuguese-speaking Adults (SAHLPA), a 50-item test proposed as a particularly helpful instrument to assess health literacy in people with limited skills, in the Portuguese population. METHODS: We used the standard procedure for cultural adaptation and administered the instrument to 249 participants. We examined construct validity using groups with expectedly increasing levels of health literacy (laypersons from the general population, engineering researchers, health researchers, and physicians), and through association with age and educational attainment, dichotomizing scores at the median of the layperson's group. RESULTS: Exploratory factor analysis revealed the instrument was one-dimensional and justified reduction to 33 items. SAHLPA-33 displayed adequate reliability (Cronbach's α = 0.73). The frequency of limited health literacy was highest among laypersons and lowest among physicians (p <0.001; p for trend <0.001). The proportion of participants with limited health literacy decreased with increasing education attainment (age- and sex-adjusted p for trend <0.001). Limited health literacy also tended to decrease with age, although the association was non-significant (sex- and education-adjusted p for trend = 0.067). CONCLUSION: We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and fairly reliable. In Portuguese low-literate adults, SAHLPA-33 fills the gap in health literacy assessment instruments, and may be used to guide communication strategies with vulnerable patients and communities

OBJETIVO: Validar la versión brasileña del Short Assessment of Health Literacy inPortuguese-speakingAdults (SAHLPA), una prueba de 50 ítems que ha sido propuesta como una herramienta particularmente útil para evaluar la alfabetización en salud en personas con bajas competencias, en la población portuguesa. MÉTODOS: Se usó el procedimiento habitual para la adaptación cultural. El instrumento fue administrado a 249 participantes. Se evaluó la validez de constructo utilizando grupos con niveles esperados crecientes de alfabetización en salud (personas no cualificadas de la población general, investigadores en el área de la ingeniería, investigadores en salud y médicos) y a través de la asociación con la edad y la escolaridad, dicotomizando las puntuaciones por la mediana de las del grupo de la población general. RESULTADOS: El análisis factorial exploratorio reveló que el instrumento era unidimensional y así ha sido reducido a 33 ítems. El SAHLPA-33 reveló una consistencia interna aceptable (α de Cronbach = 0,73). La frecuencia de alfabetización en salud limitada fue más elevada en la población general y menor en los médicos (p <0,001; p para la tendencia <0,001). La proporción de participantes con alfabetización en salud limitada disminuyó con el aumento de la escolaridad (p para la tendencia ajustada por edad y sexo <0,001). La alfabetización en salud también tendió a disminuir con la edad, aunque la asociación no era significativa (p para la tendencia ajustada por sexo y escolaridad = 0,067). CONCLUSIÓN: Se adaptó un instrumento simple y rápido para evaluar la alfabetización en salud individual y se mostró que era válido y razonablemente fiable. En los adultos portugueses con bajo nivel de alfabetización, SAHLPA-33 llena el vacío en instrumentos de evaluación de alfabetización en salud. Puede utilizarse para guiar estrategias de comunicación con personas y comunidades vulnerables

Concientización facilitadora: alternativa al concepto tradicional de la motivación en el campo de la salud / Facilitating conscientization: alternative to the traditional concept of motivation in the field of health

Durante las últimas décadas, el mundo se ha expuesto a una serie de amenazas por brotes virales emergentes de diferente índole. Ante la nueva pandemia del COVID-19 las actitudes, las creencias, las expectativas, o la representación que se haga del problema de salud/enfermedad, cumplen un papel determinante. Alfabetizar en salud es concientizar, aprender a reflexionar, mostrar a los pacientes la vivencia problemática, conseguir inculcar una conciencia crítica para hacerles capaz de percibir lo malo, y de descubrir los medios a emplear para su mejora. Aplicando el proceso de concientización de Paulo Freire, es posible el paso de una conciencia pasiva a una conciencia crítica activa (concientización), mediante un método activo de alfabetización y concientización en salud, de diálogo y de crítica, con propuestas y contenidos apropiados para cada caso

Over the past few decades, the world has been exposed to a number of threats from emerging viral outbreaks of different kinds. In the face of the new COVID-19 pandemic, attitudes, beliefs, expectations, or representations of the disease/health problem, play a determining role. Alphabetize in health is to raise consciousness, to learn to think, to show patients their problematic experience, to inculcate a critical conscience to make them capable of perceiving what is bad, and to discover the means to be used for its improvement. Applying Paulo Freire's process of conscientization, it is possible to pass from a passive conscience to an active critical conscience (conscientization), through an active method of alphabetization and conscientization in health, dialogue and critique, with appropriate proposals and contents for each case

Health Literacy in Individuals at Risk for Alzheimer's Dementia: A Systematic Review.

BACKGROUND: Health literacy (HL) refers to the capacity to access, understand, appraise and apply information for decision-making and acting in health-related matters. In the field of Alzheimer's disease (AD), expanding technologies of early disease detection, disease course prediction and eventually personalized prevention confront individuals at-risk with increasingly complex information, which demand substantial HL skills. Here we report current findings of HL research in at-risk groups. METHODS: Search strings, referring to HL, AD, amyloid and risk, were developed. A systematic review was conducted in PUBMED, Cochrane Library, PsycINFO, and Web of Science to summarize the state of evidence on HL in at-risk individuals for Alzheimer's dementia. Eligible articles needed to employ a validated tool for HL, mention the concept or one dimension (access, understand, appraise and apply information for decision-making and acting). RESULTS: 26 quantitative and 9 qualitative studies addressing at least one dimension of HL were included. Overall, there is evidence for a wish to gain knowledge about the own brain status and risk of dementia. Psychological distress may occur and the subjective benefit-risk estimation may be modified after risk disclosure. Effects on lifestyle and planning may occur. Overall understanding and appraisal of information related to AD risk seem variable with several impacting factors. In mild cognitive impairment (MCI) basic HL skill seem to be affected by cognitive dysfunction. CONCLUSIONS: Systematic assessment of HL in at-risk population for AD is sparse. Findings indicate the paramount importance of adequate communication with persons at risk, being sensitive to individual needs and preferences. Substantial research needs were identified.

Examining Generalizability of Older Adults' Preferences for Discussing Cessation of Screening Colonoscopies in Older Adults with Low Health Literacy.

BACKGROUND/OBJECTIVES: Many older adults receive unnecessary screening colonoscopies. We previously conducted a survey using a national online panel to assess older adults' preferences for how clinicians can discuss stopping screening colonoscopies. We sought to assess the generalizability of those results by comparing them to a sample of older adults with low health literacy. DESIGN: Cross-sectional survey. SETTING: Baltimore metropolitan area (low health literacy sample) and a national, probability-based online panel-KnowledgePanel (national sample). PARTICIPANTS: Adults 65+ with low health literacy measured using a single-question screen (low health literacy sample, n = 113) and KnowledgePanel members 65+ who completed survey about colorectal cancer screening (national sample, n = 441). MEASUREMENTS: The same survey was administered to both groups. Using the best-worst scaling method, we assessed relative preferences for 13 different ways to explain stopping screening colonoscopies. We used conditional logistic regression to quantify the relative preference for each explanation, where a higher preference weight indicates stronger preference. We analyzed each sample separately, then compared the two samples using Spearman's correlation coefficient, the likelihood ratio test to assess for overall differences between the two sets of preference weights, and the Wald test to assess differences in preference weights for each individual phrases. RESULTS: The responses from the two samples were highly correlated (Spearman's coefficient 0.92, p < 0.0001). The most preferred phrase to explain stopping screening colonoscopy was "Your other health issues should take priority" in both groups. The three least preferred options were also the same for both groups, with the least preferred being "The doctor does not give an explanation." The explanation that referred to "quality of life" was more preferred by the low health literacy group whereas explanations that mentioned "unlikely to benefit" and "high risk for harms" were more preferred by the national survey group (all p < 0.001). CONCLUSION: Among two different populations of older adults with different health literacy levels, the preferred strategies for clinicians to discuss stopping screening colonoscopies were highly correlated. Our results can inform effective communication about stopping screening colonoscopies in older adults across different health literacy levels.

Using the Short Graph Literacy Scale to Predict Precursors of Health Behavior Change.

BACKGROUND: Visual displays can facilitate risk communication and promote better health choices. Their effectiveness in improving risk comprehension is influenced by graph literacy. However, the construct of graph literacy is still insufficiently understood, partially because existing objective measures of graph literacy are either too difficult or too long. OBJECTIVES: We constructed a new 4-item Short Graph Literacy (SGL) scale and examined how SGL scores relate to key cognitive, affective, and conative precursors of health behavior change described in common health behavior theories. METHODS: We performed secondary analyses to adapt the SGL scale from an existing 13-item scale. The initial construction was based on data collected in a laboratory setting in Germany ( n = 51). The scale was then validated using data from nationally representative samples in Germany ( n = 495) and the United States ( n = 492). To examine how SGL scores relate to precursors of health behavior change, we performed secondary analyses of a third study involving a nationwide US sample with 47% participants belonging to racial/ethnic minorities and 46% with limited formal education ( n = 835). RESULTS: Graph literacy was significantly associated with cognitive precursors in theoretically expected ways (e.g., positive associations with risk comprehension and response efficacy and a negative association with cognitive risk perception). Patterns for affective precursors generally mirrored those for cognitive precursors, although numeracy was a stronger predictor than graph literacy for some affective factors (e.g., feelings of risk). Graph literacy had predictive value for most cognitive and affective precursors beyond numeracy. In addition, graph literacy (but not numeracy) predicted key conative precursors such as defensive processing. CONCLUSIONS: Our data suggest that the SGL scale is a fast and psychometrically valid method for measuring objective graph literacy. Our findings also highlight the theoretical and practical relevance of graph literacy.

Validation of a Scale to Assess Patients' Comprehension of Frequently Used Cardiology Terminology: The Cardiac TERM Scale in Brazilian Portuguese.

PURPOSE: The aim of this study was to psychometrically validate the translation of a questionnaire on patient understanding of cardiology terminology (TERM) to Brazilian Portuguese. DESIGN: After piloting the translation and cross-cultural adaptation, the 16-item TERM questionnaire was psychometrically tested. METHODS: Internal and test-retest reliability, as well as validity, were assessed in 322 cardiac patients. FINDINGS: Internal (α = .88) and test-retest reliability (all weighted Kappa > 0.63) exceeded the minimum recommended standards. Criterion validity was supported by significant differences in mean scores by socioeconomic indicators (p < .01). Discriminant validity was supported in that cardiac rehabilitation participants had significantly higher TERM scores (p < .001). Participants did not correctly define any of the terms, and a floor effect was identified in all terms. CONCLUSIONS: The Cardiac TERM Scale was demonstrated to have good reliability and validity. CLINICAL RELEVANCE: The scale can be used by healthcare professionals, such as nurses. Results can be used to inform patient education, which could in turn impact patient adherence to medical advice and hence outcomes.

A concept analysis of health literacy.

AIM: To propose a conceptual definition of health literacy incorporating system demands, burdens, and complexities that are a critical part of patients' level of health literacy. BACKGROUND: Health literacy is used frequently in health care and often is confused with patients' reading and comprehension levels. DESIGN: Walker and Avant's concept analysis method was used. DATA SOURCE: Cochrane Library, Cumulative Index of Nursing and Health Literature, OVID, PubMed, EBSCO Host databases, and Google Scholar. REVIEW METHOD: The primary Search terms and MeSH terms used were health literacy, patient education, patient engagement, patient activation, health communication, health promotion, and nursing. Empirical and nonempirical articles published in English were reviewed. Ten systematic literature reviews were included. RESULTS: A new definition of health literacy is provided based on four components that include: system demands, burdens, and complexities; measurable components, processes and outcomes; the dynamic nature of health literacy; and demonstration of the direct relationship of informed decisions to informed actions. Defining attributes, antecedents, and consequences are identified. Implications for nursing practice, education, and research are given. CONCLUSIONS: Because health literacy is a dynamic and quickly changing concept, further exploration and evolution of the concept is warranted as empirical research and theoretical literature emerge.

Using natural language processing and machine learning to classify health literacy from secure messages: The ECLIPPSE study.

Limited health literacy is a barrier to optimal healthcare delivery and outcomes. Current measures requiring patients to self-report limitations are time-consuming and may be considered intrusive by some. This makes widespread classification of patient health literacy challenging. The objective of this study was to develop and validate "literacy profiles" as automated indicators of patients' health literacy to facilitate a non-intrusive, economic and more comprehensive characterization of health literacy among a health care delivery system's membership. To this end, three literacy profiles were generated based on natural language processing (combining computational linguistics and machine learning) using a sample of 283,216 secure messages sent from 6,941 patients to their primary care physicians. All patients were participants in Kaiser Permanente Northern California's DISTANCE Study. Performance of the three literacy profiles were compared against a gold standard of patient self-reported health literacy. Associations were analyzed between each literacy profile and patient demographics, health outcomes and healthcare utilization. T-tests were used for numeric data such as A1C, Charlson comorbidity index and healthcare utilization rates, and chi-square tests for categorical data such as sex, race, poor adherence and severe hypoglycemia. Literacy profiles varied in their test characteristics, with C-statistics ranging from 0.61-0.74. Relations between literacy profiles and health outcomes revealed patterns consistent with previous health literacy research: patients identified via literacy profiles indicative of limited health literacy: (a) were older and more likely of minority status; (b) had poorer medication adherence and glycemic control; and (c) exhibited higher rates of hypoglycemia, comorbidities and healthcare utilization. This represents the first successful attempt to employ natural language processing to estimate health literacy. Literacy profiles can offer an automated and economical way to identify patients with limited health literacy and greater vulnerability to poor health outcomes.

[Comprehensibility of online-based patient education material in ophthalmology]. / Die Lesbarkeit von onlinebasierten Patienteninformationen in der Augenheilkunde.

BACKGROUND: Investigations have shown that the internet as a source of information in medical issues is increasing in importance. For most patients information delivered or supported by hospitals and universities is considered to be the most reliable, however, the comprehensibility of available information is often considered to be wanting. Comprehensibility scores are formulae allowing a quantitative value for the readability of a document to be calculated. OBJECTIVE: The purpose of this study was to assess data by analyzing the comprehensibility of medical information published on the websites of departments for ophthalmology of German university hospitals. We investigated and analyzed medical information dealing with three eye diseases with potentially severe irreversible damage. METHODS: The websites of 32 departments for ophthalmology of German university hospitals were investigated. Information regarding cataracts, glaucoma and retinal detachment (amotio retinae) were identified and analyzed. All information was systematically analyzed regarding comprehensibility by using the analysis program Text-Lab ( http://www.text-lab.de ) by calculation of five readability scores: the Hohenheim comprehensibility index (HVI), the Amstad index, the simple measure of gobbledygook (G-SMOG) index, the Vienna non-fictional text formula (W-STX) and the readability index (LIX). RESULTS: In 59 cases (61.46 %) useful text information from the homepage of the institutions could be detected and analyzed. On average the comprehensibility of the information was identified as being poor (HVI 7.91 ± 3.94, Amstad index 35.45 ± 11.85, Vienna formula 11.19 ± 1.93, G­SMOG 9.77 ± 1.42 and the LIX 54.53 ± 6.67). CONCLUSION: In most of the cases patient information material was written far above the literacy level of the average population. It must be assumed that the presented information is difficult to read for the majority of the patients. A critical evaluation of accessible information material seems to be desirable and available texts should be amended.

Association between Municipal Health Promotion Volunteers' Health Literacy and Their Level of Outreach Activities in Japan.

OBJECTIVES: To explore the association between health literacy and levels of three types of core activities among health promotion volunteers (developing a healthy lifestyle, outreach to family, and outreach to community members). STUDY DESIGN: A cross-sectional, anonymous, self-administered postal survey of registered health promotion volunteers in the Konan area in Shiga Prefecture in Japan, conducted in January 2010. The study sample was 575 registered health promotion volunteers. METHODS: The survey collected data on health literacy, gender, age, education, self-rated health, perceptions about the volunteer organization, and perceptions of recognition in the community. The level of engagement in health promotion activities was measured by the extent to which the participants engaged in seven healthy behaviors and promoted them to family members and the community. The authors compared the health literacy level and other characteristics of the participants by core health promotion activities, using a chi-squared test, to examine the associations between demographic and other variables and the three core activities (healthy lifestyle, outreach to family, and outreach to community).Logistic regression analysis was conducted to examine the association between the degree to which the volunteers engaged in core activities ("healthy lifestyle," "outreach to family," "outreach to community") and the levels of health literacy (low, medium, high) among health promotion volunteers, controlling for the effects of age, gender, health condition, education which may also have an impact on volunteers' outreach activities. RESULTS: Four hundred and fifty-four questionnaires were returned, a 79.0% response rate. Excluding 16 cases with missing values on health literacy or the degree of health promotion activities, 438 research subjects were included in the analysis (valid response rate: 76.2%). Health literacy and a few demographic and other characteristics of the volunteers were associated with the three core health promotion activities. In bivariate analyses, active participation in the core activities was more prevalent among older volunteers (p<0.001 for all three activities). Self-rated health condition was associated with both outreach to family (p = 0.018) and community (p = 0.046). Years of experience as volunteer and perception of being recognized in the community also had statistically significant association with outreach to the community (p<0.001). In multiple logistic regression, those with higher level of health literacy were more likely than others to actively engage in outreach to family (OR = 1.70, 95% CI 1.03 to 2.80; OR = 1.76, 95%CI 1.04 to 3.00 for medium and high, respectively) and outreach to community (OR = 2.26, 95%CI 1.34 to 3.83; OR = 2.61 95%CI 1.49 to 4.58 for medium and high, respectively). Perception of being recognized in the community also had a statistically significant and positive impact on outreach to the community (OR = 1.52, 95%CI 1.17 to 1.99). CONCLUSIONS: Volunteers with higher health literacy were more likely to actively engage in outreach to family and outreach to community. Providing educational programs to improve volunteers' health literacy may facilitate their work.

[Storytelling in Health Journalism: Online Survey of Health Journalists on Definition and Use]. / Storytelling im Gesundheitsjournalismus: Onlinebefragung von Fachjournalisten über Definition und Anwendung.

Background: Although health information is of great interest and plays an important role in almost all media, there are very few studies on the actual work of health journalists. Methods: A quantitative online survey with qualitative elements on the definition and use of storytelling in health journalism was carried out among members of various professional journalists' associations (n=86). Results: The results suggest that health journalists understand storytelling especially as a term used when an article has a dramatic construction, and the story is about real people. As reasons for using storytelling, health journalists primarily name the understandable and clear presentation of medical issues. They see better chances for identification and establishing a relationship to the readers' lives. Of particular importance seems to be that narrative elements do not distort the facts and protect the privacy rights of persons mentioned in case reports.

Talleres sobre problemas de salud prevalentes con personas integradas en grupos de trabajo en centros de mayores / Workshops on prevalent health issues with people involved in working groups in centres for the elderly

Objetivo: Evaluar cambios en conocimientos de personas mayores que participan en talleres sobre temas de salud. Diseño del estudio: Estudio “antes-después”. Emplazamiento: Comunitario. Participantes: Personas integradas en grupos de trabajo en dos centros de mayores. Intervención: Se programaron intervenciones educativas sobre gripe, osteoporosis y riesgo cardiovascular (RCV). Previo consentimiento informado, los participantes contestaron un cuestionario de conocimientos, datos sociodemográficos y estado general de salud. A continuación se exponía el tema por uno de los miembros del grupo investigador. Se terminaba con un cuestionario postest. Mediciones principales: Variables sociodemográficas, de conocimientos sobre los temas tratados y estado general de salud. Resultados: En el taller sobre gripe participaron 24 personas. Antes del taller 45,8 % conocían los síntomas, 25 % decía que conocía la prevención; después el 58,3 % (NS) y el 70,8 % (p=0,001), respectivamente. En el de osteoporosis participaron 37. Antes del taller, 59,5 % decía conocer algo sobre osteoporosis, y 89,2 % sabían que afecta a los huesos. Conocían la importancia de consumir lácteos 75,7 %. Tras el taller se planteaban cambios: alimentación (13,5 %), ejercicio (18,9 %), visitas a su médico (27 %), varios aspectos (13,5 %). En el de RCV participaron 19. Antes del taller, 57,9 % había oído sobre factores de RCV, aunque 84,2 % no sabía nombrarlos. Tras el taller se redujo en un 50 % las personas que no sabían dar el nombre de algún factor de RCV (p=0,021). Conclusiones: Los conocimientos de las personas participantes en los talleres mejoraban después de los mismos, para los diferentes temas tratados (AU)

Objective: To evaluate changes in knowledge of elderly people who take part in workshops on health issues. Study Design: Before and after study. Participants: People involved in working groups in two centres for the elderly. Procedure: Educational interventions about influenza, osteoporosis, and cardiovascular risk were programmed. Subject to prior informed consent, the participants answered a questionnaire about previous knowledge, sociodemographic data, and overall health. Then, one of the members of the research group explained a subject. To conclude, a post-test questionnaire was completed. Main measurements: Variables related to sociodemographic features, knowledge of the topics discussed, and overall health. Results: 24 people took part in the workshop on influenza. Before the workshop, 45,8% knew the symptoms, 25% said they knew about its prevention. After the workshop, 58,3% (NS) and 70,8% (p=0,001), respectively. Conclusions: People participating in the workshops improved their knowledge of the topics Discussed (AU)

[Health literacy of adults in Germany: Findings from the German Health Update (GEDA) study]. / Gesundheitskompetenz von Erwachsenen in Deutschland : Ergebnisse der Studie "Gesundheit in Deutschland aktuell" (GEDA).

BACKGROUND: In today's information society, health literacy (HL) is considered important for health maintenance and disease management. In this context, dealing with health information is fundamental and requires different cognitive and social skills. OBJECTIVES: The aim of this study was to investigate the distribution of HL levels in the adult population of Germany, and to identify associations with health behaviours and health status. MATERIALS AND METHODS: The analyses were based on data from the German Health Update (GEDA) study, a cross-sectional survey of the German-speaking adult population of Germany, which was conducted from October 2013 to June 2014. Health literacy was assessed with the short form of the European Health Literacy Questionnaire (HLS EU-Q16), along with questions about socio-demographics, health behaviours, and health status. The HLS-EU-Q16 index could be calculated for 4845 respondents. RESULTS: According to the criteria of the HLS-EU-Q16, more than half of the adults had "adequate" HL (55.8 %). Every third person (31.9 %) had "problematic" and almost every eighth person (12.3 %) had "inadequate" HL. We found significant differences in HL by educational level, but no differences in HL by sex and age group. Certain health behaviours were positively associated with health literacy. A low HL level was associated with poorer physical and mental health. CONCLUSION: The results point to a need for action to improve HL in the adult population. The strengthening of health literacy should not solely aim at the promotion of individual skills, but also give high priority to the development of health-literate settings.

[Health literacy: An introduction to the concept and its measurement]. / Gesundheitskompetenz/Health Literacy : Das Konzept und seine Operationalisierung.

Over the last 20 years, health literacy (German: Gesundheitskompetenz/health competency) has become a popular concept in research and health policy. Initially defined as an individual's ability to understand medical information, the definition has quickly expanded to describe individual-based resources for actions or conduct relevant to health, in different socio-cultural or clinical contexts. Today, researchers and practice experts can draw on a wide variety of definitions and measurements. This article provides an overview of the definitions, briefly introduces the "structure and agency" approach as an example of theorizing health literacy, and shows different types of operationalization. The article presents the strengths and shortcomings of the available concepts and measures and provides starting points for future research in public health and health promotion.

Health literacy and online educational resources: an opportunity to educate patients.

OBJECTIVE: Given the increasing accessibility of material on the Internet and the use of these materials by patients as a source of health care information, the purpose of this study was to quantitatively evaluate the level of readability of resources made available on the European Society of Radiology website to determine whether these materials meet the health literacy needs of the general public as set forth by guidelines of the U.S. National Institutes of Health (NIH) and the American Medical Association (AMA). MATERIALS AND METHODS: All 41 patient education articles created by the European Society of Radiology (ESR) were downloaded and analyzed with the following 10 quantitative readability scales: the Coleman-Liau Index, Flesch-Kincaid Grade Level, Flesch Reading Ease, FORCAST Formula, Fry Graph, Gunning Fog Index, New Dale-Chall, New Fog Count, Raygor Reading Estimate, and the Simple Measure of Gobbledygook. RESULTS: The 41 articles were written collectively at a mean grade level of 13.0 ± 1.6 with a range from 10.8 to 17.2. For full understanding of the material, 73.2% of the articles required the reading comprehension level of, at minimum, a high school graduate (12th grade). CONCLUSION: The patient education resources on the ESR website are written at a comprehension level well above that of the average Internet viewer. The resources fail to meet the NIH and AMA guidelines that patient education material be written between the third and seventh grade levels. Recasting these resources in a simpler format would probably lead to greater comprehension by ESR website viewers.

Progressive testing of health self-efficacy and literacy for personalized engagement.

Patient engagement can be enhanced through continuous monitoring of patient' health knowledge and self-efficacy levels across different co-morbid conditions and key aspects in health improvement and recovery. While self-reported test batteries and computerized instruments have been designed to perform evaluation of patient literacy and self-efficacy, they are not practical to be used in scenarios where concurrent tests are needed to understand the change over time. In this paper we propose an adaptive system that can progressively compose the most pertinent test for each user based on the provisional estimates of a patient's latent trait being measured. This requires modeling not only the latent health literacy and self-efficacy levels of patients and the difficulty and discriminating factors of test items, but also the temporal dependency among concurrent tests. The goal is to account for changes over the course of patient engagement history as the basis for devising personalized patient plans.

[Need for more research in patients' health literacy]. / Behov for mere forskning i patienters sundhedskompetence.

This paper introduces the concept of health literacy to the Danish health field by sharing the definition, conceptual model and matrix from the European Health Literacy Survey (HLS-EU). The general results of the HLS-EU are presented to show how health literacy can be measured, and how limited health literacy is a challenge for various European countries. The fact that the term health literacy is not easily translated into Danish might be a barrier for its wider use and dissemination. However, this should not be an excuse for lack of attention or action in Danish health services.