Navigational health literacy among people with chronic illness

Objectives People with chronic illness are particularly dependent on navigating and using the health care system. This requires navigational health literacy (HL-NAV). The article aims to examine the distribution and predictors of HL-NAV in a sample of chronically ill individuals. Methods Data of 1,105 people with chronic illness from the general population in Germany were collected in December 2019 and January 2020. HL-NAV was assessed by 12 items (score 0–100). Bivariate and multiple linear regression analysis were performed. Results HL-NAV score was 39.1 (SD 27.3). In bivariate analyses, HL-NAV was lower among chronically ill persons aged 65 or above, with low education, limited functional health literacy, low social status, financial deprivation, poor social support, multiple chronic conditions, and an illness duration of 6–10 years. In multivariate analyses, advanced age, lower education, less functional health literacy, lower social status, and less social support remained associated with lower HL-NAV. Discussion The results underline the importance of promoting HL-NAV among people with chronic illness. Strategies should aim at strengthening individual competencies taking into account the social and situational factors but also at reducing the demands placed on chronically ill people by providing user-friendly and trustworthy information on the health care system along the illness trajectory.

Letramento em saúde e sua relação com a qualidade de vida, o relato de doenças crônicas e de dificuldade de acesso a serviços de saúde entre idosos

Objetivo: Investigar possíveis diferenças na qualidade de vida, percepção de dificuldade de acesso a serviços de saúde e presença de doenças crônicas em idosos com letramento em saúde (LS) adequado e inadequado. Métodos: Foram avaliados 30 idosos e coletados dados de escolaridade, percepção de dificuldade de acesso a serviços de saúde, ter plano de saúde suplementar, relato de quedas e de doenças crônicas. O LS foi avaliado por meio do Short Test of Functional Health Literacy in Adults e a qualidade de vida por meio do 12-Item Short-Form Health Survey (SF-12). Os dados foram comparados entre grupos de idosos com LS adequado (n=15) e inadequado (n=15) utilizando testes t para amostras independentes, teste de Mann-Whitney e teste exato de Fisher, considerando significância de 5%. Resultados: Não houve diferença entre grupos quanto à escolaridade, escores físico e mental do SF-12. O grupo com LS inadequado apresentou percepção de menor limitação no trabalho ou outras atividades devido à saúde física; percepção de menor dificuldade de acesso a serviços de saúde; e maior proporção não sabia informar se apresentava doenças crônicas. Considerações finais: Não houve diferença na qualidade de vida, avaliada a partir das percepções de limitações e dificuldades devido à saúde física e mental, entre idosos com LS adequado e inadequado. No entanto, idosos com LS inadequado parecem apresentar percepção de menor dificuldade relacionada ao trabalho e acesso a serviços de saúde e menor conhecimento sobre a presença de doenças crônicas.

The Impact of Health Literacy and Religiosity on Attitudes Towards Physician-Assisted Death

The aim of the current study was to examine the relationship between functional health literacy and religiosity regarding attitudes towards physician-assisted death (PAD). Of participants, the majority were female (62.6%) and non-Hispanic White (79.6%), and ages ranged from 19 to 83 (M = 37.81, SD = 12.55). As measured by the Newest Vital Sign, 82.6% (n = 219) of individuals within the current sample had adequate functional health literacy, while 10.6% (n = 28) scored within the “possibly limited” range, and 6.8% (n = 18) scored within the “highly limited” range. There was a positive association between religiosity and age (r = .21, p < .001), and older participants were more likely to endorse religious beliefs and/or activities. There was a significant association between greater acceptance of attitudes towards PAD and functional health literacy (r = .17, p < .01), indicating that those with higher health literacy have more positive attitudes towards PAD. There was no significant association between attitudes towards PAD and age (r = -.02, p > .05) or education (r = -.05, p > .05). Similarly, attitudes did not differ by gender (t (256) = -.66, p > .05) or by race/ethnicity, (F(5, 253) = .73, p > .05). Of note, functional health literacy may be particularly important to monitor in this context, as several studies (i.e., Kobayashi et al., 2015) have shown that health literacy may decrease with mild cognitive impairment and may therefore provide important information regarding older adults with this condition.

Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study

ObjectivesThe aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery.DesignA prospective cross-sectional psychometric study.SettingPatients from three bariatric centres in Sweden were consecutively included in this study.ParticipantsA total of 704 patients undergoing bariatric surgery filled in the questionnaires preoperatively. Inclusion criteria were scheduled for primary bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) and greater than 17 years, proficiency in Swedish.Primary and secondary measuresPsychometric outcomes of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale.ResultsThere was a higher proportion of females (74.4%, n=523) to males (25.6%, n=180). The mean age was 42 years (SD 11.5). Limited functional health literacy and limited communicative and critical health literacy (including both inadequate and problematic health literacy) was reported in 55% (n=390) and 40% (n=285), respectively. Cronbach alpha for the Swedish Functional Health Literacy scale was α=0.86 and for the Swedish Communicative and Critical Health Literacy scale, α=0.87. Construct validity showed weak to negative correlations between the Swedish Functional Health Literacy scale and income, education and SF-36/RAND36 summary scores. Confirmatory factor analysis showed a one-factor solution for the Swedish Functional Health Literacy scale and a two-factor solution for the Swedish Communicative and Critical Health Literacy scale.ConclusionsThe Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale are valid and reliable to use for patients undergoing bariatric surgery in a Swedish context. Measuring dimensions of health literacy can be used as a guide for the development of health literacy friendly patient information in patients undergoing bariatric surgery.

Social inequalities in the self-management of type 1 diabetes: A serial multiple mediation analysis

Aims Diabetes requires complex self-management. Due to this complexity, social disparities exist in the self-management of type 1 diabetes. Various pathways to describe associations between socio-economic factors and health outcomes have been suggested. We sought to elucidate the potential of health literacy and social support to reduce social disparities in diabetes self-management. Methods Questionnaire responses were linked to data from electronic medical records, yielding a study population of 1186 people with type 1 diabetes. Mediation analyses using adjusted linear regressions were used to establish pathways between self-reported educational attainment, social support, functional health literacy and clinically obtained measures of glycaemic control. Results We found evidence of an association between education and glycated haemoglobin, partially mediated by functional health literacy and social support. However, the direct association between social support and glycaemic control was not statistically significant. Conclusions Whilst both functional health literacy and social support play a role in glycaemic control, our findings did not explain the main impact of social disparities on glycaemic control. Interventions to reduce disparities in glycaemic control related to educational attainment should focus beyond functional health literacy and social support.

Health Literacy and Diabetes Knowledge: A Nationwide Survey in a Multi-Ethnic Population

Health literacy is a key determinant of the public health and health climate of the nation. This study examined the functional health literacy of the nation, factors associated with health literacy, and its relationship with diabetes recognition. This cross-sectional survey recruited participants (N = 2895) who were 18 years and above from a population registry through disproportionate stratified sampling. The Brief Health Literacy Screen and other questionnaires were administered through face-to-face interviews, in one of the four national languages (English, Chinese, Malay or Tamil). The majority (80.5%) had adequate functional health literacy and were able to recognise symptoms of diabetes correctly (83.5% overall; 83.7% and 82.2% in those with adequate and inadequate health literacy, respectively). Those with inadequate health literacy had a higher incidence of chronic conditions (p < 0.001) compared to those with adequate health literacy in bivariate analysis. The majority of the sample had sufficient levels of physical activity (83.3%), and more than half reported an unhealthy lifestyle (57.4%). Older age, Chinese ethnicity, those who were employed, with lower education (secondary or below), and were married had significantly higher odds of inadequate health literacy. Health literacy was not associated with lifestyle, physical activity, chronic conditions and diabetes recognition. Health literacy interventions should focus on the disadvantaged social groups for improving their health literacy.

Cultural Adaptation of Health Literacy Measures: Translation Validation of the Newest Vital Sign in Arabic-Speaking Parents of Children With Type 1 Diabetes in Kuwait

Purpose The purpose of the study was to assess the feasibility of use and reliability of the Arabic version of the Newest Vital Sign (NVS-Ar) in parents of children with type 1 diabetes (T1D). Methods The final translated version of NVS-Ar was administered to 175 adult caregivers of children with T1D who are native Arabic speakers. The association between NVS-Ar scores for the parents/legal guardians and A1C for their children was assessed. The internal consistency was evaluated by Cronbach’s α, and reliability was assessed by test-retest method. Results The median (interquartile range) score was 4.0 (3-5). The internal consistency of the NVS-Ar was moderate (α = .58). The intraclass correlation coefficient was .61. There was no correlation between NVS-Ar score and A1C (Spearman’s ρ = .055; P = .62). Furthermore, there was significant inverse association between adequate health literacy and optimal glycemic control among the children, which remained evident even after adjusting for the duration of T1D, age, or education of the parents/guardians. However, it lost statistical significance after adjustment for treatment regimen. Conclusion Study findings indicate that the NVS is unlikely to be a predictive tool for functional health literacy in Arabic settings and that there is a need to properly translate and validate other tools such as the Test of Functional Health Literacy in Adults or, alternatively, to develop a reliable tool.