Health literacy: concept analysis

AIM: This paper reports an analysis of the concept of health literacy in order to clarify its meaning, reduce ambiguities associated with references to it, and promote consistency in using the concept in nursing dialogue and research. BACKGROUND: Health literacy is a relatively new concept in health promotion research. Only within the last decade have researchers identified the problems associated with health literacy, the role it plays in an individual's ability to comprehend health and self-care information, and its relationship to health outcomes. Clarifying the concept is essential so that nurses develop an awareness of the phenomenon and its relationship to the outcomes of their communication and health education efforts. METHOD: The method used for this concept analysis was that of Walker and Avant (1995). FINDINGS: Health literacy empowers people to act appropriately in new and changing health-related circumstances through the use of advanced cognitive and social skills. The defining attributes of health literacy are reading and numeracy skills, comprehension, the capacity to use information in health care decision-making, and successful functioning as a healthcare consumer. Antecedents of health literacy are literacy and a health-related experience. Consequences of health literacy include improved self-reported health status, lower health care costs, increased health knowledge, shorter hospitalizations, and less frequent use of health care services. Empirical referents of the concept are the Test of Functional Health Literacy in Adults and the health literacy component of the National Assessment of Adult Literacy. CONCLUSIONS: An analysis of the concept of health literacy enhances nurses' ability to assess more accurately their clients' levels of health literacy, thus identifying those at risk for misunderstanding health care instructions, shame associated with inadequate reading skills, and inability to adhere to health care recommendations.     

Health literacy: the new outcome indicator for evaluating a health education program

Through health promotion campaigns, health literacy has become a vital factor in determining a population's health in terms of the macro view of health. Since the 1990s, the concept has been increasingly valued in American health circles. Health literacy not only means understanding medical information, but also implies the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. There are three instruments for estimating individuals' health literacy, including the Rapid Estimate of Adult Literacy in Medicine (REALM) , the Short-Test of Functional Health Literacy in Adults (Short-TOFHLA) and the National Assessment of Adult Literacy (NAAL). Literature review reveals that health literacy is an important indicator for evaluating the effectiveness of a health education program for the 21st century. The author suggests that nurses adopt such strategies for health education as designing educational materials that prompt introspection, using a range of Internet technologies and designing strategies of community empowerment to conduct health education programs, in order to improve clients' health literacy and raise the effectiveness of such programs.     

在校高年级护生资讯素养现状调查

目的:了解在校高年级护理专业学生(以下简称护生)资讯素养现状,为进一步提高护生资讯素养提供参考依据。方法:采用护理系学生资讯素养能力评估问卷对550名在校大三护生进行问卷调查。结果:在校高年级护生资讯素养能力平均得分为(2.65±0.41)分,处于中等水平,各维度得分排序由高到低分别为电脑素养、媒体素养、网络素养和传统素养。结论:在校高年级护生资讯素养处于中等水平,因此高等护理院校应增加资讯素养课程,为提高护生资讯素养奠定基础。     

专业心理求助污名在本科护生心理健康素养与专业心理求助态度之间的中介作用

目的了解心理健康素养对护生专业心理求助态度的影响,以及专业心理求助污名在其中的中介作用。方法采用心理健康素养量表、专业心理求助污名量表和专业心理求助态度量表对郑州市两所高校护理专业在校学生进行调查。结果护生心理健康素养、专业心理求助污名和专业心理求助态度得分分别为(112.61±10.90)、(25.44±6.99)、(98.77±12.53)分。心理健康素养与专业心理求助态度呈正相关,专业心理求助污名与专业心理求助态度呈负相关(均P<0.01)。专业心理求助污名在护生心理健康素养与专业心理求助态度之间起中介作用,中介效应占总效应的34.09%。结论护生的专业心理求助态度处于中上水平,护生不仅可以通过提高心理健康素养水平来改善专业心理求助态度,还可以通过降低专业心理求助污名程度来改善专业心理求助态度。     

Psychometric evaluation of the Chinese version of short-form Test of Functional Health Literacy in Adolescents

Aims and objectives. The purpose of this study is to develop and evaluate the psychometric properties of the Chinese version of short-form Test of Functional Health Literacy in Adolescents. Background. Assessing health literacy is vital to design health education programme; however, there are no measurement tools exist for use specifically in Chinese adolescents. Design. A non-experimental design was used to test the psychometric properties of the Test of Functional Health Literacy in Adolescents. Methods. The short-form Test of Functional Health Literacy in Adolescents was translated and back translated into a Chinese language version. Thirty high school students were recruited to validate the scenario of Test of Functional Health Literacy in Adolescents. Based on the multiple-stage stratified random sampling method, 300 high school students from four counties in Taiwan were invited to participate in this study to evaluate the psychometric properties of Test of Functional Health Literacy in Adolescents. Results. The Functional Health Literacy in Adolescents had good internal consistency reliability and excellent test-retest reliability. Confirmatory factor analysis resulted in a one-factor solution. Conclusion. Contrary to the original version of the Test of Functional Health Literacy in Adolescents, the findings revealed that the 36-item, one-factor model for the Test of Functional Health Literacy in Adolescents is the best-fit model. Relevance to clinical practice. This is a suitable instrument to assess health literacy levels in Chinese adolescents before health education programmes can be appropriately planned, implemented and evaluated.     

Associations between working memory, health literacy, and recall of the signs of stroke among older adults

ABSTRACT: Stroke remains a major cause of mortality and disability among older adults. Although early treatment after stroke is known to reduce both mortality and disability, the first step in seeking early treatment is dependent on the rapid recognition of the signs of stroke. Recall of the signs of stroke may be dependent on factors that exist before the stroke itself. Although it is known that both working memory and health literacy decline with advancing age, these factors have not been thoroughly examined with respect to recall of the signs of stroke. Therefore, the purpose of the current study was to investigate associations between working memory, health literacy, and recall of the signs of stroke among older adults. Community dwelling older adults (≥65 years of age) were recruited from two senior centers. Fifty-six participants meeting inclusion criteria provided demographic and health information and were asked to read a public service brochure listing the five warning signs of stroke. Working memory was then assessed using the Wechsler Adult Intelligence Scale 3rd Edition Working Memory Index. Health literacy was assessed by the Short Test of Functional Health Literacy in Adults. Participants' recall of the five warning signs of stroke was evaluated. The mean age was 80.4 years. The mean number of the signs of stroke recalled was 2.9 ± 1.33. Working memory and health literacy were positively correlated with recall of the signs of stroke (r = .38, p < 0.01; r = .44, p < 0.01). In a simultaneous regression, only health literacy remained a significant predictor of recall. There was no statistically significant interaction between working memory and health literacy. Findings from this study indicate that working memory and health literacy were associated with successful recall of the warning signs of stroke in older adults. Further studies are needed to determine if programs that include cognitive and literacy assessments could identify older adults who need additional support to learn and recall the signs of stroke.     

Psychometric evaluation of the MSU CAM health literacy scale

Background/PurposeThe rise in the use of alternative health care approaches (CAM) increases the need for adequate health literacy. The MSU Health Literacy Scale was developed to measure CAM health literacy. Psychometric evaluation of the scale is presented in this article.MethodsA test retest design was utilized and data from this instrument evaluation research project were used to explore the validity and several forms of reliability of the MSU Health Literacy Scale. The data analysis was based on the scores of 241 individuals at the T1 data collection and the scores of 188 at the T2 administration of the instrument.ResultsThere were significant correlations between the MSU CAM Health Literacy Scale and Newest Vital Sign (r = 0.330 p = .000) and with a single question health literacy measure (r = .255 (p = .000). Cronbach’s alphas were adequate for each administration of the scale (T1 = .774 and T2 = .754). The correlation of scores between the T1 administration and the T2 administration were significant (r = .696 (p = .000).ConclusionsThis psychometric evaluation provides confirmation of convergent validity and stable reliability. The scale can be used in future research and clinical endeavors.     

Empathy in health professional students: A comparative cross-sectional study

BackgroundIt has been shown that empathy strengthens the relationship between patients and health professionals and also improves patient and health professional satisfaction, which helps promote the best clinical outcomes. Empathy is considered an essential prerequisite for a nurse to effectively care for a patient and for a holistic understanding of a patient's perspective in a student population.ObjectivesThe main aim was to compare empathy levels between health professional students attending different university courses.DesignA comparative study with a cross-sectional approach was conducted in two successive academic year cohorts of 1st year health professional students at a public Italian university.Participants and MethodsA sample of 1st year health professional students at a public Italian university was investigated using the Jefferson Scale of Empathy Health Professional Students version (JSE-HPS).ResultsOverall, 502 health professional students were included in the study. The students in nursing showed significantly higher empathy levels than the students in other health professions. Furthermore, the female students were found to exhibit significantly more overall empathy than the male students were.ConclusionsThe undergraduate nursing students showed a significantly higher mean score of empathy measured by the Jefferson Scale of Empathy Health Professional Students version (JSE-HPS) than the students attending other health undergraduate courses. This could mean that a particular aptitude in establishing a help-relationship with other people exists among the students that choose to become a nurse.     

Health literacy and health outcomes in HIV seropositive persons

Inadequate health literacy has been associated with worse health status and more hospitalizations. We examined the influence of personal characteristics and health literacy on body change distress, depressive symptoms, and HIV symptom intensity in a convenience sample of 489 HIV-seropositive adults throughout the United States. Health literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM) instrument. Those with higher health literacy scores reported more body change distress, depressive symptoms, and HIV symptom intensity. Being Latino and having higher health literacy scores were associated with poorer health outcomes. These results challenge the utility of the REALM to examine the relationship between health literacy and adverse health status.     

Assessing oral health literacy of university nursing students: A cross-sectional exploratory study

AimResearch has proven a link between oral health and numerous chronic systemic diseases. To achieve better health outcomes, there is a need to involve interprofessional primary health care providers, such as nurses to raise awareness and promote oral health. Nurses have regular contact with patients which provides a unique opportunity to impart disease-specific information and technical skills for patients to self-manage their oral health conditions. However, the baseline oral health literacy of undergraduate nursing students at the University of Sydney is not known. Before creating a targeted curriculum to improve oral health literacy amongst nursing students, it is essential to assess the baseline oral health knowledge of these students. This study aimed to assess the oral health literacy level among undergraduate nursing students of the University of Sydney, Australia.DesignAn exploratory research approach was used.MethodsA cross-sectional survey study was conducted using the validated Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument. A univariate general linear model was used to explore the association of CMOHK total score with demographic and educational variables.ResultsA total number of 197 nursing students participated in the survey, with a mean CMOHK score of 15.48, SD 3.27. 72% were categorized as having good, 16% fair and 12% poor oral health knowledge. The analysis from the six individual knowledge domains of the CMOHK revealed lower percentages of correct responses in the periodontal disease and oral cancer knowledge domains. Students with English as their second language, on average, scored 2 fewer correct responses (p <.001) than students whose first language was English. Low socioeconomic status was not associated with a low level of oral health literacy.ConclusionThe baseline results show a good level of general oral health knowledge as measured by the CMOHK. However, periodontal disease and oral cancer were identified as the particular domains where a knowledge gap exists. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nursing students. Culturally responsive pedagogy may need to be considered for students with English as their second language. This baseline survey data may potentially facilitate integrating oral health in nursing education and practice.     

Associated factors with treatment adherence of patients diagnosed with chronic disease: Relationship with health literacy

AimThis study aimed to examine the relationship between the health literacy level and treatment adherence in patients with chronic disease.BackgroundNonadherence to treatment and insufficient health literacy can cause a decrease in understanding treatment methods, an increase in medication errors, and an increase in morbidity and mortality rates.Materials and methodsThis cross-sectional study comprised a total of 200 patients who were taking medication for a chronic disease. Data were collected using an 18-item questionnaire for sociodemographic and medical characteristics, the Adult Health Literacy Scale (AHLS), and the Morisky Medication Adherence Scale (MMAS).ResultsOf the patients, 42.5% reported that they took three or more medications per day, and 32.0% reported that they did not know the side effects of these medications. Of the patients, 39.0% had low adherence to treatment. The mean score of the AHLS was 12.8 ± 4.74 (min = 2; max = 21). A statistically significant positive correlation was found between the AHLS scores and MMAS scores (r = 0.604; p = 0.001).ConclusionsThis study revealed that patients' adherence to treatment increased as their health literacy increased. Thus, it is recommended that health literacy levels of the patients be raised through effective interventions to ensure better adherence to treatment.     

乌鲁木齐市脑卒中高危人群健康素养现况及影响因素分析

目的了解乌鲁木齐市脑卒中高危人群健康素养水平及相关影响因素,从而为乌鲁木齐市脑卒中一级预防提供策略支持。方法采用便利抽样法,选取2019年6月—2020年4月在新疆医科大学健康管理中心接受健康体检的脑卒中高危人群为研究对象,共2368名。应用自行构建的脑卒中风险评估模型筛选脑卒中高危人群,采用慢性病患者健康素养量表了解该人群的健康素养情况,并采用多重线性回归分析该人群健康素养的影响因素。结果脑卒中高危人群的慢性病患者健康素养量表总分为(95.55±8.84)分。4个维度的具备率由高到低依次为经济支持、健康信息获取能力、健康意愿、交流互动能力。单因素分析结果显示,不同年龄、婚姻状况、学历人群的慢性病患者健康素养量表得分比较,差异有统计学意义(P<0.05)。多重线性回归分析结果显示,年龄、学历、婚姻状况是脑卒中高危人群健康素养的影响因素(P<0.05)。结论乌鲁木齐市脑卒中高危人群健康素养水平受年龄、婚姻状况分布、文化程度分布的影响,应根据本地区脑卒中高危人群的特点做好其健康教育及健康促进工作。     

健康素养在门诊原发性高血压患者自我管理和社会支持的中介作用

目的探讨高血压患者健康素养在社会支持和自我管理中所起的作用,为今后改善居民健康素养并最终提高自我管理水平寻找理论依据。方法采用慢性病患者健康素养问卷、高血压患者自我管理问卷和社会支持评定量表对419例原发性高血压患者进行调查。结果高血压患者的健康素养总分为(102.36±10.93)分,75.89%的患者具备健康素养;自我管理总分为(74.18±9.64)分,处于中等水平;社会支持总分为(40.44±6.56)分,处于中等水平;健康素养和社会支持均与自我管理呈显著正相关(P0.01);健康素养在自我管理和社会支持之间存在中介作用。结论对原发性高血压患者通过健康素养的培养训练,能够提高患者自我管理能力,增加患者的社会支持,有利于患者的病情控制。     

中老年住院冠心病患者疾病相关健康素养与社会支持现状分析

目的了解中老年住院冠心病患者疾病相关健康素养与社会支持的现状。方法运用冠心病健康素养问卷、社会支持量表对乌鲁木齐市某三级甲等医院190例冠心病患者进行调查。结果中老年住院冠心病患者健康素养总分为(74.83±31.89)分,处于较低水平;社会支持总分为(42.01±9.16)分,处于中等水平;冠心病健康素养与社会支持的相关系数为0.684。结论住院冠心病患者冠心病健康素养较低,且社会支持与健康素养水平呈正相关。在中老年住院冠心病患者健康促进过程中,应重视社会支持系统对冠心病健康素养的积极影响。     

110例乳腺癌女性患者健康素养与癌症复发恐惧的相关性研究

目的 调查乳腺癌女性患者健康素养及癌症复发恐惧现状,并探究两者的相关性。方法 采用一般资料调查表、中文版疾病进展恐惧简化量表、慢性病患者健康素养量表对江西省某三级甲等医院110例乳腺癌女性患者进行调查,采用Pearson相关性分析检验其健康素养及癌症复发恐惧的相关性。结果 乳腺癌患者健康素养总分为（88.32±10.41）分,复发恐惧得分为（28.98±6.11）分,患者健康素养水平与癌症复发恐惧呈负相关（r=-0.773,P<0.01）。结论 乳腺癌患者健康素养处于中等水平,癌症复发恐惧处于中等偏低水平,健康素养与癌症复发恐惧呈负相关,即健康素养水平越低,其癌症恐惧程度越高。建议医护人员提供针对性的信息支持、鼓励患者与外界沟通互动、开展心理社会干预等以提升乳腺癌女性患者健康素养水平,继而减轻其对癌症复发的恐惧。