A systematic scoping review and content analysis of organizational health literacy responsiveness assessment tools.

The characteristics of health literate organizations have been variously described in recognition that it is important for organizations to respond to the diversity of people's health literacy strengths and challenges. A systematic scoping review was conducted to identify, assess and classify international self-assessment tools aimed at measuring the capability of organizations to embody health literate characteristics. Following the JBI Scoping Manual, a search was conducted in six databases and identified 2693 articles. After screening, 16 studies published between 2007 and 2023 across eight countries were eligible for inclusion. Results were summarized and a finite list of items from existing tools was generated. Content analysis was performed to classify these items. Whilst most assessment tools in the included studies were healthcare-focused, other settings included schools and government departments. The 16 assessment tools included a total of 661 items, and 647 items were retained that met the definition of health literacy responsiveness. Items were classified into six domains (communication; navigation of resources; culture; policies and practice; involvement or engagement and workforce development), with high agreement between two researchers (91.5%). The 647 items were reviewed to exclude items that were too contextually specific, focused solely on service users, were too broad or had suitable alternatives; 210 items were finally retained. This research is two-fold: provides a synthesis of existing organizational health literacy responsiveness assessment tools across settings; and provides a list of items, which will be essential to developing context specific assessment tools through Delphi methods in the future.

Quasi-experimental design for using an interactive social media intervention program to improve truck drivers' health beliefs and eating behaviors.

BACKGROUND: Truck drivers have difficulties participating in health education programs delivered at a fixed time and place due to the mobility of their workplace. Interventions conducted via social media can overcome these limitations of time and place. This study aimed to investigate the effect of a nutrition education intervention program delivered via a social media platform on the healthy eating behaviors of truck drivers. METHODS: This study adopted a quasi-experimental design. A 12-week intervention program was conducted for a social-media group (n = 125) and a conventional-teaching group (n = 117) from February to May 2020. The social-media group participated in a social-media-based health intervention on the LINE application. The intervention involved the provision of online messages, online instant responses, a picture-based food log, an audio e-book, and a loyalty e-card. The conventional-teaching group participated in a healthy diet course and a hygiene education manual. The generalized estimation equation (GEE) was applied to evaluate the intervention effects on the outcome measures derived from the Health Belief Model. RESULTS: The results of the GEE showed the social-media-based intervention strategies significantly decreased perceived barriers of consuming a healthy diet (p = < 0.001), increased willingness to follow cues of action (p = 0.036), improved the self-efficacy of healthy eating behaviors (p = 0.001), and increased the score of healthy eating behaviors (p < 0.001) compared with the conventional teaching strategies. For the social-media and conventional-teaching groups, no significant changes occurred in self-perceived health status, self-perceived susceptibility, or self-perceived severity after the intervention. More than 90% of the participants in the social-media group believed the social-media-based intervention strategies could help implement and maintain healthy eating behaviors. CONCLUSIONS: The results indicate social-media-based intervention strategies can facilitate approaching a population without a fixed workplace, such as truck drivers. Health promoters and planners focusing on occupational health can consider developing social-media-based intervention strategies for improving truck drivers' health status.

Lifestyle and Addictive Behaviors Among Chinese Adolescents in Hong Kong, Macau, Taipei, Wuhan, and Zhuhai-a First Cross-subculture Assessment.

PURPOSE: This study aimed at assessing the differences in prevalence rates of common health behavior among adolescents in the five Chinese cities and the influential factors at the contextual and individual levels. METHOD: We compared the standardized rates of three lifestyle behaviors (sedentary, dietary, and physical activity) and three addictive behaviors (cigarette smoking, alcohol consumption, and participation in gambling) among a sample of 13,950 adolescents. The sample was randomly selected from five cities, including Hong Kong, Macau, Taipei, Zhuhai, and Wuhan. Population size, GDP per capita, and literacy at the city level as well as parental monitoring and school performance at the student's level were assessed. Multi-level mixed effect models were used to examine the interaction of individual level factors with study sites. RESULTS: The six health behaviors differed significantly across sites with the highest rates of alcohol consumption in Hong Kong (39.5 %), of cigarette smoking in Macau (9.8 %), and of gambling in Taipei (37.1 %) and Hong Kong (35.9 %). The city-level measures were associated with only a few behavioral measures. Relative to Hong Kong, parental monitoring had stronger association with the three addictive behaviors in the other sites. CONCLUSION: Findings suggest that although the study sites share similar Chinese culture, students in the five cities differed from each other with regard to levels of health behaviors. Relative to the broad socioeconomic development, differences in parental monitoring played a significant role in explaining the observed difference.

Effects of different cardiopulmonary resuscitation education interventions among university students: A randomized controlled trial.

Cardiopulmonary resuscitation (CPR) education for the public may improve bystander intention to perform CPR on cardiac arrest patients. Studies have shown that different CPR education intervention methods can improve learning performance, with key indicators including attitude toward to CPR, intention to perform CPR, and degree of CPR knowledge and skills. The present study compared the traditional face-to-face method to hybrid and virtual reality (VR) methods to observe difference in learning performance and length of performance retention. This study adopted randomized controlled trial to compare CPR learning performance between traditional face-to-face, hybrid, and VR methods. Participants from each intervention group completed a pretest and 2 posttests. The measurement tools included an attitude and intention questionnaire, knowledge examination, and skill examination with a RESUSCI ANNE QCPR ® manikin. The performance among all participants in pretest showed no significant difference between the intervention groups, indicating no difference in their background attitude, knowledge, and skill level. Significant differences were observed in the average degree of intention to perform CPR between the hybrid and traditional groups in 1st and 2nd posttest. Compared to the pretest results, the posttests revealed significantly higher attitude toward CPR, intention to perform CPR, knowledge examination results, accuracy of overall chest compression, accuracy of CPR procedure, accuracy of AED usage, accuracy of chest compression rate, and accuracy of chest compression depth. The average time to reattending CPR learning and practice session was 11-12 weeks reported by participants. The hybrid and VR methods to CPR education resulted in the same level of improvement in learning performance as traditional face-to-face teaching. The suggested frequency for renewing CPR knowledge and skills is 12 weeks which may be considered in new strategies aimed at promoting CPR education and exposure to the public.

Sedentary Behavior and Phase Angle: An Objective Assessment in Physically Active and Inactive Older Adults.

The purpose of the present study was to investigate the associations of the objectively assessed total sedentary behavior (SB) amount and SB patterns with phase angle (PhA) in older populations and to conduct a comparison analysis for those who are physically active (meet 150 min/week) and inactive (less than 150 min/week). During May to August 2023, a convenience sampling was used to recruit older adults (aged ≥ 65 years) living in a community in Taiwan. The total SB amount (minutes/day), SB patterns (including SB bouts and breaks), and physical activity were assessed by a triaxial accelerometer. A multifrequency bioelectrical impedance analyzer (BIA) was used to measure PhA. Multiple linear regression analysis was employed to examine the associations between SB and PhA in the total number of participants and stratified in the physically active and inactive groups. For the whole sample (n = 166; mean age: 72.1 ± 5.5 years), the total SB amount and patterns of SB were not associated with PhA. For those physically active, the total SB amount and SB patterns were not associated with PhA. Among those physically inactive, the total SB amount was negatively related to PhA (B: -0.059, 95% CI: -0.118, 0.000). This study underscores the importance of minimizing the total SB amount in physically inactive older adults, providing evidence for future interventions targeting SB and PhA in this population.

Burnout and Health Issues among Prehospital Personnel in Taiwan Fire Departments during a Sudden Spike in Community COVID-19 Cases: A Cross-Sectional Study.

A spike in COVID-19 cases in Taiwan's communities caused a significant increase in workload and infection concerns among prehospital personnel working in Taiwan fire departments. The present study was aimed at investigating their health status during this period. The target population was prehospital personnel who are from Taiwan fire departments, and who responded to COVID-19 patients during the community outbreak period. A questionnaire was employed to assess their physical and mental health status. The results showed that prehospital personnel suffered from moderate to severe degrees of burnout. Workload, body burden, and perceived pressure increased significantly during this period. Participants received more support from friends, family, and colleagues than they did from authorities. The paramedics reported higher scores for personal burnout than the emergency medical technicians (EMTs). Compared to non-COVID-19 response units, special COVID-19 response units reported higher scores for workload, body burden, and supportive environment. The results suggested that personal and work-related burnout were associated with higher perceived pressure. This study is the first investigation of physical and mental health burdens among prehospital personnel in Taiwan fire departments during the COVID-19 pandemic. The physical and mental health status of these personnel should be continuously monitored, and intervention provided as necessary.

Factors Related to COVID-19-Preventive Behaviors among Flight Attendants.

The health and safety of airline employees have been important issues during the 2019 coronavirus disease (COVID-19) pandemic. The exposure of flight attendants to passengers with severe acute respiratory syndrome coronavirus 2 infection without protective equipment is known to cause in-flight transmission and the worldwide spread of the virus. However, very few studies have focused on flight attendants' COVID-19-preventive behaviors and related factors. This cross-sectional study was performed to investigate relationships between COVID-19-preventive behaviors and relevant factors in a convenience sample of flight attendants. In total, 261 flight attendants working for two international airlines were recruited. A self-developed questionnaire was used to assess participants' COVID-19 information-seeking behavior, perceived susceptibility, severity, self-efficacy, and preventive behaviors. Analysis of variance and Pearson's correlation analysis were performed to analyze COVID-19 preventive behaviors according to socio-demographic and COVID-19-related factors. Multiple regression analysis was used to predict the flight attendants' COVID-19-preventive behaviors. The factors that primarily influenced participants' COVID-19-preventive behaviors were gender (women; ß = 0.17, p < 0.001), information-seeking behavior (ß = 0.39, p < 0.000), perceived severity (ß = 0.130, p < 0.05), and self-efficacy (ß = 0.17, p < 0.05). These factors explained 30.6% of the variance in COVID-19-preventive behaviors among flight attendants. Identification of the preventive behaviors performed by this population is important, as it aids the development of strategies to enhance such behaviors, thereby reducing the in-flight spread of COVID-19.

Factors associated with patients' decision on colorectal cancer screening.

ABSTRACT: Cancer prevention and control are critical public health concerns. However, the screening uptake and referral rate for colorectal cancer (CRC) in Taiwan remain low. This study focused on the factors influencing whether a patient with a CRC diagnosis chooses to undergo referral follow-up.A cross-sectional research and used the Health Belief Model was method applied in this study. Variables such as demographic factors, CRC diagnosis-related knowledge factors, and health belief factors were employed to investigate the decisive factors that affect the health behavior of patients diagnosed with CRC who test positive on the fecal occult blood test. Study identified prospective participants in Daliao District, Kaohsiung City, Taiwan aged 50 to 75 years. A structured questionnaire was administered to the individuals, and 200 responded. The questionnaires of 100 who went for a referral group and 80 who did not a nonreferral group were analyzed. The questionnaire was reliable and valid, as determined through an expert evaluation and pretest, respectively.Among the 200 participants, T test indicated that those who underwent a referral were significantly more likely to be younger (Age [Mean ±â€ŠSD] n: 62.7, 7.1%; Unreferred group: n: 65.1, 7.0%; Referred group: n:60.7, 6.6%; P ≤ .001), be more educated (P = .002), exercise more (P < .05), and have more family members with cancer (P = .001) or CRC (P < .05). Participants who underwent a referral also had significantly more knowledge (P < .001). Furthermore, those who underwent a referral had significantly perceived greater susceptibility (P < .05), greater benefits (P = .002), and lower barriers (P < .001) of screening; they also received greater encouragement to do so from sources (e.g., clinicians or the media) around them (P = .009).Age, education level, number of family members with cancer or CRC, exercise habits, knowledge of CRC, perceived susceptibility, perceived benefits, perceived barriers, and encouragement from others influence referral behavior. Government policy should focus on older patients and health education, especially in the mass media. Hospitals should also ensure the ease of referrals to lower perceived barriers.

Using the health belief model to explore nursing students' relationships between COVID-19 knowledge, health beliefs, cues to action, self-efficacy, and behavioral intention: A cross-sectional survey study.

ABSTRACT: Nursing educators should equip nursing students with sufficient knowledge about coronavirus disease 2019 (COVID-19), perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and behavioral intention in order to prevent the spread of COVID-19.The purpose of this study was to use the health belief model to elucidate nursing students' relationships between knowledge about COVID-19, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and behavioral intention.A cross-sectional survey design was adopted and purposive sampling was utilized. A total of 361 nursing students participated in the study. Quantitative analysis was employed for all data analysis.The findings showed that the nursing students had the following mean scores on knowledge of COVID-19 9.43 [standard deviation (SD)1.19], perceived susceptibility 19.41 (SD2.68), perceived severity 20.31 (SD 4.09), perceived benefits 26.52 (SD 4.08), perceived barriers 15.17 (SD5.88), cues to action 3.30 (SD1.70), self-efficacy 17.68 (SD2.83), and behavioral intention 18.46 (SD2.33). Nursing students' demographic background, knowledge of COVID-19, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy explained 58.1% of the variance in behavioral intention (R2 = 0.581, F = 29.775, P < .001).Nursing educators can increase nursing students' knowledge of COVID-19, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy as effective means of health promotion to improve their behavioral intention to prevent the spread of COVID-19.

Relevant Work Factors Associated with Voice Disorders in Early Childhood Teachers: A Comparison between Kindergarten and Elementary School Teachers in Yancheng, China.

Background: Early childhood teachers consist of kindergarten and elementary school teachers in the lower grades. Young children at school may increase the vocal load of these teachers. Therefore, the objectives of this study were to determine the prevalence of voice disorders and the associated factors in early childhood teachers, and to determine if differences exist between kindergarten and elementary school teachers. Method: A cross-sectional survey was performed in July 2019 as a network questionnaire. Through cluster sampling, teachers (n = 414) from all five public kindergartens (n = 211) in the urban area of Yancheng, China, and four public elementary schools (n = 203) in the same school district participated in this study. Multivariate logistic regression models were used to analyze the associations among the prevalence of voice disorders in the teachers, school type, and relevant factors. Results: Our results indicated, based on the Voice Handicap Index scale (VHI-10, China), that the prevalence of voice disorders in early childhood teachers was 59.7%, while that in elementary school teachers (65.5%) was significantly higher than that in kindergarten teachers (54.0%) during the previous semester. Contributing factors included daily class hours, classroom air humidity, and speaking loudly during teaching. Additionally, certain types of voice usage in teaching such as falsetto speak, speaking more than other teachers, not using vocal techniques, and habitual voice clearing, were significantly associated with voice disorders. Conclusion: Most early childhood teachers have voice disorders. Compared with the kindergarten teachers, the elementary school teachers experienced a significantly higher prevalence of voice disorders. Several factors among work organization, work environment, and types of voice usage in teaching were associated with the voice disorders in early childhood teachers. The finding suggests that voice training should be provided for early childhood teachers, classroom teaching time should be decreased, and the number of teachers in basic subjects should be increased in the lower grades of elementary schools.

The effectiveness of a health promotion intervention on the meaning of life, positive beliefs, and well-being among undergraduate nursing students: One-group experimental study.

Nursing educators have a responsibility to value undergraduate nursing students' physical, psychological, spiritual, and social health promotion.The purpose of the study was to examine the effectiveness of a health promotion intervention concerning meaning of life, positive beliefs, and well-being among undergraduate nursing students in a health promotion curriculum.The study was adopted a pretest, posttest, and post post-test design in 1-group experimental study with a purposive sample of 112 undergraduate nursing students who attended in a health promotion curriculum and voluntarily completed a reliable 3-part questionnaire (content validity index = 0.95; Cronbach's αs = meaning of life, 0.97; positive beliefs, 0.94; and well-being 0.96).Undergraduate nursing students showed significant (all P < .001) improvements on the meaning of life, positive beliefs, and well-being immediately after the intervention, which were sustained over time.Nursing educators should incorporate these variables into the health promotion curriculum to enhance undergraduate nursing students' physical, psychological, spiritual, and social health promotion.

Simulated directed-learning in life-education intervention on the meaning of life, positive beliefs, and well-being among nursing students: A Quasi-experimental study.

Nursing educators have the responsibility to equip nursing students with knowledge about the meaning of life, positive beliefs, and well-being in order to enhance their physical, psychological, spiritual, and social health education and promotion. The purpose of this study was to explore nursing students' simulated directed-learning in a life-education intervention on the meaning of life, positive beliefs, and well-being in regard to immediate and delayed effects in improving physical, psychological, spiritual, and social health education and promotion.The method of this study was constituted a quasi-experimental design with experimental and control groups for pre-test, post-test, and post-post-test. Purposive sampling and non-random distribution were used in the study. Assigned to the experimental group, 54 participants were third-year nursing students enrolled in a health education course with simulated directed-learning in a life-education intervention. Assigned to the control group, 56 participants were third-year nursing students enrolled in a caring care course without simulated directed-learning in a life-education intervention. A 56-item questionnaire was utilized, and the content validity index (CVI) was 0.95, as determined by seven expert scholars. The reliability of the questionnaire (n = 45) on Cronbach's α were: meaning of life 0.96, positive beliefs 0.95, and well-being 0.96. The statistical package SPSS 23.0 was used to analyze all of the data in the study. Frequencies, percentages, pre-test mean and SD, post-test mean and SD, post-post-test mean and SD, chi-squared test, t test, and generalized estimating equation (GEE) were employed for data analysis.Nursing students in the experimental group compared with the control group exhibited significant differences in meaning of life on the pre-post-test (ß = 16.40, P < .001) and pre-post post-test (ß = 25.94, P < .001), positive beliefs on the pre-post-test (ß = 5.64, P < .01) and pre-post post-test (ß = 9.21, P < .001), and well-being on the pre-post-test (ß = 14.33, P < .001) and pre-post post-test (ß = 23.68, P < .001).Nursing students in the experimental group showed a significant improvement in the simulated directed-learning with a life-education intervention on meaning of life, positive beliefs, and well-being in the immediate and delayed effects that enhanced their physical, psychological, spiritual, and social health education and promotion.

Nursing students' relationships among meaning in life, well-being, and positive beliefs: A cross-sectional survey study.

Nursing educators have a core responsibility to develop nursing students' health promotion. The purpose of this study was to explore nursing students regarding their relationships among meaning in life, well-being, and positive beliefs. A cross-sectional survey design was adopted in this study. Purposive sampling was used. A total of 219 nursing students participated in the study. Quantitative analysis was utilized for the data analyses. The study found that nursing students had the following mean scores on the meaning in life, 4.33 (86.60%) standard deviation (SD) 0.79; well-being, 4.23 (84.60%) SD 0.78; and positive beliefs, 4.32 (86.40%) SD 0.75. The nursing students' characteristics, meaning in life, and well-being explained 79% of the variance in positive beliefs (adjusted R = 0.79, F = 114.57, P < .001). Nursing educators can promote meaning in life and well-being to nursing students as an effective way to increase their positive beliefs.

An Investigation of the Outcomes of PGY Students' Cognition of and Persistent Behavior in Learning through the Intervention of the Flipped Classroom in Taiwan.

The Postgraduate Year (PGY) Program allows doctors-in-training to learn about the diagnosis, treatment and nursing of various common, general diseases. These items form the core curriculum and are mostly learned through caring for patients and clinical teaching. Doctors-in-training are evaluated for their knowledge through written tests or assignments, based on which the effectiveness of their training is also assessed; however, this generally produces a negative learning attitude among them. So we introduced the flipped classroom into PGY training program to change PGY students' learning behavior. Although the flipped classroom is highly valued and has been practiced by teachers in schools of various levels, very few attempts have been made until now to report the learning outcomes achieved through the flipped classroom by means of rigorous research methods. Therefore we tried to employed Ajzen and Fishbein's (1980) theory of reasoned action and Bandura's self-efficacy to predict and explain the participants' behavioral intention when participating in the core curriculum learning of the flipped classroom and to assess the change in students' learning behavior and learning effectiveness. From August 2013 to July 2014, 39 PGY students from the General Surgery of the Tri-Service General Hospital were selected as the participants of this study. The control group included 43 students of the previous year, that is, the year before the intervention of the flipped classroom. A comparative analysis was performed. The questionnaire's related matrices indicated highest correlation between self-efficacy and behavioral intention (r = 0.491, P < 0.01), followed by attitude (r = 0.365, P < 0.01) and subjective norms (r = 0.360, P < 0.01.) All three showed positive correlations with behavioral intention; among attitude, subjective norms, and self-efficacy, the pairwise correlations also reached significance level. The flipped classroom can indeed change PGY students' the learning behavior from "passive learning" to "active learning."

The prevalence and risk factors of visual impairment among the elderly in Eastern Taiwan.

Visual impairment is associated with disability and poor quality of life. This study aimed to investigate the prevalence and associated risk factors of visual impairment among the suburban elderly in Eastern Taiwan. The cross-sectional research was conducted from April 2012 to August 2012. The ocular condition examination took place in suburban areas of Hualien County. Medical records from local infirmaries and questionnaires were utilized to collect demographic data and systemic disease status. Logistic regression models were used for the simultaneous analysis of the association between the prevalence of visual impairment and risk factors. Six hundred and eighty-one residents participated in this project. The mean age of the participants was 71.4±7.3 years. The prevalence of vision impairment (better eye<6/18) was 11.0%. Refractive error and cataract were the main causes of vision impairment. Logistic regression analysis showed that people aged 65-75 years had a 3.8 times higher risk of developing visual impairment (p=0.021), while the odds ratio of people aged > 75 years was 10.0 (p<0.001). In addition, patients with diabetic retinopathy had a 3.7 times higher risk of developing visual impairment (p=0.002), while the odds ratio of refractive error was 0.36 (p<0.001). The prevalence of visual impairment was relatively high compared with previous studies. Diabetic retinopathy was an important risk factor of visual impairment; by contrast, refractive error was beneficial to resist visual impairment. Therefore, regular screening of ocular condition and early intervention might aid in the prevention of avoidable vision loss.

Effects of tooth scaling reminders for dental outpatients.

We investigated the effect of sending reminders for patients to attend appointments for tooth scaling. A total of 389 outpatients were assigned to three intervention groups (reminders sent by postcard, mobile-phone text message or telephone call) and one control group. Reminders accompanied by short health education messages were sent to patients in each of the intervention groups. The outpatient revisiting behaviour of the patients was monitored. Patients who were reminded to come in for tooth scaling were 2.6 (95% CI 1.3-5.4) to 2.9 (CI 1.1-7.8) times more likely to revisit compared to those who were not reminded. For every one point increase in the patient satisfaction score, patients were 3.8 (CI 1.2-11.6) times more likely to revisit. Patients with a high level of patient satisfaction and who had also received a reminder had the highest return rates (26%). Most patients (89-96%) had good feelings regarding the reminders; 65% of the patients agreed that reminders had enhanced their intention to revisit; 91% of patients hoped to continue to receive reminders concerning broader dental health information. A reminder combined with health education is an effective way of improving preventative dental visiting behaviour.