(Mis)informed about what? What it means to be a science-literate citizen in a digital world.

Science literacy is often held up as crucial for avoiding science-related misinformation and enabling more informed individual and collective decision-making. But research has not yet examined whether science literacy actually enables this, nor what skills it would need to encompass to do so. In this report, we address three questions to outline what it should mean to be science literate in today's world: 1) How should we conceptualize science literacy? 2) How can we achieve this science literacy? and 3) What can we expect science literacy's most important outcomes to be? If science literacy is to truly enable people to become and stay informed (and avoid being misinformed) on complex science issues, it requires skills that span the "lifecycle" of science information. This includes how the scientific community produces science information, how media repackage and share the information, and how individuals encounter and form opinions on this information. Science literacy, then, is best conceptualized as encompassing three dimensions of literacy spanning the lifecycle: Civic science literacy, digital media science literacy, and cognitive science literacy. Achieving such science literacy, particularly for adults, poses many challenges and will likely require a structural perspective. Digital divides, in particular, are a major structural barrier, and community literacy and building science literacy into media and science communication are promising opportunities. We end with a discussion of what some of the beneficial outcomes could be-and, as importantly, will likely not be-of science literacy that furthers informed and critical engagement with science in democratic society.

Building on Evidence to Improve eHealth Literacy in Older Adults: A Systematic Review.

This review aimed to provide information on ways to improve eHealth literacy in older adults by assessing current studies examining eHealth literacy. To achieve the aim, this review focused on what theories or theoretical frameworks were used in the studies, what factors were related to eHealth literacy, and what outcome variables were used in eHealth literacy interventions for older adults. Five electronic databases were searched to identify eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was followed to select relevant studies, and narrative synthesis was performed. Among a total of 27 studies, 13 described theories or theoretical frameworks. Credibility in Internet health information, knowledge, and experience were identified as modifiable factors related to eHealth literacy. The most frequently used outcome variable was eHealth literacy efficacy. Nurses who are interested in improving eHealth literacy in older adults should consider appropriate theoretical frameworks and multiple factors influencing eHealth literacy.

Health literacy: The role of NHS library and knowledge services.

Health literacy is key to person-centred, preventative healthcare and is both a societal and individual responsibility. This feature describes work undertaken by Health Education England, the Community Health and Learning Foundation and NHS Library and Knowledge Services to raise awareness among NHS staff and other key partners of the impact of low health literacy. It highlights a range of health literacy resources and ideas for developing and adapting these tools for remote delivery during and post-pandemic. D.I.

Limited Ability of Three Health Literacy Screening Items to Identify Adult English- and Spanish-Speaking Emergency Department Patients With Lower Health Literacy.

STUDY OBJECTIVE: Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy. METHODS: Participants were Spanish- or English-speaking adult patients randomly selected from 4 geographically spread, US, urban, safety-net EDs. Participants completed the 3 health literacy screening items, as well as the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the 3 health literacy screening items were estimated, as compared with the SAHL-S&E. RESULTS: According to the SAHL-S&E, 36% of the 1,165 English speakers and 35% of the 1,605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were: needing others to help read materials (English 0.59, 95% confidence interval [CI] 0.56 to 0.62; Spanish 0.58, 95% CI 0.56 to 0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60 to 0.66; Spanish 0.59, 95% CI 0.56 to 0.62), and confidence with completing forms (English 0.62, 95% CI 0.59 to 0.65; Spanish 0.60, 95% CI 0.57 to 0.63). Areas under the curve for the 3 screening items combined were: English 0.66 (95% CI 0.63 to 0.70) and Spanish 0.62 (95% CI 0.59 to 0.64). CONCLUSION: The 3 health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher-validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.

Epilepsy through the eyes of the media: A paradox of positive reporting and challenges of access to advanced neurotechnology.

OBJECTIVE: Media coverage of disorders and medical advancements can impact public perception regarding the riskiness, effectiveness, and accessibility of treatment options. We studied that coverage for epilepsy with a focus on surgical interventions and emerging neurotechnologies. METHODS: Epilepsy-related English language articles published through 2019 were retrieved from online International news media with a circulation of 80,000 or above. We used directed content analysis of news articles to code content into a priori categories both to identify salient themes and to characterize their valence. RESULTS: One hundred forty-six unique articles matched our search terms. Overall, there was a steady increase in epilepsy reporting over time, with a majority of articles published with a positive tone. Neuromodulation was the focus of over 50% of all the articles in the time points analyzed. Vagus nerve stimulation (VNS) and deep-brain stimulation (DBS) were discussed more prominently than other types of neurotechnological interventions; VNS was the neurotechnological focus in 39% of the pediatric articles; resective surgery was the focus in 34% of adult articles. Access, support, and epilepsy literacy were the central themes in the context of ethical, legal, and social issues. SIGNIFICANCE: News media can influence the trust that the public places in science and medicine, and by extension, influences health policy. As innovations in neurotechnology for epilepsy emerge, understanding of individual and societal values is essential to their beneficial evolution and translation to care.

Library Jargon Creates Barriers for Potential Users of Health Library and Information Services.

This paper is based on Helen Kiely's Masters dissertation on MA in Library and Information Service Management, successfully completed at the University of Sheffield in 2018. The aim of the study was to explore the extent to which users of a health care library service understood common terminology used by clinical librarians/information professionals. A survey was developed based on the terminology used for common services and was distributed to staff and students at an acute NHS Foundation Trust. One hundred and eight people participated over a four week period and were asked to provide definitions to the terms. Analysis of the responses for accuracy and common themes indicates that jargon can be a barrier to user access and recommendations are made with respect to the need for outreach to users and the language used in this practice for creating better accessibility. F.J.

Increasing genomic literacy among adolescents.

PURPOSE: Adolescents increasingly need to be "genomics literate," and may engage more with video educational formats than traditional written formats. We conducted a pilot study to assess and compare the impact of two modes of education about genome sequencing (GS) on adolescents' genomic knowledge and genomic-related decisions. METHODS: Using an online survey, 43 adolescents ages 14-17 years were randomly assigned to watch a video or read a pamphlet about GS. Measures included pre- and postintervention assessment of genomic knowledge, perceived utility of these materials for decisions about participating in genetic research, interest in receiving GS results, and overall satisfaction with these materials. Analyses described results for all participants and compared results between intervention groups. RESULTS: Self-reported genomic knowledge increased overall (p < 0.001). Postintervention knowledge about GS limitations was higher among video group than pamphlet group participants (p = 0.038). More video group than pamphlet group participants expressed satisfaction with the material's understandability (45% vs. 29%) and suitability (91% vs. 76%). Interest in receiving personal GS results was significantly associated with being female (p = 0.01) and younger (14-15 years vs. 16-17 years) (p = 0.002). CONCLUSION: A video format may be preferable for increasing genomic literacy among adolescents. Further research with adolescents is needed to better understand how gender and age may impact genomic decisions and preferences.

The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis.

BACKGROUND: Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. DATA SOURCES: Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. METHODS: Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. RESULTS: The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. DISCUSSION: Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.

Deciphering the Signal From the Noise: Caregivers' Information Appraisal and Credibility Assessment of Cancer-Related Information Exchanged on Social Networking Sites.

With the rise in the use of the Internet for health-related purposes, social networking sites (SNSs) have become a prominent platform for cancer communication and information exchange. Studies of cancer communication on SNS have mostly focused on understanding the quantity, content, quality, and user engagement (eg, likes and comments) with cancer-related information on SNS. There is less of an understanding of when and why people coping with cancer turn to SNS for cancer-related information, and how users appraise the credibility of cancer-related information obtained on SNS. In this study, we use data from in-depth qualitative interviews with 40 primary caregivers of pediatric patients with cancer to examine how cancer caregivers engage in information appraisal and credibility assessment of cancer-related information obtained on SNS. Findings show that cancer caregivers turned to SNS for cancer-related information because information on SNS was immediate, targeted in response to specific caregiver questions and concerns, and tailored to the specific information needs of cancer caregivers. Cancer caregivers evaluated the credibility of cancer-related information obtained on SNS through assessment of the SNS user who posted the information, frequency the same information was shared, and external corroboration. Findings have important implications for cancer communication and information interventions and point to elements of SNS cancer communication that can be integrated into health professional-facilitated communication and cancer information strategies.

The impact of traditional literacy and education on health literacy in adolescents with asthma.

Introduction: People with low health literacy have poorer self-management of chronic diseases like asthma. Studies of parent health literacy and education level on the management of children's chronic illnesses reveal inconclusive results. We hypothesized a correlation between parent and adolescent health literacy in teens with asthma. Methods: Sociodemographic data were obtained; health literacy was assessed on adolescents and parents with three instruments: Rapid Estimate of Adolescent/Adult Literacy in Medicine (REALM), Single Item Literacy Screener (SILS) and Newest Vital Sign (NVS). Agreement between scores was examined by calculating weighted kappa statistics and performing Bowkers test of symmetry. Results: In all, 243 adolescents and 203 parents completed health literacy assessments yielding 198 paired observations. 9th-12th graders, 60.6% female, 72.7% African-American (AA), mean age: 15.3 years (±0.9). Parent education ranged from < high school (19.1%) to college graduate (24.0%). Agreement between adolescent and parent scores was poor: REALM (κw = 0.26), SILS (κw = 0.12), and NVS (κw = 0.29) and disagreement did not significantly differ by race. Positive correlations of moderate strength (overall and between racial groups) were found between reading scores and both REALM and NVS scores, and between REALM and NVS scores. Due to the inverse relationship of SILS scores with health literacy level, SILS scores (overall and between racial groups) were weakly and negatively correlated with reading scores, REALM and NVS. Conclusion: Correlation between education level and traditional literacy suggests that these are contributing factors to the health literacy of adolescents with asthma. Correlation between adolescent and caregiver health literacy was not supported.

Understanding the public's profile of mental health literacy in China: a nationwide study.

BACKGROUND: In the wake of China's massive economic development, attention has only recently turned to the enormous treatment gap that exists for mental health problems. Our study is the first comprehensive, national examination of the levels and correlates of the public's ability to recognize mental illness in the community and suggest sources of help, setting a baseline to assess contemporary Chinese efforts. METHODS: Data were collected in China as part of the Stigma in Global Context - Mental Health Study (SGC-MHS) through face-to-face interviews using vignettes meeting clinical criteria for schizophrenia and major depression. Our analysis targets the Han Chinese participants (n = 1812). Differences in the recognition of mental health problems were assessed using a chi-square test and further stratified by vignette illness type and urban vs. rural residence. Adjusted regression models estimated the effects of each predictor towards the endorsement three types of help-seeking: medical doctor, psychiatrist, and mental health professional. RESULTS: As expected, recognition of mental health problems is low; it is better for depression and most accurate in urban areas. Perceived severity increases endorsement of the need for care and for treatment by all provider types. Recognition of a mental health problem specifically decreases endorsement of medical doctors while increasing recommendations for psychiatrists and mental health professionals. Neurobiological attributions decrease recommendations for mental health professionals as opposed to general or specialty physicians. CONCLUSIONS: Continued efforts are needed in China to promote mental illness recognition within rural areas, and of schizophrenia specifically. Promoting recognition of mental illness, while balancing the special challenges among individuals who understand the neurobiological roots of mental illness, may constitute a key strategy to reduce the sizeable mental health treatment gap in China.

Mental Health Literacy Among Chinese Rural Residents: A Survey From Hubei Province in Central China on People's Perception of Mental Illnesses.

A survey was carried among 412 participants to examine mental health literacy in rural China. Two vignettes depicting schizophrenia and depression were presented, and participants were asked to reflect on their recognition and the beliefs about the causes, consequences, and the treatments of the conditions described. Results show that the recognition rates for schizophrenia and depression were 76.9% and 67.7%, respectively. Participants believed work stress, life stress, and encountered frustration were the most important reasons for mental illnesses. Participants believed that mental illnesses could cause many severe consequences to patients, such as emotional pain, bringing pain to the family, deterioration of interpersonal relationships, and destroying the individual's life. The participants were more likely to recommend nonmedical treatment for the patients in the two vignettes. Participants having a higher educational level were more likely to be aware of the consequences of the mental illnesses, and they also had a more positive attitude toward seeking professional help.

Applying Organizational Health Literacy to Maternal and Child Health.

Purpose Describe the development of an innovative teaching activity that applies organizational health literacy to maternal and child health (MCH). Description Health literacy is a strong predictor of health behavior and outcomes. While the study of health literacy has traditionally been confined to skills and capacities of individuals, the significant role of the social and physical environmental contexts in facilitating or hindering one's ability to obtain, understand, and make informed decision about their health has been recognized. MCH organizations play a critical role in influencing health literacy across system levels. This teaching activity aims to equip students with knowledge and skills needed to foster organizational health literacy. Assessment The teaching activity is assembled within a toolkit which includes the following: (1) instructor lesson plan; (2) interactive PowerPoint presentation with instructor notes; (3) field assignment description; (4) health literacy attribute assessment worksheets; and (5) grading rubric. The teaching tool was pilot tested by a student research team member to assess the educational value and assignment logistics, resulting in minor edits (i.e., addition of interviewer probes, and option of a group project-format to permit triangulation of multiple organizational interviews). Conclusion The field of MCH is expanding in complexity, and the demands of health systems on women, children, and families must be mediated by conscious efforts within organizations. Through teaching the importance and function of organizational health literacy to students in MCH, educators can prepare an emerging workforce to improve health literacy, and ultimately the quality of healthcare for women, children, and families.

Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis.

BACKGROUND: Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. OBJECTIVE: The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. METHODS: We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. RESULTS: Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. CONCLUSIONS: Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.

Mobile Health Application and e-Health Literacy: Opportunities and Concerns for Cancer Patients and Caregivers.

Health literacy is critical for cancer patients as they must understand complex procedures or treatment options. Caregivers' health literacy also plays a crucial role in caring for cancer patients. Low health literacy is associated with low adherence to medications, poor health status, and increased health care costs. There is a growing interest in the use of mobile health applications (apps) to improve health literacy. Mobile health apps can empower underserved cancer patients and their caregivers by providing features or functionalities to enhance interactive patient-provider communication and to understand medical information more readily. Despite the potentiality of improving health literacy through mobile health apps, there exist several related concerns: no equal access to mobile technology, no familiarity or knowledge of using mobile health apps, and privacy and security concerns. These elements should be taken into account for health policy making and mobile apps design and development. Importantly, mobile apps should be developed with the goal of achieving a high range of user access by considering all health literacy level and various cultural and linguistic needs.

Involving libraries in improving health literacy to achieve Sustainable Development Goal-3 in developing economies: a literature review.

BACKGROUND: The Goal 3 (SDG-3) of the United Nations' Sustainable Development Goals (SDG) incorporates 13 targets that cut across pressing health concerns globally. Health literacy has however been linked to achieving good health in the society, and its improvement in developing economies could aid the achievement of SDG-3. OBJECTIVE: The review focused on identifying actions that can be implemented by libraries to enhance health literacy and access to information among health care practitioners and consumers to support the achievement of SDG-3 in developing countries, especially Nigeria. METHOD: A literature search was conducted on reputable academic databases, namely sciencedirect, doaj, google scholar, pubmed and jstor. Similar keyword combinations were used to obtain articles, with filters set to search the keywords in article titles or abstract. Relevant criteria were used to screen the literature. RESULTS: Results from the literature searching were grouped under six themes that emerged from the literature. The value of libraries in health care was discussed, and suggestions were made for implementation in libraries. CONCLUSION: It was concluded that libraries in developing economies have to take actions to improve users' health literacy in order to become prominent stakeholders in the process of achieving SDG-3.

Mental health literacy as theory: current challenges and future directions.

BACKGROUND: Mental health literacy (MHL) is one increasingly researched factor thought to influence mental health behaviors. Researchers have argued for expanding the definition of MHL to include additional constructs, but no consensus has yet been reached on what constructs should be included as part of MHL. AIMS: The purpose of this paper is to (i) elucidate how the expansion of the MHL construct has impeded the growth of MHL research and (ii) through the lens of construct and theory development, highlight how these challenges might be remedied. METHODS: An inclusive search of the literature was undertaken to identify MHL studies. The principles of construct and theory development guided a critical analysis of MHL. RESULTS: The review of the literature found that MHL violates many principles of what constitutes an acceptable construct definition. To address these concerns, we proposed conceptualizing MHL as a theory and recommended principles of theory development that should be taken into consideration. CONCLUSION: A theory of MHL can guide future researchers to clearly delineate important constructs and their interrelationships. For practitioners, a theory of MHL can help inform how to improve MHL at both the individual and community level.

The Web-Based Randomized Controlled Intervention as the Enhancer of Cancer Prevention.

Background and Objectives: Cancer is an unresolved public health issue in society. With the advent of the internet and the development in the technological sector, access to basic health-related information has become more frequent among patients and healthy individuals. The aim of this study is to evaluate the impact of educational intervention on the participant's willingness to undergo selected medical procedures in case of suspected cancer. Materials and Methods: From 14 May 2015 to 13 November 2016, a total of 1118 who visited the Polish scientific website were enrolled in the 'Polish Online Randomized Intervention aimed at Neoplasm Avoidance' (PORINA) and randomized into two groups (educational and control). The original Cancer Knowledge Index (CKI) was used for the evaluation of participants' cancer-related knowledge. They were asked to declare whether they would consent to undergo selected medical procedures necessary for cancer diagnosis or treatment. Results: Most participants declared their readiness to undergo abdominal ultrasonography, computed tomography, and a nevi excision. The most noticeable changes were found for potential consent to undergo breast fine needle aspiration, mammography and gastroscopy. Conclusions: The level of oncological knowledge has an impact on individual decision to consent to particular medical procedures. Conducted educational intervention has significantly increased the readiness to undergo selected medical procedures.

The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review.

BACKGROUND: With the burden of chronic illness increasing globally, self-management is a crucial strategy in reducing healthcare costs and increasing patient quality of life. Low income and low health literacy are both associated with poorer health outcomes and higher rates of chronic disease. Thus, self-management represents an important healthcare strategy for these populations. The purpose of this study is to review self-management interventions in populations with low income or low health literacy and synthesize the efficacy of these interventions. METHODS: A systematic review of trials evaluating the efficacy of self-management interventions in populations with low income or low health literacy diagnosed with a chronic illness was conducted. Electronic databases were primarily searched to identify eligible studies. Data were extracted and efficacy summarized by self-management skills, outcomes, and content tailoring. RESULTS: 23 studies were reviewed, with ten reporting an overall positive effect on at least one primary outcome. Effective interventions most often included problem-solving as well as taking action and/or resource utilization. A wide range of health-related outcomes were considered, were efficacious empowerment and disease-specific quality of life were found to be significant. The efficacy of interventions did not seem to vary by duration, format, or mode of delivery or whether these included individuals with low health literacy and/or low income. Tailoring did not seem to impact on efficacy. DISCUSSION: Findings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management.

Impact of limited English proficiency on presentation and outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

Doctor-patient language discordance has been shown to lead to worse clinical outcomes. In this study of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction at an Australian health service, we demonstrated that limited English proficiency (LEP) is an independent predictor of prolonged symptom-to-door time, but does not lead to worse 30-day mortality compared with English-proficient patients. More effort needs to be placed in providing public health education in varied languages to encourage early presentation to hospital for patients with LEP.