Psychometric properties of the health literacy instrument in Brazil (HLS-EU-BR47).

BACKGROUND: Health literacy (HL) is a key component of health promotion and sustainability and contributes to well-being. Despite its global relevance, HL is an under-researched topic in South America but is now debuting its exploration in Brazil. To leverage its benefits for South America, the mere translation of validated tools into Portuguese is insufficient. Rather, it is necessary to examine their validity. This study aims to assess the psychometric properties of the European Health Literacy Questionnaire (HLS-EU-BR47) using the Item Response Theory (IRT) in a population-based sample of adults in Brazil. METHODS: A cross-sectional online study was conducted across Brazil and included 1028 participants aged 18 years and above (80% women). Cronbach's alpha, McDonald's omega, factor analysis, graded responses model, Item Characteristic Curve, HL levels based on this, HL standard calculation, IRT, and regular score correlation were computed. RESULTS: The instrument exhibit high reliability (Cronbach's alpha 0.95). Factor analysis yielded one factor. IRT was appropriate for data analysis because it allowed quality evaluation of items and constructed a scale to quantify HL. The 47 items and latent features of respondents in the same unit of measurement are positioned in the construction of the HLS-EU-BR47 instrument. The percentages of individuals at each HL level, calculated using IRT, were found to be comparable to those obtained through the standard computation, e.g., 3.2% of people reported very low HL versus 10.8% inadequate HL, 56.2% reported low HL versus 39.5% problematic HL, 31.1% had moderate HL versus 30.1% sufficient HL, and 9.5% had high HL versus 19.7% with excellent HL. The mean HL scores were comparable between women and men (33.9 vs. 33.7, P = 0.36). CONCLUSION: This study provides new evidence of the validity of a widely used HL instrument for the population of South America (in this case, Brazil). This tool can be utilized by citizens, health professionals, and regional/national policymakers to inform the development of initiatives to assess and improve the HL of individuals, groups, and communities. Further studies are needed to confirm and extend the findings and to explore the influence of local cultures and practices in the vast Brazilian territory on HL.

Adaptations in dental public health services during the COVID-19 pandemic in municipalities of Southern Brazil: a grounded theory and collaborative research / Adaptações nos serviços públicos odontológicos durante o Pandemia COVID-19 em municípios do Sul do Brasil: uma teoria fundamentada e pesquisa colaborativa

ABSTRACT The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective.

RESUMO Analisar as ações de saúde bucal em quatro municípios brasileiros durante a pandemia de COVID-19, segundo um modelo de referencial teórico sobre gestão da atenção à saúde bucal. Estudo qualitativo realizado em dois momentos. Foi desenvolvido um modelo teórico-empírico sobre o significado da gestão do cuidado em saúde bucal, seguindo o método da Teoria Fundamentada nos Dados. Participaram 14 dentistas e cinco gestores de saúde, por meio de entrevista aberta. Posteriormente, no segundo momento, foi realizada uma pesquisa colaborativa, e o modelo foi aplicado para analisar os documentos produzidos em cada município para o enfrentamento local da pandemia, em quatro municípios do Estado de Santa Catarina, sul do Brasil. O modelo forneceu uma estrutura para analisar as ações de enfrentamento da pandemia nos serviços de saúde bucal. Foram identificadas ações em todas as dimensões do modelo: redução da oferta de atendimento odontológico devido à restrição de acesso aos serviços eletivos; a busca por padrões de assistência à biossegurança; disseminação de diretrizes padronizadas e com base científica; a tentativa de manter a assistência odontológica integral por meio da readaptação de serviços especializados e ações coletivas; e realocação de profissionais de saúde bucal para atendimento em outros setores. O referencial de gestão da atenção à saúde bucal pode servir de referência para redesenhar as ações e serviços de saúde bucal em outros municípios em período de pandemia de COVID-19, em uma perspectiva mais ampla.