Health literacy and its determinants among school-going children: a school-based cross-sectional study in Nepal.

Limited health literacy is linked to unhealthy behaviors, adverse health outcomes, poor quality of life and financial burdens on society. However, little is known about the level of health literacy, especially among school-going children. This cross-sectional study assesses health literacy levels and their determinants in 354 school children from Kathmandu Metropolitan City, utilizing a multi-stage cluster sampling method. The 10-item Health Literacy for School-Aged Children was used to measure the student's literacy levels. Bivariate analysis and multivariable logistic regression at the significance level of 0.05 were performed to determine factors associated with limited health literacy. The majority of participants (76.6%) had moderate health literacy, while 13.8% had a high level and 9.6% had a low level of health literacy. Students from nuclear families had lower odds [adjusted odds ratio (aOR): 0.4; 95% CI: 0.2-0.8] of having limited health literacy. Students whose mother education was up to secondary school (aOR: 10.1; 95% CI: 1.3-78.9), students with pre-existing mental health conditions (aOR: 3.7; 95% CI: 1.4-9.6) and students with unsatisfactory health status (aOR: 3.9; 95% CI: 1.5-10.5) had higher odds to have limited health literacy. These results suggest the importance of prioritizing school health promotion and education activities for students with pre-existing mental health conditions and mothers with low educational attainment. Implementing peer support group programs for children with mental illnesses, mobilizing school health professionals and introducing interventions such as vocational training of mothers can collectively improve health literacy among school-going children.

Health literacy of patients consulting in an expert gynecological tertiary center: A pilot study.

BACKGROUND: Previous studies have highlighted patients with chronic conditions seek for medical knowledge and therapeutics on their own. So far, no data exist on the health literacy of patients with gynecological conditions and especially those suffering from endometriosis, whose symptoms' have a major impact on their daily lives. METHOD: The objective was to evaluate the health literacy of patients consulting in a referral expert center for the management of endometriosis and gynecological cancers. The secondary objective was to compare the health literacy of patients with endometriosis to patients without. We conducted an observational, prospective, monocentric study in the gynecological department of Tenon Hospital (Paris, France) between July 6, 2022 to January 3, 2023. All patients fulfilled the validated French version of HLS-EU-Q16 questionnaire. RESULTS: One hundred and ten patients were included. The two following questions were identified as the most difficult among patients with endometriosis: "Find information about treatments for their disease" and "know when it would be helpful to have another doctor's opinion". Compared to patients consulting for other conditions, it was more difficult for patients with endometriosis to respectively "find information about treatments for diseases" and "use information given by the doctor to take decisions about the illness" (p = 0.003). Compared to patients consulting for cancer, it was more difficult for patient with endometriosis to "find information about treatments for diseases" (p = 0.02). CONCLUSION: Progresses in the capacity of the health care to better inform the patients would be highly beneficial, especially for those suffering from endometriosis.

Designing a health literacy model for patients with diabetes.

BACKGROUND: Low health literacy levels among individuals with type 2 diabetes are common and may be a fundamental barrier to increasing self-efficacy and self-care in patients. Therefore, the present study aimed to propose a model for educating health literacy in diabetic patients in hospitals affiliated with the Islamic Azad University of Medical Sciences, Tehran. METHODS: This research was applied in terms of purpose, mixed-methods (qualitative-quantitative) in terms of data type, qualitative content analysis, and cross-sectional survey in the quantitative aspect (fitness of model). The statistical population in the qualitative section included 18 participants from experts in the field of health care. In the quantitative section, 220 educators working in hospitals affiliated with the Islamic Azad University of Medical Sciences, Tehran, were selected using stratified random sampling. Data collection tools included interviews in the qualitative section and research-made questionnaire in the quantitative section. For data analysis, coding was used in the qualitative section, and structural equation modeling was used in the quantitative section. RESULTS: For this model, 6 dimensions, 17 components, and 78 items were identified. The results showed that the basic literacy dimension had a coefficient of 0.729, the specialized literacy dimension had a coefficient of 0.712, diabetes management had a coefficient of 0.654, social literacy dimension had a coefficient of 0.630, cultural literacy dimension had a coefficient of 0.605, and media literacy had a coefficient of 0.535, respectively, contributing the most to the health literacy of diabetic patients. CONCLUSION: Since the "Health Literacy Education" model has a good fitness, it is recommended that this model will be applied in different settings such as hospitals in order to improving the health level of patients.

Readability, Understandability, Usability, and Cultural Sensitivity of Online Patient Educational Materials (PEMs) for Lower Extremity Reconstruction: A Cross-Sectional Study.

Background: Lower extremity reconstructive surgery is an evolving field wherein patients rely on accessible online materials to engage with their perioperative care. This study furthers existing research in this area by evaluating the readability, understandability, actionability, and cultural sensitivity of online health materials for lower extremity reconstruction. Methods: We identified the 10 first-appearing, educational sites found by searching the phrases "leg saving surgery", "limb salvage surgery," and "leg reconstruction surgery". Readability analysis was conducted with validated tools, including Simple Measure of Gobbledygook (SMOG). Understandability and actionability were assessed with Patient Education and Materials Assessment Tool (PEMAT), while cultural sensitivity was measured with Cultural Sensitivity Assessment Tool (CSAT). A Cohen's κ value was calculated (PEMAT and CSAT analyses) for inter-rater agreement. Results: The mean SMOG reading level for websites was 13.12 (college-freshman reading level). The mean PEMAT understandability score was 61.8% and actionability score was 26.0% (κ = 0.8022), both below the 70% acceptability threshold. The mean CSAT score was 2.6 (κ = 0.73), exceeding the 2.5 threshold for cultural appropriateness. Conclusion: Online PEM for lower extremity reconstruction continue to fall below standards of readability, understandability, and actionability; however, they meet standards of cultural appropriateness. As patients rely on these materials, creators can use validated tools and positive examples from existing PEM for greater patient accessibility.

Contexte : La chirurgie reconstructrice du membre inférieur est un domaine en pleine évolution où les patients s'appuient sur des documents en ligne afin de se lancer dans leurs soins périopératoires. Cette étude est la prolongation d'une recherche existante dans ce domaine pour évaluer la lisibilité, l'intelligibilité, la mise en pratique et la sensibilité culturelle des documents de santé disponibles en ligne pour la reconstruction du membre inférieur. Méthodes : Nous avons identifié 10 sites éducatifs d'apparition récente en faisant une recherche avec les mots « chirurgie de sauvetage de la jambe ¼, « chirurgie de sauvetage d'un membre ¼ et « chirurgie reconstructrice de la jambe ¼. Une analyse de lisibilité a été effectuée avec des outils validés dont Simple Measure of Gobbledygook (SMOG). L'intelligibilité et la mise en pratique ont été évaluées avec PEMAT, tandis que la sensibilité culturelle était mesurée avec le CSAT (outil d'évaluation et de sensibilité culturelle). La valeur k de Cohen a été calculée pour les analyses avec le PEMAT et le CSAT, pour la concordance interévaluateurs. Résultats : Le niveau de lisibilité moyen avec le SMOG pour les sites Web était de 13.12 (niveau de lecture d'entrée au collège). Le score moyen d'intelligibilité (PEMAT) était de 61.8% et le score de mise en pratique était de 26.0% (kappa = 0,8022), tous les deux en dessous du score d'acceptabilité de 70%. Le score CSAT moyen était de 2.6 (kappa = 0,73), dépassant le seuil de 2.5. Conclusion : Les documents éducatifs pour patients sur la reconstruction du membre inférieur restent en dessous des normes de lisibilité, d'intelligibilité et de mise en action. En revanche, ils satisfont les normes de respect de la culture. Considérant que les patients s'appuient sur ces documents, leurs créateurs peuvent utiliser des outils validés et des exemples positifs issus de documents existants pour une plus grande accessibilité par les patients.

An Analysis of the Knowledge Among Midwifery Students at Medical University-Pleven Regarding Human Papillomavirus (HPV) and HPV-Associated Diseases.

Background and objective Comprehensive health literacy and prevention have been the key methods to reduce the spread of human papillomavirus (HPV) and HPV-associated disease development. Raising awareness among young individuals about the risk factors and the ways to prevent the infection is often the starting point of primary prevention. In light of this, we aimed to assess the awareness of midwifery students at Medical University-Pleven about (HPV) and HPV-associated diseases. Material and methods We conducted a survey-based study among first-year students at Medical University-Pleven in the period spanning January to March 2020, which involved a direct group survey. We initially reached out to 445 students and 284 (63.8%) of them responded; 12 of them were midwifery students. In the period from May through November 2022, the same type of survey was repeated among 75 midwifery students, and 47 (62.7%) responded. A set of classic statistical methods were used to present and analyze the collected quantitative and qualitative data. The responses in the questionnaires were reviewed and recoded according to the requirements of the statistical program. The significance of the results, the findings, and the conclusions was set at p<0.05. A comparative analysis was employed to statistically compare the results to present the differences between the groups of traits studied. Data processing was performed using MS Office Excel 2019 and SPSS Statistics v.28 (IBM Corp., Armonk, NY). Results Over half (70.6%) of the first-year midwifery students were aware of the infection caused by HPV. Among them, 10 students (29.4%) were familiar with the risk factors for HPV and HPV-associated diseases, and all of the fourth-year respondents knew about the studied issue. The majority of the respondents - 61.8% of the freshmen and 100% of the fourth-year students- were aware of HPV vaccine availability. Conclusions In the course of their training, the midwifery students at Medical University-Pleven acquired enough knowledge about the risk factors of HPV-associated diseases and the availability of vaccines to prevent them.

Animations to communicate public health prevention messages: a realist review protocol.

INTRODUCTION: With digital and social media advances, animated health communications (health animations) are highly prevalent globally, yet the evidence base underpinning them remains unclear and limited. While individual studies have attempted to explore the effectiveness, acceptability and usability of specific features of health animations, there is substantial heterogeneity in study design, comparators and the animation design and content. Consequently, there is a need to synthesise evidence of health animations using an approach that recognises this contextual complexity, which may affect their impact. METHODS AND ANALYSIS: This project aims to understand why, how, for whom, to what extent and in which contexts health animations are expected to promote preventive health behaviours. We will conduct a realist review following Pawson's five iterative stages to (1) define the review scope and locate existing theories; (2) search for evidence; (3) select and appraise evidence; (4) extract data and (5) synthesise data and refine theory. Engagement with stakeholders involved in developing, testing, implementing or commissioning health communications, including animations, will allow the initial programme theory to be tested and refined. The findings will be reported in accordance with Realist and Meta-narrative Evidence Syntheses: Evolving Standards. ETHICS AND DISSEMINATION: Ethical approval for the public stakeholder work was provided by the Northumbria University Research Ethics Committee. We will disseminate the findings widely through outputs tailored to target specific professional, public and patient audiences. Dissemination will occur through stakeholder engagement as part of the research, a peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42023447127.

Development and Validation of a Mobile-Centered Digital Health Readiness Scale (mDiHERS): Health Literacy and Equity Scale.

BACKGROUND: There has been a rapid expansion of digital health care services, making the need for measuring and improving digital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: Health Literacy and Equity Scale (mDiHERS) to measure digital health readiness. OBJECTIVE: We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, and to ensure the effective use of mobile-centered digital health services. METHODS: This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participants included patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and experts in medical and nursing informatics. The scale development involved a literature review, focus group interviews, and content validity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403 completing the survey. The scale's validity and reliability were assessed through exploratory factor analysis and Cronbach α. The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diverse settings. RESULTS: The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation process confirmed the scale's construct validity, with 4 factors explaining 65.05% of the total variance. The scale's reliability was established with Cronbach α values ranging from 0.84 to 0.91. The scale's development considered the technical proficiency necessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objective skills in digital health literacy. CONCLUSIONS: The mDiHERS is a validated tool for measuring patients' readiness and ability to use digital health services. The mDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital health services and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidence and competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit from digital health care.

Evaluation of Generative Language Models in Personalizing Medical Information: Instrument Validation Study.

BACKGROUND: Although uncertainties exist regarding implementation, artificial intelligence-driven generative language models (GLMs) have enormous potential in medicine. Deployment of GLMs could improve patient comprehension of clinical texts and improve low health literacy. OBJECTIVE: The goal of this study is to evaluate the potential of ChatGPT-3.5 and GPT-4 to tailor the complexity of medical information to patient-specific input education level, which is crucial if it is to serve as a tool in addressing low health literacy. METHODS: Input templates related to 2 prevalent chronic diseases-type II diabetes and hypertension-were designed. Each clinical vignette was adjusted for hypothetical patient education levels to evaluate output personalization. To assess the success of a GLM (GPT-3.5 and GPT-4) in tailoring output writing, the readability of pre- and posttransformation outputs were quantified using the Flesch reading ease score (FKRE) and the Flesch-Kincaid grade level (FKGL). RESULTS: Responses (n=80) were generated using GPT-3.5 and GPT-4 across 2 clinical vignettes. For GPT-3.5, FKRE means were 57.75 (SD 4.75), 51.28 (SD 5.14), 32.28 (SD 4.52), and 28.31 (SD 5.22) for 6th grade, 8th grade, high school, and bachelor's, respectively; FKGL mean scores were 9.08 (SD 0.90), 10.27 (SD 1.06), 13.4 (SD 0.80), and 13.74 (SD 1.18). GPT-3.5 only aligned with the prespecified education levels at the bachelor's degree. Conversely, GPT-4's FKRE mean scores were 74.54 (SD 2.6), 71.25 (SD 4.96), 47.61 (SD 6.13), and 13.71 (SD 5.77), with FKGL mean scores of 6.3 (SD 0.73), 6.7 (SD 1.11), 11.09 (SD 1.26), and 17.03 (SD 1.11) for the same respective education levels. GPT-4 met the target readability for all groups except the 6th-grade FKRE average. Both GLMs produced outputs with statistically significant differences (P<.001; 8th grade P<.001; high school P<.001; bachelors P=.003; FKGL: 6th grade P=.001; 8th grade P<.001; high school P<.001; bachelors P<.001) between mean FKRE and FKGL across input education levels. CONCLUSIONS: GLMs can change the structure and readability of medical text outputs according to input-specified education. However, GLMs categorize input education designation into 3 broad tiers of output readability: easy (6th and 8th grade), medium (high school), and difficult (bachelor's degree). This is the first result to suggest that there are broader boundaries in the success of GLMs in output text simplification. Future research must establish how GLMs can reliably personalize medical texts to prespecified education levels to enable a broader impact on health care literacy.

The effect of health literacy on patient compliance in patients to whom prostate biopsies were recommended.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is the gold standard diagnostic method for prostate cancer. In people with low health literacy, accurate and early diagnosis rates decrease, making it difficult to maintain health and compliance with treatment. In our study, we investigated how health literacy and sociocultural parameters affected compliance and awareness in patients with suspected prostate cancer, for whom TRUS-Bx was planned. METHODS: In the study, 98 male patients aged 50-80 years, recommended for TRUS-Bx, were included in our study. The data including age, prostate-specific antigen, prostate volume, digital rectal examination findings, education leveland area of residence of the patients included in the study were recorded. Health Literacy Survey-Turkey- Questionnaire 47 and Turkish Health Literacy Scale-32 forms were completed by the patients who agreed to participate in the study, and their scores were recorded. Patients scheduled for TRUS-Bx were divided into two groups: those who attended their appointments and underwent the biopsy, and those who did not attend their scheduled appointments. The effect of health literacy and other parameters on the TRUS-Bx requirement was examined between the two groups. Furthermore, 52 patients who underwent TRUS-Bx were divided into two groups as malignancy (malignant) detected and not-detected (benign) patients according to the pathology results, and the parameters were analyzed separately for these groups. RESULTS: The education level of the patients who underwent the TRUS-Bx procedure was found to be statistically higher (p = 0.026). Health Literacy Survey-Turkey- Questionnaire 47 and Turkish Health Literacy Scale-32 scores were statistically significantly higher in the TRUS-Bx group (p = 0.001, p < 0.001, respectively). In the logistic regression analysis, education level, Health Literacy Survey-Turkey- Questionnaire 47 and Turkish Health Literacy Scale-32 were found to be important predictors for awareness of the requirement for TRUS-Bx. CONCLUSION: The study's findings indicate that patients with higher health literacy and education levels were more likely to receive an early diagnosis and promptly proceed with the recommended TRUS-Bx after visiting a urologist.

Health-related word recognition and pronunciation by patients in Gauteng, South Africa in English and native languages.

BACKGROUND:  Low health literacy has been found to affect people's ability to take care of their own health and follow the principles of disease prevention. Incomprehension of health education and healthcare instructions may lead to poor health outcomes. AIM:  The aim of the study was to describe and compare a sample of primary healthcare patient's ability to recognise and pronounce health-related words in English and in his or her native language. SETTING:  The study was conducted in 12 primary healthcare (PHC) clinics in Gauteng, South Africa. METHODS:  A prospective, quantitative, comparative research design using a survey method was used to assess the ability to recognise and pronounce health-related words of 401 respondents using the REALM-R (SA) tool. RESULTS:  Most respondents were 18-29 years (32%) and 30-49 years (53%) old. More than half (54%) of the respondents have completed grade 12 schooling. Adequate English health-related word recognition and pronunciation levels were at 19.5%, while native health-related word recognition and pronunciation levels were far better, ranging between 55.6% and 97.0%. CONCLUSION:  Respondents showed better word recognition and pronunciation of the health-related words in their native language than in English. Providing health information in the patient's native language and on their level of understanding may therefore improve patient health outcomes.Contribution: The study is the first of its kind to determine word recognition and pronunciation of health-related words in English and a native language of South African PHC patients. Knowing this may assist healthcare professionals to give health education and instructions on the patient's level of understanding.

Using Immersive Environments in E-Mental Health Rehabilitation Programs Directed to Future Health Professionals to Promote Empathy and Health Literacy about Schizophrenia.

Rehabilitation involves all types of patients, including people with schizophrenia. Schizophrenia is considered a complex syndrome characterized in general by fundamental and characteristic distortions of thinking and perception. The quality of life of a person with schizophrenia can be compromised by difficulty in carrying out their daily tasks and by the social stigma of their condition. The importance of training and sensitizing students in rehabilitation areas to this type of problem to improve the rehabilitation processes in which they will participate as future professionals involves empathy and the ability to communicate with these populations. It is possible through virtual reality to create immersive environments to simulate some psychotic symptoms characteristic of people with schizophrenia, such as visual hallucinations and hearing voices. The aim of this study was to test the effect of exposure to experiences characteristic of schizophrenia through two different types of immersive environments, graphical computational virtual reality and 360° video, on students from areas of social rehabilitation regarding empathy, social distance, and attitudes towards people with schizophrenia. Although the results were positive for the three parameters under study, no significant differences were found for each of them between the environments to which the participants were exposed. This study concluded that the choice between the two types of immersive environments should be based on the project's objectives, the target audience's needs, and available resources, rather than the type of environment itself, as their impact was similar.

Barriers to Engagement with Gastrointestinal Health Management.

BACKGROUND: Although behavioral interventions have been effective in gastrointestinal (GI) conditions, barriers exist in implementing these interventions into clinical practice. The majority of previously published studies have focused on workforce limitations and have not considered individual and social determinants of health (SDoH) factors that can impact engagement in GI behavioral healthcare. AIMS: To characterize barriers to engagement in appointment attendance and health management, explore individual and SDoH factors impacting GI behavioral healthcare engagement, and identify barriers that occur more often for patients with SDoH-related vulnerability (low health literacy and/or financial insecurity). METHODS: A survey was distributed to adult patients who had been seen in Gastroenterology at the Dartmouth-Hitchcock Medical Center from June 2022 to December 2022. RESULTS: One hundred participants [mean age = 58 years, 57.1% women] completed the survey. SDoH vulnerability was present in 32.3% of the population. For the entire sample, 73% reported at least one barrier to accessing care and 75% reported at least one factor which impacted health management. Those with SDoH vulnerability reported significantly more barriers to attending appointments and to managing health. In addition, they were significantly more likely to endorse physical health problems, difficulty affording medical bills, pain, mobility issues, trauma experiences, significant stress, and difficulty with concentration. CONCLUSIONS: Patients in a GI clinic reported multiple barriers to accessing care and participating in health management. Innovative, multi-level strategies are needed to address barriers to ensure that all patients are able to obtain quality GI behavioral health services.

Adaptation and validation of the All Aspects of Health Literacy Scale (AAHLS) in healthcare settings of Addis Ababa, Ethiopia.

BACKGROUND: Since health literacy is known to be related to health outcomes, it should be measured to explain how it is associated with the health status of the population. Health literacy tools are designed to measure different dimensions of health literacy of individuals based on their objective. The AAHLS tool is comprehensive and can cover all aspects of health literacy. Overall in Ethiopia, there is no standard health literacy tool that has been developed or/and validated. Therefore, the aim of this study was to adapt and validate the All Aspects of Health Literacy Scale (AAHLS) in healthcare facilities in Addis Ababa city, Ethiopia. METHODS: A mixed-method, facility-based, cross-sectional study was conducted in Addis Ababa city from February 1, 2022, to May 30, 2022. The study was conducted in three phases: forward and backward translation and expert review, cognitive interviews and survey administration. For the cognitive interviews, a total of 16 participants and for the survey administration, 199 participants were involved. Coding and analysis of the qualitative data were performed using OpenCode 4.03 computer software. Then, pretesting (survey administration) was conducted to check the validity and reliability of the tool. CFA was conducted using SPSS version 26 and Stata version 14. RESULTS AND DISCUSSION: The original three response categories were revised to five response categories based on the cognitive interview findings and expert reviews. The survey was administered to 199 participants, 55.8% of whom were males. The Kaiser‒Meyer‒Olkin measure of sampling adequacy was 0.685, with a significant difference according to Bartlett's test of sphericity (p < 0.001). After removing the empowerment factor model fit indices, the internal reliability and convergent and divergent validities improved. Confirmatory factor analysis showed that the model fit indices of the tool were satisfactory. The overall internal consistency, Cronbach's alpha, was 0.71. CONCLUSION: The three response categories of the tool were revised to five response categories. The AAHLS tool was revised to include 10 items. The tool has exhibited adequate model fitness. The validated tool can be used for future health literacy assessments and interventions.

Impacts of educational interventions of librarian instruction on health information seeking attitudes and behaviors in an employee wellness program.

Objective: Health literacy and its potential impacts on the wellbeing of patrons remain a highly regarded objective among health science and medical librarians when considering learning outcomes of patron communities. Librarians are positioned to champion literacy instruction activities. This study aimed to examine health information seeking attitudes and behaviors in an academic-based employee wellness program before and after health literacy workshops were developed and facilitated by an academic health sciences librarian. Methods: The intervention included instruction informed by Don Nutbeam's Health Literacy Framework and the Research Triangle Institute's Health Literacy Conceptual Framework. Sixty-five participants obtained through convenience sampling attended workshops and were invited to respond to pre- and post-session surveys. Using a quantitative quasi-experimental methodology, surveys collected health literacy indicators including preferred sources and handling practices of in-person and online health information. Results: Findings indicated workshops influenced information seeking behaviors as participants documented a decrease in social media use for health and wellness information (-36%) and medical information (-13%). An increase in the usage of consumer health databases (like Medline Plus) was also indicated post-workshop for health and wellness information (18%) and medical information (31%). Conclusion: Favorable impacts are evident in this small-scale study; however, more research is needed to confirm the influence of these methods on larger and more diverse populations. Librarians should continue to develop and disseminate theory-informed tools and methods aimed at engaging various communities in constructive health information seeking practices.

The Role of Health Literacy in Skin Cancer Preventative Behavior and Implications for Intervention: A Systematic Review.

BACKGROUND: Health literacy is essential for individuals to access, understand, and utilize information and services to inform health related decisions and actions. As one of the most diagnosed and preventable forms of cancer, skin cancer disease risk can be reduced through preventative behavior. Currently, there is no focused study looking specifically at health literacy and skin cancer. An understanding of how health literacy affects skin cancer-related preventive behaviors can improve current practices in skin cancer prevention. OBJECTIVE: To systematically identify, synthesize, and summarize findings on the role of health literacy in skin cancers (including cutaneous squamous cell carcinoma, basal cell carcinoma, and melanoma), with a focus on preventive behaviors using studies that utilized quantifiable health literacy measurements. METHODS: A literature search was performed by searching PubMed, Embase, PsycINFO, and CINAHL from inception until September 26, 2023 to identify cross-sectional, case-control, cohort, or randomized controlled studies that investigated the association between health literacy and skin cancer prevention and diagnosis. RESULTS: Health literacy levels varied across geographic regions, specific populations, and ethnicities. Most of the included studies found a positive association between higher health literacy and better skin cancer preventative behaviors. This included sun-protective behaviors such as: wearing sleeved shirts or shirts with collars, using gloves, covering head and face, limiting sun exposure, more sunscreen use, and less sunbathing or indoor tanning. Higher health literacy was associated with increased likelihood to engage in genetic testing and less family influence on health in one study which assessed determinants of interest in skin cancer genetic testing. Another study investigating family communication about skin cancer found that higher health literacy was associated with increased family communication regarding general cancer risk. One sun protection interventional education program was effective at increasing participants' knowledge, awareness of skin cancer risk, willingness to change sun protection, and use of sun protection, but results varied between ethnic groups. CONCLUSIONS: Skin cancer-related educational interventions can be effective in improving health literacy and potentially lessen the impact of skin cancer through positive behavior modification, early detection, and disease knowledge and awareness. Interventions need to be tailored to its target population to maximize effectiveness due to the varying baseline of health literacy identified across different geographic and ethnic groups. Protocol Registration PROSPERO CRD42022340826.

The digital readiness of future physicians: nurturing the post-pandemic medical education.

BACKGROUND: The COVID-19 pandemic has accelerated the integration of digital technologies in the healthcare sector. Telemedicine has notably emerged as a significant tool, offering a range of benefits. However, various barriers, such as healthcare professionals' insufficient technological skills and competencies, can hinder its effective implementation. Scholars have examined the readiness of future physicians, with some studies exploring their readiness before or during the COVID-19 crisis. There is, however, a noteable gap in the literature concerning the post-pandemic period. This study aims to identify gaps in current medical education programs by examining two primary aspects: (1) technical readiness (encompassing general and health-related digital competencies) and (2) behavioural readiness, which includes prior experiences and future intentions related to telemedicine education and implementation among medical students and residents. METHODS: A cross-sectional study was conducted using a web-based questionnaire administered to medical students and residents at a major Northern Italian university. The survey responses were analyzed to ascertain whether their distributions varied across demographic variables such as gender and level of education. RESULTS: The most commonly owned technologies were laptops and smartphones, with smartphones perceived as the easiest to use, while desktop computers presented more challenges. Approximately 38% of respondents expressed apprehension about applying digital health information in decision-making processes. There was a significant lack of both personal and academic experience, with only 16% of students and residents having used telemedicine in a university setting. Despite this, 83% of participants expressed a desire for training in telemedicine, and 81% were open to experimenting with it during their academic journey. Moreover, 76% of respondents expressed interest in incorporating telemedicine into their future clinical practice. CONCLUSIONS: This study highlights the need for medical students and residents to receive specific education in digital health and telemedicine. Introducing curricula and courses in this domain is critical to addressing the challenges of digital healthcare.

Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology.

BACKGROUND: Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. OBJECTIVE: This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. METHODS: Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. RESULTS: In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. CONCLUSIONS: Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL.

Toward a semiotics of midwifery: Multimodal communication's effects on accessibility, equity, and power dynamics.

According to semiotics, we live in a world of signs, where almost anything can act as a signifier and convey meaning. But what of the semiotic landscape of midwifery? What signs are present within a client's multi-sensory experience of their midwifery care? How are these signs functioning to increase equity and accessibility? Or worse, how might certain aspects of the client's experience communicate unjust power dynamics? Semiotics allows us to examine a wide communicative and educational environment. By paying particular attention to the multivalent meanings of different signs-be they written, visual, oral, or even physical-we can start to see how multimodal communication plays a vital role in a client's perception of equity and power. One way to improve client experience is by approaching education and semiotic experience from the same place as trauma-informed care. A more health-literate sensitive approach viewed through the lens of semiotics assumes all clients have little previous knowledge or comfort within a care setting. This hyperawareness and criticality of the semiotic environment would allow midwives to acknowledge various sensory and communicative biases and intentionally redesign the entire client experience. The semiotic landscape is then curated to meet the needs of the most important audience-those marginalized and discriminated against whether that is because of education, finances, race, gender, or any other intersectional identity. We must acknowledge the fact that all sign systems can either reinforce abusive power relations or work to improve them. For what is at stake here is not just a client's overall comfort, but their full understanding of the care they are receiving, the options they have, and their autonomy within their entire perinatal experience.

Predictors of dementia among the oldest old: longitudinal findings from the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)".

BACKGROUND/AIMS: Our current study aimed to investigate the determinants of dementia among the oldest old using longitudinal data from a representative sample covering both community-dwelling and institutionalized individuals. METHODS/DESIGN: Longitudinal representative data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" that surveyed community-dwelling and institutionalized individuals aged 80 years and above (n = 1,296 observations in the analytic sample), living in North Rhine-Westphalia (most populous state of Germany). The established DemTect was used to measure cognitive impairment (i.e., probable dementia). A logistic random effects model was used to examine the determinants of probable dementia. RESULTS: The mean age was 86.3 years (SD: 4.2 years). Multiple logistic regressions revealed that a higher likelihood of probable dementia was positively associated with lower education (e.g., low education compared to medium education: OR: 3.31 [95% CI: 1.10-9.98]), a smaller network size (OR: 0.87 [95% CI: 0.79-0.96]), lower health literacy (OR: 0.29 [95% CI: 0.14-0.60]), and higher functional impairment (OR: 13.45 [3.86-46.92]), whereas it was not significantly associated with sex, age, marital status, loneliness, and depressive symptoms in the total sample. Regressions stratified by sex were also reported. DISCUSSION: Our study identified factors associated with dementia among the oldest old. This study extends current knowledge by using data from the oldest old; and by presenting findings based on longitudinal, representative data (also including individuals residing in institutionalized settings). CONCLUSIONS: Efforts to increase, among other things, formal education, network size, and health literacy may be fruitful in postponing dementia, particularly among older women. Developing health literacy programs, for example, may be beneficial to reduce the burden associated with dementia.