The right pick: Does a self-assessment measurement tool correctly identify health care consumers with inadequate health literacy?

OBJECTIVES: The aim of this study was to investigate whether a self-report measurement instrument (the Brief Health Literacy Screen, BHLS) correctly identifies healthcare consumers with inadequate health literacy. The yardstick for assessing the tool was the Newest Vital Sign (NVS). METHODS: The study used baseline data from the Västerbotten Intervention Programme - VIsualiZation of Asymptomatic Atherosclerotic disease for Optimum Cardiovascular Prevention (VIPVIZA), a randomized controlled trial that is nested within the Västerbotten Intervention Program (VIP) in Sweden. Our analyses were computed on a subsample of 460 persons who underwent the measure of both health literacy scales. ROC analysis was used for the crucial computations. RESULTS: The potential of the BHLS to identify healthcare consumers with inadequate health literacy remained unsatisfying for the complete sample, but reached an acceptable level for women and persons with only basic education. CONCLUSIONS: The relationship is somewhat weaker than in comparable research in various other European countries. The differences might partly have been caused by the use of self-perception questions. Self-delusions, invariably a part of self-perception, may have affected the respective measure. PRACTICE IMPLICATIONS: Caution is advised when patients' health literacy is assessed by only a few questions for self-report.

Effects of Objective and Subjective Health Literacy on Patients' Accurate Judgment of Health Information and Decision-Making Ability: Survey Study.

BACKGROUND: Interpreting health information and acquiring health knowledge have become more important with the accumulation of scientific medical knowledge and ideals of patient autonomy. Health literacy and its tremendous success as a concept can be considered an admission that not all is well in the distribution of health knowledge. The internet makes health information much more easily accessible than ever, but it introduces its own problems, of which health disinformation is a major one. OBJECTIVE: The objective of this study was to determine whether objective and subjective health literacy are independent concepts and to test which of the two was associated more strongly with accurate judgments of the quality of a medical website and with behavioral intentions beneficial to health. METHODS: A survey on depression and its treatments was conducted online (n=362). The Newest Vital Sign was employed to measure objective, performance-based health literacy, and the eHealth Literacy Scale was used to measure subjective, perception-based health literacy. Correlations, comparisons of means, linear and binary logistic regression, and mediation models were used to determine the associations. RESULTS: Objective and subjective health literacy were weakly associated with one another (r=0.06, P=.24). High objective health literacy levels were associated with an inclination to behave in ways that are beneficial to one's own or others' health (Exp[B]=2.068, P=.004) and an ability to recognize low-quality online sources of health information (ß=-.4698, P=.005). The recognition also improved participants' choice of treatment (ß=-.3345, P<.001). Objective health literacy helped people to recognize misinformation on health websites and improved their judgment on their treatment for depression. CONCLUSIONS: Self-reported, perception-based health literacy should be treated as a separate concept from objective, performance-based health literacy. Only objective health literacy appears to have the potential to prevent people from becoming victims of health disinformation.

Unsusceptible to Social Communication? The Fixture of the Factors Predicting Decisions on Different Vaccinations.

Protection Motivation Theory (PMT) holds that individuals under threat base their protection decisions on threat and coping appraisals. In the case of preventable communicable diseases, the theory holds that motivation for vaccination will be higher the more alarming a person's threat appraisals and the more promising her coping appraisals are. This study aims at describing how the influence model of PMT accommodates different changes and conditions: the addition of new factors such as knowledge, health literacy, and attitudes, and the inclusion of several highly similar threats in the form of different communicable diseases. The question raised is: Do people, when making vaccination decisions, think of vaccination as a unified entity or as separate units? In the first case, they would show similar factors across different vaccinations, probably thinking of the common biomedical functioning of vaccination. In the latter case, the predictors would change from vaccination to vaccination, and people might have different treatments of the subject in public communication on their minds. Data came from a representative survey among adult Swiss residents. Among the results are the following: PMT is affirmed; people show a unified way of determining their motivation to vaccinate; knowledge contributes strongly to protection motivation; and neither public discussion of threats nor experiences among acquaintances shows much of an impact.

Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis.

BACKGROUND: Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people's ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. OBJECTIVE: We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. METHODS: Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one's general practitioner (GP). Path analysis was employed for data analysis. RESULTS: We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. CONCLUSIONS: The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary.

Introducing the chronic disease self-management program in Switzerland and other German-speaking countries: findings of a cross-border adaptation using a multiple-methods approach.

BACKGROUND: Stanford's Chronic Disease Self-Management Program (CDSMP) stands out as having a large evidence-base and being broadly disseminated across various countries. To date, neither evidence nor practice exists of its systematic adaptation into a German-speaking context. The objective of this paper is to describe the systematic German adaptation and implementation process of the CDSMP (2010-2014), report the language-specific adaptation of Franco-Canadian CDSMP for the French-speaking part of Switzerland and report findings from the initial evaluation process. METHODS: Multiple research methods were integrated to explore the perspective of workshop attendees, combining a longitudinal quantitative survey with self-report questionnaires, qualitative focus groups, and interviews. The evaluation process was conducted in for both the German and French adapted versions to gain insights into participants' experiences in the program and to evaluate its impact. Perceived self-efficacy was measured using the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G). RESULTS: Two hundred seventy eight people attending 35 workshops in Switzerland and Austria participated in the study. The study participants were receptive to the program content, peer-led approach and found principal methods useful, yet the structured approach did not address all their needs or expectations. Both short and long-term impact on self-efficacy were observed following the workshop participation (albeit with a minor decrease at 6-months). Participants reported positive impacts on aspects of coping and self-care, but limited effects on healthcare service utilization. CONCLUSIONS: Our findings suggest that the process for cross-border adaptation was effective, and that the CDSMP can successfully be implemented in diverse healthcare and community settings. The adapted CDSMP can be considered an asset for supporting self-management in both German-and French-speaking central European countries. It could have meaningful, wide-ranging implications for chronic illness care and primary prevention and potentially tertiary prevention of chronic disease. Further investigations are needed to tailor the program for better access to vulnerable and disadvantaged groups who might benefit the most, in terms of facilitating their health literacy in chronic illness.

H1N1 Influenza Pandemic in Italy Revisited: Has the Willingness to Get Vaccinated Suffered in the Long Run?

BACKGROUND: The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians' willingness to get vaccinated in case of a novel influenza pandemic. DESIGN AND METHODS: We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012. RESULTS: Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one's life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance. CONCLUSIONS: The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter. Significance for public healthWhereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people's willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public's concerns when having to communicate during the next outbreak of pandemic influenza.

Causes, coping, and culture: a comparative survey study on representation of back pain in three Swiss language regions.

INTRODUCTION: This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations-back pain-and a third concept is added to the picture: culture. AIM: The aim of this study is (a) to explore the causal factors to which persons with back pain attribute the further course of their illness, (b) to find out whether the attributed causes are predictors of coping maxims, and (c) to find out whether cultural factors affect attributions and coping and moderate the relationship between the two. METHODS: A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking). RESULTS: Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases. IMPLICATIONS: The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers' communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations.

Effect of smoke-free legislation on Ticino gastronomy revenue.

OBJECTIVE: To provide evidence on the effects of smoke-free laws on gastronomy revenue in a European setting based on objective data. Damage to gastronomy revenue is a widely used argument against smoke-free legislation. METHOD: Gastronomy revenue in Ticino is compared with the rest of Switzerland before and after Ticino banned smoking from gastronomy in April 2007, being the first (and at the time of the study only) Swiss canton to do that. The study uses breakdowns by cantons of taxable revenue of gastronomy branches and retailers (for comparison) provided by the Swiss tax authorities for the years 2005-2008. RESULTS: Revenues of restaurants and bars were not damaged by the Ticino smoke-free law. Decreases in Ticino happened before the smoke-free law came into effect. Evidence for night clubs is inconclusive. DISCUSSION: The absence of detrimental effects on restaurant and bar revenue corroborates the gist of research on the subject from other countries. The argument that the decline of bar and restaurant sales prior to the implementation of the ban might have occurred in anticipation of the new regulation is not considered tenable.

Use of cognitive enhancement medication among northern Italian university students.

This study assesses the use of cognitive enhancement medication among university students in Northern Italy. It was conducted as a cross-sectional analysis on the basis of a paper-and-pencil survey of 77 undergraduate students attending courses in the Faculty of Medicine of the University of Milan, Milano, Italy. Although the share of students who have taken cognitive enhancement medication themselves in the past is still small (16%), the use of these drugs is rather common and freely communicated in some social circles. Enhancing the ability to study outside of the class was students' primary motive for use. Students who think that there is no or an acceptable risk involved in cognitive enhancement medication are more likely to take drugs and dietary supplements than those who perceive the risk as high.

Prior family communication and consent to organ donation: using intensive care physicians' perception to model decision processes.

ABSTRACT: Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no card is found on a potential donor, families have to be approached about donation. The aim of this paper is to model the role that some family communication factors play in the family decision to consent or not to organ donation by a brain dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open answers and comments. Eight heads of intensive care units (ICU) of Swiss hospitals and one representative from Swisstransplant were interviewed. Questions asked respondents to estimate the prevalence and effect of communication factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family of the deceased person is almost always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives' predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians' approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about it, make people think about organ donation and try to change unfavourable predispositions. ACKNOWLEDGEMENT: the authors wish to thank the interviewees whose collaboration has provided them an overview of today's situation in Switzerland.

What to eat in the land of cheese and chocolate: a content analysis of Swiss print media messages on a healthy diet.

This paper describes a specific coding scheme for measuring health-related media content on the level of single assertions and in relative complexity. The basic idea is to code messages into an if-part (nutrition, physical activity, body weight) and a then-part (weight and health). Detailed codeplans can then be used to determine the specific nature of the if- and then-parts of an assertion. An exemplary analysis of Swiss-German newspaper and magazine messages between March 1, 2003 and June 30, 2005 provides evidence of recommendations that are more or less in line with official suggestions for a healthy diet: Newspapers and magazines tell their readers to eat vegetables, fruit, grain and cereal products, dairy products, and to care about vitamin and minerals intake. They also advise to stay away from tobacco, alcohol, fast food, sugar, and animal fat. Results are interpreted as evidence for the existence of a rather good source for diet information in print media, which is, however, very likely to be counteracted by other media content.

An internet-based approach to enhance self-managementof chronic low back pain in the italian-speaking population of Switzerland: results from a pilot study.

OBJECTIVE: To illustrate the development and pilot evaluation of a website designed to enhance self-management of chronic low back pain for the Italian-speaking population of Switzerland. METHODS: 20 patients affected by chronic low back pain used a website--specifically created for the project--for a period of five months, under the monitoring of a team of health professionals. Evaluation was carried out by means of a telephone questionnaire administered at baseline and at the end of the intervention, and intermediate online user-testing performed in the fourth month of the intervention. A control group of 15 patients was created to assist the evaluation. RESULTS: Compared to the control group, results from the pilot evaluation suggest a decrease in the intensity of back pain in people with access to the website; an increase in physical activity; a reduction in both medical consultation and the use of painkillers, and a gain in declarative and procedural knowledge. This coincides with a general positive assessment of the website. CONCLUSION: The study supports the need to test the proposed approach on a wider scale.