Literacia em saúde da pessoa internada em serviço de cirurgia oncológica / Health literacy of patients admitted to a surgical oncology unit / Alfabetización en salud de las personas ingresadas en un servicio de cirugía oncológica

Resumo Enquadramento: A literacia em saúde (LS) é a capacidade da pessoa obter e traduzir informações a fim de manter e melhorar a saúde. Objetivo: Caracterizar o nível de LS da pessoa internada num hospital oncológico; avaliar a fiabilidade do instrumento European Health Literacy Survey in Portuguese (HLS-EU-PT). Metodologia: Estudo transversal, quantitativo, descritivo e metodológico. Amostra de 188 pessoas internados num serviço de cirurgia oncológica entre maio e setembro de 2020, os dados foram colhidos através de formulário de caracterização sociodemográfica, de saúde e instrumento de avaliação da LS. Resultados: O HLS-EU-PT apresentou elevado nível de consistência interna. Todos os domínios e níveis de processamento do instrumento se correlacionam positivamente entre si. Os participantes apresentam em média um nível problemático de LS. Conclusão: Os resultados indiciam a necessidade de um maior investimento na capacitação da LS. São necessários mais estudos nesta e noutras populações e contextos de prestação de cuidados de saúde, de forma a direcionar a prática de cuidados na resposta eficaz aos problemas de saúde.

Abstract Background: Health literacy (HL) is the ability of an individual to obtain and translate information in order to maintain and improve their health. Objective: To characterize the level of HL of patients admitted to an oncology hospital and assess the reliability of the Portuguese version of the European Health Literacy Survey (HLS-EU-PT). Methodology: Cross-sectional, quantitative, descriptive, and methodological study. Sample of 188 patients admitted to a surgical oncology unit between May and September 2020. Data were collected through a sociodemographic and health characterization form and a HL assessment tool. Results: The HLS-EU-PT had a high level of internal consistency. All domains and information-processing levels correlated positively with each other. Participants had on average a problematic level of HL. Conclusion: The results indicate the need for greater investment in HL training. Further studies are needed in this population and in other populations and healthcare settings to provide an effective response to health problems.

Resumen Marco contextual: La alfabetización en salud (AS) es la capacidad de una persona para obtener y traducir información con el fin de mantener y mejorar su salud. Objetivo: Caracterizar el nivel de AS de las personas ingresadas en un hospital oncológico; evaluar la fiabilidad del instrumento European Health Literacy Survey in Portuguese (HLS-EU-PT). Metodología: Estudio transversal, cuantitativo, descriptivo y metodológico. Muestra de 188 personas ingresadas en un servicio de cirugía oncológica entre mayo y septiembre de 2020, se recogieron datos mediante un formulario de caracterización sociodemográfica y de salud, y una herramienta de evaluación de AS. Resultados: El HLS-EU-PT mostró un alto nivel de consistencia interna. Todos los dominios y niveles de procesamiento del instrumento correlacionaron positivamente entre sí. Por término medio, los participantes tienen un nivel problemático de AS. Conclusión: Los resultados indican la necesidad de una mayor inversión en formación en AS. Son necesarios más estudios en esta y otras poblaciones, y en entornos sanitarios para orientar la práctica asistencial hacia una respuesta eficaz a los problemas de salud.

Validity and reliability of the translated Marathi version of the 14-item health literacy scale.

Introduction: Various tools for measuring health literacy are designed to assess reading comprehension and numeracy in English speakers. There is a need to develop a tool in the vernacular language and estimate health literacy levels in Indian settings. The present study was conducted with the objectives to develop a Marathi version of a 14-item health literacy scale (HLS-14) to test the reliability and validity of its Marathi version and to estimate the health literacy among patients attending the out-patient department at a tertiary care centre. Methodology: The present study was conducted among 50 adult patients attending the out-patient department of a tertiary hospital from July 2022 to December 2022. The 14-Item Health Literacy Scale available in English was translated into Marathi and back-translated to English, and the final version was developed. Bilingual study subjects were asked to fill the scales on day 0 and on day 7. Cronbach's alpha was calculated for internal validity, and the correlation coefficient was calculated for the reliability of the tool and health literacy was estimated. Results: When items of the Health Literacy Scale were analysed, all the items barring 2, 6, and 10 gave an r-value of more than 0.70, which shows good reliability of each translated item. The Cronbach's alpha value found for the current translated Marathi questionnaire is 0.66. Internal consistency is good. The mean total health literacy score was 51.16 ± 6.81. Conclusions: A translated Marathi version of HLS-14 is developed, which is valid and reliable. The health literacy among the study participants is marginal.

The impact of public art education on college students' mental health literacy.

Introduction: This study aims to explore the impact of public art education on the mental health literacy of College Students. Methods: Conducted over a four-month period, the intervention involved freshmen from a Chinese college, comparing 1,334 students in the experimental group with 1,139 in the control group. Data were collected through a self-developed questionnaire and a standardized mental health literacy scale before and after the intervention. Results: Results showed that the experimental group's overall mental health literacy score significantly increased from 64.051 pre-intervention to 79.260 post-intervention, while the control group showed no significant changes during the same period. The experimental group demonstrated significant improvements in their ability to identify psychological disorders, belief in receiving professional help, attitudes towards seeking appropriate help, and knowledge in seeking mental health information. Furthermore, the frequency of classroom interaction was positively correlated with improvements in mental health literacy (regression coefficient = 2.261***), highlighting the critical role of active participation in public art education settings. Conclusion: This study underscores the importance and effectiveness of implementing public art education in higher education and provides empirical support for future educational policies and practices.

Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis.

Objective: To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL). Methods: 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics. Results: The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants. Conclusion: This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL. Innovation: Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.

Relationship between awareness of digital game addiction, health literacy, and sociodemographic characteristics of mothers: A structural equation modeling analysis.

AIM: Mothers' digital game addiction awareness and their health literacy levels are critical factors for addiction prevention strategies in children. Therefore, the present study is significant. This study examines the relationship between awareness of digital game addiction, health literacy, and the sociodemographic characteristics of mothers. METHOD: This cross-sectional study was conducted with 457 mothers of children aged 5-11 years in Turkey. The data were collected using a personal information questionnaire, the Awareness of Digital Game Addiction Scale, and the Health Literacy Scale between May and September 2021. RESULTS: This study revealed that mothers are highly aware of digital game addiction and have high health literacy. Furthermore, health literacy was determined to significantly and directly affect awareness of digital gaming addiction. Awareness of digital gaming addiction significantly and directly affects children owning their own technological devices and how much time mothers spend with their children. CONCLUSION: The study's results confirmed that mothers' health literacy had a positive and statistically significant effect on awareness of digital gaming addiction. As the health literacy levels of mothers increased, the internal and external awareness of digital gaming addiction increased. It is recommended to design intervention programs that increase mothers' awareness of digital game addiction. These programs should be planned according to the health literacy levels of mothers.

Predictors of Intention to use Health Literacy Strategies in Patient Education among Health Care Professionals at Public Hospitals of Bahir Dar City: Application of Theory of Planned Behavior.

PURPOSE: Health literacy strategies were using plain language, using visual aids, using the teach-back method, limiting the number of items provided, and providing culture-sensitive care. This study aimed to assess predictors of intention to use health literacy strategies in patient education among healthcare professionals. DESIGN: An institutional-based cross-sectional study, theory of planned behavior. SETTING: Bahir Dar, Northwest Ethiopia, from March 10 to April 10, 2023. SUBJECTS: 422 healthcare professionals. MEASURES: Six items with a response range from 1 = strongly disagree to 5 = strongly agree each item was summed on a five-point Likert scale and its score range (6-30). ANALYSIS: Linear regression, SPSS version 25. RESULTS: A total of 389 healthcare professionals participated with a response rate of 92.18%. The overall mean intention towards health literacy strategies score was 24.02 with (SD ± 3.84). Subjective norm [(ß, .231; 95% CI: .129, .333)], attitude [ß, .162; 95% CI: .072, .252], perceived behavioral control [(ß, .121; 95% CI: .022, .221)], having got training [(ß, .125; 95% CI: .348, .530)] and knowing health literacy [(ß, .251; 95% CI: .131, .371)] were factors. CONCLUSION: The mean score of intention to use health literacy strategies was very low. Attitude, subjective norm, perceived behavioral control, training, and knowledge of health literacy strategies were predictors. Therefore, different strategies should be applied to increase the utilization of health literacy strategies.

Measurement properties of the Mental Health Literacy Scale (MHLS): A systematic review.

BACKGROUND: Since its creation, the Mental Health Literacy Scale (MHLS) has been used worldwide in mental health literacy studies. OBJECTIVE: This study aimed to systematically evaluate, summarize, and compare the measurement properties of MHLS validation studies. METHODS: PsycINFO, CINAHL, ERIC, Scopus, Embase, MEDLINE, and PubMed databases were searched from May 30, 2015, to December 31, 2023. Peer-reviewed studies validating the MHLS and its measurement properties were included, irrespective of language, study population, and setting. Studies using the MHLS as an outcome measure, as a comparative instrument to validate another instrument, or using other MHL measures and grey literature was excluded. RESULTS: Of the 685 search results, 16 studies were deemed eligible. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) RoB criteria showed 15/15 studies exhibited 'Very Good' or 'Adequate' internal consistency, 3/6 reliability, 1/8 content validity, 14/14 structural validity, 6/7 hypothesis testing for convergent validity, 2/7 hypothesis testing for known-group validity, and 0/1 error measurement. The Cronbach's alpha ranged from 0.720 to 0.890, and the Intra-class Correlation Coefficient ranged from 0.741 to 0.99, while content validity was limited regarding the quality of evidence rating. The four-factor and unidimensional structures were 35.7 % and 28.6 %, respectively, the most common models. CONCLUSION: The MHLS exhibited strong evidence of construct validity and reliability, ensuring consistent and accurate evaluation of MHL and improving research credibility and generalizability. However, the low number of identical language versions of MHLS studies prohibited statistical pooling and quantitative summaries.

Needed competence for registered nurses working at a patient-centred telehealth service aimed to engage and empower people living with COPD: A five-month participatory observational study.

BACKGROUND: The global population of older aged 65 and over is increasing, which means an increase in people living with long-term health conditions and multimorbidity. Implementing new digital health technologies enables increased patient empowerment and responsibility, and the ability to respond to changes in their condition themselves, with less involvement of healthcare professionals. Important parameters need to be addressed for this digitally enabled empowerment to be successful, these include increased individual and organizational health literacy, the establishment of joint decision-making activities among patients and healthcare professionals, and efforts that target the individual's ability to manage their condition, which include education to increase skills and providing technology for self-monitoring. OBJECTIVE: To identify needed competencies of digital healthcare professionals to be able to provide the needed services to service users with chronic obstructive pulmonary disease in a 24/7 digital healthcare service. METHOD: Five registered nurses' work was observed weekly for five months. In total 13 participatory observations were conducted. Data from the observations was transcribed and analysed through inductive content analysis. RESULTS: Five main categories were identified in the analysis; 1) tasks, 2) communication, 3) the relationships between the registered nurses, 4) service users, and 5) technology. These categories contain different competencies needed for registered nurses working in a digitalized healthcare system. CONCLUSIONS: Future digital healthcare professionals will require several competencies, to be able to deliver proper care in a digital health community that goes beyond traditional healthcare competencies, including social, technological, and communication skills.

Health Literacy and Health-Related Quality of Life in Older Adults With Mild Cognitive Impairment.

OBJECTIVES: Health literacy is considered crucial in health status outcomes, but little is known about the association among cognitively impaired persons. This study investigated the association between health literacy and health-related quality of life (HRQoL) in older adults with mild cognitive impairment (MCI). We further examined whether the association between health literacy and HRQoL depends on age, sex, and educational attainment. DESIGN: A cross-sectional study was conducted between January and December 2022. SETTING AND PARTICIPANTS: The study population was 233 older adults with MCI who visited the Veterans Health Service Medical Center in Korea. METHODS: The diagnosis of MCI was confirmed by a physician based on clinical and neuropsychological assessments. The European Health Literacy Survey Questionnaire and EuroQol Five Dimensions Questionnaire were used to measure the health literacy and HRQoL of the participants. RESULTS: HRQoL was significantly correlated with health literacy (r = 0.25, P ≤ .001) and its 3 subdomains (r = 0.27, P ≤ .001 for health care; r = 0.19, P = .004 for disease prevention; and r = 0.18, P = .005 for health promotion). After adjustment for potential covariates, older adults with higher levels of health literacy were significantly associated with better HRQoL: ß = 0.02 (P = .0021) for health literacy, ß = 0.07 (P = .0001) for health care, and ß = 0.04 (P = .0443) for disease prevention. The interactions between HRQoL and health literacy with the specific variables of age, sex, and education demonstrated a statistical significance (ß = 0.02 with age, ß = 0.03 with sex, and ß = 0.06 with education). CONCLUSIONS AND IMPLICATIONS: There was a significant association between health literacy and HRQoL among older adults with MCI. This finding suggests that improving health literacy of older adults with MCI may enhance HRQoL. An education intervention is recommended to reduce the existing health disparities due to low health literacy.

Analysis of health literacy demands in the Food Guide for the Brazilian Population

The present study aims to identify the health literacy demands, organized based on their different domains, present in the second edition of the Dietary Guidelines for the Brazilian Population (2014). It is an exploratory-descriptive study, based on the application of a protocol, previously validated for the national context, for health literacy load analysis of the material, with subsequent content analysis of selected excerpts, organized in a matrix. The analysis of the results identified possible barriers to understanding and make meaning of the Guide recommendations, organized according to the fundamental, scientific, civic, and cultural domains of health literacy, which ranged from the use of non-colloquial language and jargon to the impossibility of following the recommendations present therein, due to the context of the social group. The results point to the need to bring the form and content of the material closer to the health literacy demands of its potential beneficiaries, facilitating access, understanding, evaluation and significance of its recommendations by health workers and groups of the population for whom it is intended.

The present study aims to identify the health literacy demands, organized based on their different domains, present in the second edition of the Dietary Guidelines for the Brazilian Population (2014). It is an exploratory-descriptive study, based on the application of a protocol, previously validated for the national context, for health literacy load analysis of the material, with subsequent content analysis of selected excerpts, organized in a matrix. The analysis of the results identified possible barriers to understanding and make meaning of the Guide recommendations, organized according to the fundamental, scientific, civic, and cultural domains of health literacy, which ranged from the use of non-colloquial language and jargon to the impossibility of following the recommendations present therein, due to the context of the social group. The results point to the need to bring the form and content of the material closer to the health literacy demands of its potential beneficiaries, facilitating access, understanding, evaluation and significance of its recommendations by health workers and groups of the population for whom it is intended.

Evaluating cancer patient-reported experience measures against health literacy best practices.

PURPOSE: Positive patient experiences can lead to better adherence to cancer treatment and greater patient health outcomes. The primary aim of this descriptive study was to determine whether commonly used cancer PREMs have been developed according to health literacy best practices. The secondary and third aims were to examine the development of PREMs and to assess their comprehensiveness against principles of patient-centered care. METHODS: To assess adherence to best practice literacy principles regarding readability and understandability of commonly used cancer PREMs, three validated readability calculators and a validated instrument were utilized. To better understand how PREMs were developed, data about survey items, patient involvement, and expert consultation were collected. Finally, the Picker framework was used to evaluate the comprehensiveness of PREMs against principles of patient-centered care. RESULTS: Thirty-five PREMs studies met inclusion criteria for the study. The mean reading grade level of cancer PREMs was 9.7 (SD = 0.75, range = 8.2-11.2) with best practice recommendation being a grade 6 reading grade level. Twenty-eight PREMs were rated on understandability, with a mean score of 74% (SD = 10.6, range = 46-93%, with optimal score of greater than 80%). The mean number of items across PREMs was 49 (SD = 31, range = 13-136). Recommendations for the number of items to include in a questionnaire is 25-30 items. Most PREMs (n = 33, 94.3%) asked ≥ 1 double-barreled question. All PREMs addressed ≥ 2 patient-centered care principles. CONCLUSION: Cancer PREMs included in this study did not meet evidence-informed thresholds for readability and understandability. As such, it is possible that there may be gaps in how we understand the care experiences of low health literacy populations. Future development of PREMs should engage patients with low health literacy to ensure their perspectives are accurately captured and that PREMs are designed to meet the needs of all patients.

Digital empowerment in mental health: A meta-analysis of internet-based interventions for enhancing mental health literacy.

Background: Poor mental health literacy (MHL) in the global population significantly contributes to the treatment gap associated with mental disorders. In the digital age, leveraging Internet-based MHL interventions offers scalability and broader accessibility. This meta-analysis aimed to evaluate the effects of Internet-based interventions in improving MHL and mental health. Method: Up to Feb 2024, seven databases were searched for Internet-based interventions on MHL (knowledge, stigma, help-seeking attitudes and intentions) and mental disorders (general distress, anxiety, and depressive symptoms). The random-effects meta-analyses at post-intervention and long-term follow-up assessments were performed. Results: Twenty-nine eligible studies involving 11,582 participants were included. Significant positive effects were observed across various domains: knowledge increase (immediate: g = 0.459, 95 %CI: 0.285 to 0.634; follow-up: g = 0.487, 95 %CI: 0.348 to 0.626), immediate stigma reduction (g = -0.332, 95 %CI: -0.479 to -0.186), immediate enhancement of help-seeking attitudes (g = 0.168, 95 %CI: 0.046 to 0.3291) and help-seeking intentions (g = 0.135, 95 %CI: 0.072 to 0.198), as well as immediate mental health improvements (g = -0.074, 95 %CI: -0.115 to -0.033). Conclusion: Overall, these findings underscore the promising effects of internet-based interventions in improving MHL and mental health, while maintaining these effects over time remains challenging, particularly in reducing stigma and promoting long-term help-seeking behaviors. Addressing methodological limitations, adopting a more interactive approach, and implementing targeted interventions are crucial to maximizing the effectiveness and advancing mental health care worldwide.

The Effect of Health Literacy on Health Status in Patients with Heart Failure: A Path Analysis.

Background: Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention. Methods: This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data. Results: The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2±19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status. Conclusion: Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers.

Research on the status and influencing factors of maternal health literacy among postpartum women in urban villages.

AIM: To comprehensively identify the status and influencing factors on maternal health literacy among postpartum women in Guangzhou urban villages. DESIGN: An explanatory sequential mixed-method research was conducted from November 2021 to July 2022. METHODS: The quantitative survey was conducted among postpartum women in Guangzhou urban villages using the convenience sampling principle, and a questionnaire survey was used to reflect the status and influencing factors on maternal health literacy. The qualitative interview conducted purposive sampling based on the survey and semi-structured interviews with women to supplement the non-quantifiable influencing factors. RESULTS: The quantitative survey showed that the maternal health literacy score of 501 women was 193.84 ± 22.23. The quantitative results suggested that ethnicity, education, income, household registration, delivery mode and social support were important influencing factors (p < .15). The qualitative interviews were conducted with 16 women and revealed three themes and eight sub-themes, including demographic factors (ethnicity, education, income, occupation and family history), pregnancy factors (delivery mode and pregnancy complications) and social factors (social support), which influenced maternal health literacy through three routes: women's motivation, access and ability in screening health information. CONCLUSION: Maternal health literacy among postpartum women in urban villages needs to be improved, especially critical health literacy. Maternal and infant workers need to guide women to develop appropriate health information concepts and consider the realistic knowledge needs of women in different socio-cultural and economic backgrounds. They should also construct a comprehensive social support system for women to better improve maternal health literacy. IMPACT: Highlights the positive benefits of maternal health literacy among postpartum women, as preparation for providing accurate and effective maternal and child health education services. PATIENT OR PUBLIC CONTRIBUTION: The information on maternal health literacy in this study was based on an interview with postpartum women in Guangzhou urban villages during the study period.

Health literacy and its association with antibiotic use and knowledge of antibiotic among Egyptian population: cross sectional study.

BACKGROUND: High prevalence of inappropriate antibiotic use in different sectors of the community indicates a possible strong influence of social and cultural context, which may be influenced by social determinants of health and thereby affecting individuals' health-related behavior, including antibiotic use. And such health-related behavior is largely determined by individuals' health literacy. OBJECTIVE: The purpose of this research was to examine the relationship between the Egyptian population's health literacy, antibiotic use, and antibiotic knowledge. METHOD: In Egypt, researchers used a cross-sectional study design, between the period of January and March 2024 using validated questionnaires and recruited a convenient sample of adults from seven governorates representing different geographic areas, and socioeconomic and educational backgrounds with the help of the validated questionnaires the HLS-EU-Q16, a shortened version of the European Health Literacy Survey Questionnaire (derived from the World Health Organization's Antibiotic Resistance: Multi-Country Public Awareness Survey) and, familiarity with drugs and understanding of antibiotic resistance via online methods and face-to-face interviews. RESULTS: The survey included a participation of 500 persons in total. The participants' age distribution indicated that 28.8% (n = 144) were aged 18-24, while 27.4% (n = 137) were within the 25-34 age group. Moreover, a total of 274 participants, accounting for 54.8% of the sample, described themselves as female. Significantly, 60.7% of the patients indicated acquiring antibiotics without a prescription. The evaluation of health literacy (HL) levels among the participants revealed that 36.2% had problematic HL, while 8.4% showed inadequate HL. A strong positive link was found between the scores of antibiotic knowledge and the scores of HL (R = 0.876; P-value = 0.001). CONCLUSION: Overall, it is imperative to implement awareness-raising curricula and public health education initiatives without delay. Furthermore, it is highly advised to implement public health awareness initiatives about the appropriate use of antibiotics, alongside national policies aimed at regulating the availability and prescription of antibiotics.

College students' utilization of the Internet to search for mental health information: Effects on mental health literacy, stigma, and help-seeking.

OBJECTIVE: The current study examined how college students search online for mental health information and the impact of these searches on mental health literacy, stigma, and help-seeking. METHOD: Undergraduate participants (N = 270; Fall 2015 to Spring 2019) were randomly assigned to search online for information about coping with anxiety for themselves or a friend (experimental activity), or to utilize Google Maps to answer navigational questions (control). RESULTS: Participants who conducted an online search demonstrated greater mental health literacy including optimism about psychotherapy, and lower levels of certain types of stigma, but lower willingness to seek/recommend professional help. Participants were more likely to recommend professional help for a friend compared to themselves. CONCLUSIONS: Online searches for mental health information have the potential to increase mental health literacy. Universities can harness the Internet to reduce help-seeking barriers but should also address when it is appropriate to engage in self-help versus seek professional help.

Enhancing Digital Health Awareness and mHealth Competencies in Medical Education: Proof-of-Concept Study and Summative Process Evaluation of a Quality Improvement Project.

BACKGROUND: Currently, there is a need to optimize knowledge on digital transformation in mental health care, including digital therapeutics (eg, prescription apps), in medical education. However, in Germany, digital health has not yet been systematically integrated into medical curricula and is taught in a relatively small number of electives. Challenges for lecturers include the dynamic field as well as lacking guidance on how to efficiently apply innovative teaching formats for these new digital competencies. Quality improvement projects provide options to pilot-test novel educational offerings, as little is known about the acceptability of participatory approaches in conventional medical education. OBJECTIVE: This quality improvement project addressed the gap in medical school electives on digital health literacy by introducing and evaluating an elective scoping study on the systematic development of different health app concepts designed by students to cultivate essential skills for future health care professionals (ie, mobile health [mHealth] competencies). METHODS: This proof-of-concept study describes the development, optimization, implementation, and evaluation of a web-based elective on digital (mental) health competencies in medical education. Implemented as part of a quality improvement project, the elective aimed to guide medical students in developing app concepts applying a design thinking approach at a German medical school from January 2021 to January 2024. Topics included defining digital (mental) health, quality criteria for health apps, user perspective, persuasive design, and critical reflection on digitization in medical practice. The elective was offered 6 times within 36 months, with continuous evaluation and iterative optimization using both process and outcome measures, such as web-based questionnaires. We present examples of app concepts designed by students and summarize the quantitative and qualitative evaluation results. RESULTS: In total, 60 students completed the elective and developed 25 health app concepts, most commonly targeting stress management and depression. In addition, disease management and prevention apps were designed for various somatic conditions such as diabetes and chronic pain. The results indicated high overall satisfaction across the 6 courses according to the evaluation questionnaire, with lower scores indicating higher satisfaction on a scale ranging from 1 to 6 (mean 1.70, SD 0.68). Students particularly valued the content, flexibility, support, and structure. While improvements in group work, submissions, and information transfer were suggested, the results underscore the usefulness of the web-based elective. CONCLUSIONS: This quality improvement project provides insights into relevant features for the successful user-centered and creative integration of mHealth competencies into medical education. Key factors for the satisfaction of students involved the participatory mindset, focus on competencies, discussions with app providers, and flexibility. Future efforts should define important learning objectives for digital health literacy and provide recommendations for integration rather than debating the need for digital health integration.

Evaluation of adolescents' cardiovascular health behaviors and health literacy levels in Turkey.

PURPOSE: The study aimed to examine the relationship between cardiovascular health behaviors and health literacy levels of adolescents. DESIGN AND METHODS: Cross-sectional design was used in this study. The sample consisted of 1228 students from two secondary schools in Turkey. The study data were collected in 2020. The data were collected via the Cardiovascular Health Behavior Scale and the The Health Literacy Scale. RESULTS: Cardiovascular Health Behavior Scale for Children mean score was 56.07 ± 10.80. The Health Literacy Scale total mean score of the students was 30.93 ± 5.31. The mean scores of the Cardiovascular Health Behavior Scale for those who were 14 years old, female, studying in the 8th grade, whose parents were primary school graduates, and presence of a person who has had a heart attack in the family were found to be statistically significantly higher. The average health literacy score of students who were female, high income, and who had parents with a baccalaureate or graduate degree was found to be statistically significantly higher. The Cardiovascular Health Behavior Scale and The Health Literacy Scale showed a weak negative correlation. CONCLUSIONS: The cardiovascular health behaviors and health literacy of adolescents were found to be moderate. In order to improve adolescents' health literacy and help them develop good cardiovascular health habits from an early age, interventions should be planned and overseen in collaboration. PRACTICE IMPLICATIONS: Adolescent health promotion requires that nurses assess adolescents' cardiovascular health behaviors and health literacy levels. To achieve the objectives of enhanced cardiovascular health behaviors and better health literacy, parent cooperation is also required.

The association between health literacy and screening for disease-specific complications among community-dwelling adults with diabetes.

Introduction: Diabetic retinopathy and nephropathy are examples of complications of uncontrolled diabetes. We hypothesized that health literacy has a defining role in understanding the importance of attending routine screening for diabetes complications. Therefore, our study investigated the relationship between verbal health literacy (VHL) and written health literacy (WHL) and screening for disease-specific complications in individuals with diabetes. Methods: Cross-sectional data on 28,210 participants with diabetes was derived from the 2021 Korean Community Health Survey. Adjusted multiple logistic regression analysis was employed to investigate the association between VHL and WHL and diabetes complication screening. Further analysis was also carried out to further comprehend the relationship between those two forms of health literacy and other factors with diabetic retinopathy and nephropathy screening. Results: Compared to those with high VHL, participants with low VHL had lower odds of diabetes complication screening; OR 0.89 (95% CI 0.84-0.95). The same was true for WHL, those who were uninterested reported the lowest odds ratio; OR 0.73 (95% CI 0.69-0.78), followed by low WHL; OR 0.88 (95% CI 0.82-0.94), of undergoing diabetes complication screening, when compared to individuals with high WHL. Our subgroup analysis presented similar results for diabetic nephropathy and retinopathy with both VHL and WHL. Conclusion: Among individuals with diabetes, limited VHL and WHL was significantly associated with lower odds of diabetes complication screening. Interventions aimed at improving health literacy and associated health outcomes in the community setting are warranted.

Influence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy.

BACKGROUND: In the information age of health care, nurses often face information overload, leading to negative emotions, e.g., anxiety that may impede the adoption of evidence-based practice and clinical decision-making process. Nurses with higher digital health literacy can effectively process and manage information. Despite this, no research has explored the relationship between information anxiety, digital health literacy, and core competency among nurses. Therefore, this study aims to investigate the mediating effects of digital health literacy on information anxiety and core competency among nurses. METHODS: From July to October 2023, the data for this cross-sectional study were collected. The study surveyed a total of 608 nurses from three tertiary hospitals in Fujian Province, and the survey instruments included a sociodemographic information questionnaire, Chinese revision version of the Digital Health Literacy Instrument (CR-DHLI), Information Anxiety Scale (IAS), and Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and Pearson correlation analysis were conducted using SPSS 29.0, and the mediating effect of digital health literacy was examined using Mplus. RESULTS: The mean score of nurses' information anxiety, digital health literacy, and core competency was 3.03 ± 0.91, 2.46 ± 0.56, 2.72 ± 0.88, respectively. And the mediation model of information anxiety on core competency for nurses showed a good model fit index (χ²/df = 2.207, CFI = 0.985, TLI = 0.982, RMSEA = 0.045, SRMR = 0.035). Digital health literacy was positively correlated with nurses' core competency but negatively correlated with information anxiety. The results of path analysis revealed that information anxiety had negative and significant direct effects on NCC (ß = -0.119, P = 0.004) and DHL (ß = -0.297, P < 0.001). DHL had a positive effect on NCC (ß = 0.306, P < 0.001). Digital health literacy played a partial mediating role, accounting for 43.54% of the relationship between information anxiety and nurses' core competency. CONCLUSIONS: Information anxiety among nurses was at relatively high levels, which had a negative impact on the core competency of nurses. This issue requires attention from nursing managers. The mediating role of digital health literacy in the relationship between information anxiety and core competency among nurses has been established. Nursing managers should strengthen the evaluation of nurses' DHL and devise effective support strategies to enhance DHL, thus improving the core competence of nurses in information age.