Effectiveness of the refined health literacy course on improving the health literacy competencies of undergraduate nursing students: quantitative and qualitative perspectives.

People with limited health literacy comprise a high-risk group for adverse health outcomes. Nurses must be made aware of the importance of health literacy and communicate with patients in plain language, which will solve the obstacles for patients using health care services. Providing health literacy education for nurses is an important strategy for health literacy practices. This study aimed to develop a refined health literacy course for nursing students and evaluate its effectiveness. The study used a single-group pre- and post-test quasi-experimental design and conducted focus group interviews. The intervention was an eight-hour course and applied team-based learning combined with various teaching methods. The study enrolled second-year nursing students of a university in eastern Taiwan via convenient sampling. A self-reported structured questionnaire was used to compare the participants' familiarity with health literacy, attitude, confidence in oral communication, and ability in written communication before and after the course. To discuss the learning experience of the course, the study held two focus groups with 12 participants. A total of 81 participants completed the pre- and post-test questionnaires. The results showed that familiarity with health literacy (t=9.12, t<.001), attitude (t=4.89, t<.001), confidence in oral communication (t=4.12, t<.001), and ability in written communication (t=8.83, t<.001) showed improvement after the course. Data analysis of focus group interviews yielded two categories and seven themes for the learning experience, most of which showed participants' positive learning experiences in the health literacy course. The course effectively enhanced the nursing students' knowledge and attitude toward health literacy and the ability to communicate with patients using health literacy principles. The results can provide a reference for integrating health literacy education into the undergraduate nursing curriculum.

Health literacy training program for community healthcare providers using hybrid online team-based learning in Taiwan.

BACKGROUND: Health literacy (HL) has proven to be a determining factor influencing the health of individuals. Community health providers (CHPs) work on the front line of improving public HL. Increasing their understanding of HL and their ability to incorporate HL into healthcare can reduce obstacles in healthcare services. This study evaluated the effectiveness of an HL training program for CHP by using the hybrid online team-based learning (TBL) model. METHODS: A quasi-experimental study and focused group interviews were conducted. We developed a six weeks HL online course for CHPs. The program included teaching videos for pre-class preparation, a 90-min online TBL model, and a case discussion in the last two weeks. Team application activities were designed for each class to enhance knowledge application. A total of 81 CHPs from 20 public health centers took the course and provided complete data for analysis. Learning effectiveness was evaluated based on the familiarity, attitude, and confidence in implementing HL practices, course satisfaction, and participants' learning experiences. RESULTS: The comparison showed that the participants' familiarity with HL (4.29 ± 1.76 vs 6.92 ± 1.52, p < .001), attitude (7.39 ± 1.88 vs 8.10 ± 1.44, p = .004), and confidence in implementing HL practices (6.22 ± 1.48 vs 7.61 ± 1.34, p < .001) increased after the course. The average satisfaction with the teaching strategies was 4.06 ± .53 points, the average helpfulness to practice was 4.13 ± .55 points, and the overall feedback on satisfaction with learning was 4.06 ± .58 points (the full score was 5 points). According to the learning experience of the 20 participants in the focus group discussion, the experiences of teaching strategies and the learning experiences of the HL course were summed up into two categories, seven themes, and 13 subthemes. The results showed a positive experience with the hybrid online TBL program. CONCLUSION: The use of hybrid online TBL model is a feasible and valid approach for the HL training of CHPs. The result can serve as a reference for the on-the-job training of various healthcare workers.

[The Effectiveness of a Shared Reading Program Among Parents of Newborns].

BACKGROUND: Early parent-child shared reading has been demonstrated to promote the development of literacy, reading skills and learning achievement in young children. Parent-child shared reading intervention programs may strengthen the willingness and reading competence of parents. PURPOSE: To explore the attitudes and skills related to parent-child shared reading before and after an intervention program conducted in a nursery room and outpatient pediatric clinic. METHODS: A single-group pretest-posttest quasi-experimental design was conducted. Seventy-five parents of newborns in the baby rooms from two hospitals in Hualien County were conveniently sampled. Parents who had just given birth received health education before discharge from the hospital from nurses focusing on the knowledge and skills of shared reading. Three age-matched picture books with reading fact sheets and consultation support were offered free to parents of children in three, respective, age groups (newborn, 4-months old and 6-months old) during parent-child visits to the pediatric clinic for regular health examinations and vaccinations. A self-designed questionnaire was administered to analyze the parents' demographic variables, reading environment, parents' attitudes toward parent-child shared reading, and familiarity with regard to parent-child shared reading skills. RESULTS: Parent-child reading attitudes were positively correlated with skill familiarity (r = .39). The presence or absence of children's books at home, the parent-child relationship, and parental reading habits explained 32.0% of the variance in parent-child shared-reading attitudes (R2 = .32). The presence or absence of children's books at home and the presence or absence of a library card for the child explained 44.0% of the variation in familiarity with co-reading skills (R2 = .44). Parent-child shared reading attitude scores (t = -5.14, p < .001) and skill familiarity of parents (t = -7.52, p < .001) both increased significantly after the intervention program. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Parent-child shared reading educational intervention programs may be used to improve parental attitudes and skills related to parent-child shared reading.

Familiarity, Attitude, and Confidence of Health Literacy Practice among Community Healthcare Providers in Taiwan.

Health literacy (HL), which is a determinant of individuals' health as well as a personal and public asset, can be improved by community healthcare providers (CHPs) with the capability of providing HL services. The purpose of this study was to explore CHPs' familiarity with and attitudes toward HL and their confidence in implementing HL practices. A cross-sectional online survey was conducted involving a total of 104 CHPs from 20 public health centers in Taiwan. It was based on a structured questionnaire involving self-evaluation by participants. The scores for familiarity, attitudes, and confidence in implementing HL practices were mean = 4.36, SD = 1.99; mean = 7.45, SD = 1.93; and mean = 6.10, SD = 1.77 (out of 10 points), respectively. The results of the multiple regression analysis showed that the two independent variables of familiarity and attitude could predict confidence in implementing HL practices (R2 = 0.57, F(2101) = 58.96, p < 0.001). The CHPs surveyed were not especially familiar with HL; thus, they recognized its importance, but they lacked confidence in implementing HL practices. Increasing practitioners' familiarity with HL may therefore boost their confidence in implementation. The research results can serve as a reference when planning HL education and training.

Determinants of pro-environmental behavior among excessive smartphone usage children and moderate smartphone usage children in Taiwan.

INTRODUCTION: Although there is evidence linking the relationships between smartphone usage with health, stress, and academic performance, there is still inadequate knowledge about the influence on pro-environmental behaviors. This study seeks to bridge this gap by adapting the theory of attribution framework to examine the effects of personal norms, social norms, perceived behavioral control on pro-environmental behavior of smartphone usage in children. METHODS: A total of 225 children aged between 11 to 12 from eight selected public primary schools at the Hsinchu Science and Industrial Park in Taiwan were surveyed. Two distinct groups (excessive versus moderate usage) were purposefully selected for comparison, of which 96 participants were excessive smartphone users while the remaining 129 were moderate smartphone users. RESULTS: Findings revealed significant differences between excessive and moderate smartphone usage children groups in personal norms (p < 0.001), social norms (p = 0.002), perceived behavioral control (p = 0.001), and pro-environmental behavior (p = 0.001). Findings for excessive smartphone usage children showed that social norms (ß = 0.428, t = 4.096***, p < 0.001) had a direct predictive impact on pro-environmental behavior. In contrast, while there was no direct path established between personal norms and pro-environmental behavior (ß = 0.177, t = 1.580, p > 0.05), as well as social norms and pro-environmental behavior for moderate smartphone usage children (ß = 0.181, t = 1.924, p > 0.05), but such a relationship could be developed through the mediating effect of perceived behavioral control (ß = 0.497, t = 4.471***, p < 0.001). DISCUSSION: The results suggested that excessive smartphone usage children lack positive perceived behavioral control, and their pro-environmental behavior could only be predicted through explicit social norms, whereas pro-environmental behavior of moderate smartphone usage children was implicitly influenced by personal norms through perceived behavioral control.

Exploring Knowledge and Experience of Health Literacy for Chinese-Speaking Nurses in Taiwan: A Cross-Sectional Study.

Background: Health literacy has become the best predictor of healthcare status. However, two-thirds of health providers are unaware of patients' health literacy. Thus, the aim of the study is to investigate factors related to Chinese-speaking nurses' knowledge and experience of health literacy. Methods: This cross-sectional study used a web-based survey. A total of 430 nurses were recruited by stratified sampling from different levels of hospitals and community health centers in Taiwan. Primary outcome measure by Health Literacy Knowledge and Experience. Results: The participants' overall health literacy knowledge was limited; the correct responses were 51%. The education level of the participants, job category, working years, and having attended in-service patient education programs were the predictors of knowledge of health literacy (p < 0.05); Institute, job category, and having attended in-service patient education programs were the predictors of experience of health literacy (p < 0.01). Conclusions: Participants' education levels and In-service patient education programs are beneficial factors to improve nurses' knowledge of health literacy. Furthermore, nursing education should emphasize on how to identify individuals' health literacy and using readable healthcare materials to improve health education.

Physical Outdoor Activity versus Indoor Activity: Their Influence on Environmental Behaviors.

There are strong evidences linking physical outdoor activity and health benefits; however, little is known about the impact on environmental behaviors. Thus, this study aims to close this gap by investigating the influence of physical outdoor activity on environmental behaviors. A total of 416 surveys were distributed to students in eight public primary schools located near the Hsinchu Science and Industrial Park in Taiwan. Findings from the analysis revealed that subjective norms had a more influential effect on environmental behaviors for participants who engaged in physical activity at outdoor parks. In contrast, descriptive norms had a direct predictive impact on environmental behaviors for participants whose main physical activity venue was at the indoor after-school centers. Research results also highlighted attitude as the strongest predictive variable influence on environmental behaviors for children who engaged in physical indoor and outdoor activities.

Translation and validation of an instrument for measuring the suitability of health educational materials in Taiwan: suitability assessment of materials.

BACKGROUND: It is essential to provide readily comprehensible health information to the public to increase healthy behaviors and improve outcomes. Researchers in English-speaking countries possess well-developed instruments to evaluate the suitability of health education materials. However, few of these instruments are available for use in Chinese-language environments. PURPOSE: This study aimed to translate the Suitability Assessment of Materials (SAM) into Chinese. Researchers used a rigorous translation and testing process to provide a valid instrument to evaluate the suitability of health education materials written in Chinese. METHODS: The translation process included forward- and back-translations and a test for translation equivalence that evaluated semantic and content equivalence. A panel discussion was held on the discrepancies between the original English and back-translated English versions. The content validity index was calculated to confirm the validity of the SAM Chinese version. Two raters used the Chinese-version SAM to evaluate seven health education handouts. A Cohen's kappa coefficient was calculated to estimate interrater agreement, and Cronbach's alpha assessed the internal consistency of the instrument. RESULTS: Discussions on the differences between the original English and initially translated Chinese versions of the SAM resulted in a final 22-item SAM Chinese version. The content validity index of the final Chinese-language SAM scale was .99, the Cohen's kappa coefficient of agreement was .25, and the Cronbach's alpha value was .91. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SAM Chinese version is a valid and reliable instrument with potential use in evaluating the suitability of health education materials written in Chinese.

Knowledge of using acetaminophen syrup and comprehension of written medication instruction among caregivers with febrile children.

AIM: This article aims to explore caregivers' knowledge of acetaminophen and comprehension of written medication instructions about acetaminophen syrup when administered to febrile children. BACKGROUND: Fever is one of the most common problems about which primary caregivers seek medical advice for their children. Administration of acetaminophen is the most common form of treatment for febrile children. Medication safety is of the upmost importance for medication administration in this patient group. DESIGN: A cross-sectional study design was used. METHODS: The study included 102 caregivers with febrile children under six years old. A self-designed questionnaire was used to solicit participants' responses concerning: (1) approaches to fever management prior to hospital admission; and (2) knowledge and comprehension of antipyretic medication administration. Caregivers were asked to answer specific questions about the instructions provided with the medication. Results. Antipyretic by oral (66%) and antipyretic suppository (60%) were the most commonly used forms of fever management in febrile children. After reading the written medication instructions, one-third of the participants had more than one misunderstanding of the instructions for medication with timing, time interval of administration and/or medication dosage. Almost two-thirds of the participants misunderstood the side effects of acetaminophen. Participants with a poorer academic background were associated with poorer comprehension of the provided instructions. CONCLUSION: Administration of antipyretic medication is the most common approach taken to reduce children's temperature. A significant percentage of primary caregivers appear to lack a thorough understanding of the instructions provided with antipyrexial medication. RELEVANCE TO CLINICAL PRACTICE: Written medication instruction is a major source of information for primary caregivers. Clinical nurses have a potentially important role to play to provide caregivers with legible and understandable medication instructions and to ensure that caregivers fully comprehend this information.

Pattern of relapse after curative surgery for metastatic colorectal cancer.

OBJECTIVE: To investigate patterns in the relapse frequency after curative surgical intervention, with the intention of determining the feasibility of a complete holiday from chemotherapy for metastatic colorectal cancer (mCRC) patients. METHODS: Patients with stage IV mCRC who received curative surgical intervention between January 1999 and December 2009 at Changhua Christian Hospital, Changhua, Taiwan were investigated retrospectively. Factors influencing the frequency and pattern of relapse were analyzed by logistic regression. Factors influencing overall survival (OS) were analyzed with Cox proportional hazard ratios. Significant factors were extracted and relationships to OS were evaluated by Kaplan-Meier with Log-Rank test. RESULTS: One hundred and thirty-two patients were included in the study in which 94 (71.2%) suffered from relapse. The number of relapses peaked between 3 and 6 months. The incidence of relapse and Disease-free survival had a negative influence on OS, with a hazard ratio (HR) of 0.36 (95% CI: 0.01-0.26) and 0.93 (95% CI: 0.90-0.95). The prognosis was significantly worse when the relapse (n=25) occurred within 6 months after metastectomy (p<0.001). Patients exhibited significantly better long-term OS if the relapse does not occur within 28 months after surgery (p<0.001). CONCLUSION: Early relapse indicated a worse prognosis. We determined that if mCRC patients remain cancer-free for 28 months after curative surgery, their chance of long-term survival is significantly better.

[Concept analysis of health literacy].

Health literacy has risen to become one of the dominant issues in Taiwan's healthcare system today. Level of health literacy impacts upon public health outcomes. Nevertheless, healthcare professionals in Taiwan remain largely unfamiliar with the concept and importance of health literacy. This paper employs concept analysis as described by Walker & Avant to introduce and analyze the attributes, antecedents and consequences of health literacy. Defining attributes of health literacy include: 1. enabling an individual to function successfully in a healthcare context; 2. facilitating the obtaining, comprehending, communicating and evaluating of health information to make appropriate health decisions and conduct positive health practices; and 3. achieving a good health status. The antecedent of health literacy is literacy. Consequences of health literacy include differences in health outcomes such as health knowledge, use of healthcare services and health status. Hopefully, through concept analysis, findings can help promote nursing clinical practice and related research quality.

[Grandparents health in the grandparent-grandchild households].

Grandparents raising grandchildren is a widespread phenomenon that has continued to increase during the last decade. The responsibility for raising grandchildren is a challenge to grandparents, not only in terms of financial burdens but also of attendant health problems. The purpose of this paper was to describe from a nursing perspective the health of grandparents in grandparent-grandchild households. The health issues of grandparents were discussed in the physical, mental, social and spiritual domains. By reviewing and discussing the literature on the issue of grandparents raising grandchildren, a conceptual framework was constructed to provide information for further studies into this issue.

[Concept analysis of susceptibility].

This conceptual analysis of susceptibility used the method described by Walker & Avant (1995) to analyze the attributes, antecedent and consequence of susceptibility. By review and analysis of the related literature we found that the defined characteristics of susceptibility were the following: (1) A person (or a group of people) has some specific characteristics. (2) A person (or a group of people) has a relatively high degree of probability of experiencing influences while being exposed at a certain time point to a certain environment. (3) The changes caused by the influences usually result in some harm to a person (or a group of people). (4) The changes will usually occur within an expected timeframe. The antecedent to susceptibility is that a person (or a group of people) should be exposed to the specific influencing environment. The consequence is an increase in the possibility and level of harm, defect and negative outcome. The person nevertheless retains some ability to control the changes. The article hopes that nursing professionals can precisely apply the results from this conceptual analysis of susceptibility as they provide health care services.