Lost in the Shuffle: Low Health Literacy in Geriatric Fracture Patients and Families Regarding Post-Acute Care-A Prospective Study.

INTRODUCTION: This study aims to evaluate health literacy (HL) in geriatric orthopaedic trauma patients and their families as it relates to their post-acute care (PAC) in skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). METHODS: This nonrandomized controlled clinical trial included patients aged 65 years and older treated for acute fracture at a Level 1 trauma center and discharged to either IRF or SNF. First 106 patients enrolled served as the control group and received standard discharge instructions. The second 101 patients were given a set of oral and written instructions regarding PAC detailing important questions to ask upon arrival to their facility. RESULTS: The mean HL score for all patients/families was 2.4 out of 5. No significant difference was noted in HL scores (2.4 versus 2.3) or median LOS (22 versus 28 days) between the control and intervention groups. Family involvement (68%) slightly improved HL scores (2.6 versus 1.9, P < 0.001). Patients discharged to IRF had better HL scores (3.4 versus 2.3, P < 0.001), shorter LOS (median 15 vs 30 days, P < 0.001), and trended toward improved knowledge of discharge goals (48.1% versus 35.6%) than those in SNF. CONCLUSION: System-wide solutions are necessary to improve geriatric HL and optimize outcomes in orthopaedic trauma.

The revision and factor analytic evaluation of the German version of the depression literacy scale (D-Lit-R German).

BACKGROUND: Depression is a common mental health disorder and the second leading cause of disability worldwide. In people with depression, low depression literacy, which could be characterized by a poor recognition of depressive symptoms and less knowledge about the availability of treatment options, can hinder adequate therapy for depression. Nevertheless, questionnaires measuring depression literacy in Germany are rare. Consequently, for the present study, the German Depression Literacy Scale (D-Lit) has been revised and evaluated. METHODS: First, a team of clinical psychologists revised the D-Lit German scale. Next, cognitive interviews were conducted with patients with depression to improve the comprehensibility of the scale items. Our revision of the D-Lit-R German scale was then subjected to an anonymous online study. Finally, the data went through an exploratory factor analysis, and sociodemographic subgroup analyses were performed. RESULTS: N = 524 individuals (age 18-80) completed the D-Lit-R German scale and a questionnaire on their sociodemographic data. Cronbach´s alpha was estimated as α = .72, and McDonald's Omega (categorical) was estimated as ω = .77. The mean Item difficulty was M = .75 (SD = .15). An EFA was performed for a unidimensional model, a 5-factor-model and at last a 3-factor-model. The 5-factorial model showed a good model fit (χ2emp,WLSMV(131) = 92.424, p > .05; CFI = 1, RMSEA = 0, SRMR = .07) but was rejected since the content of the potential 5 factors could not be determined. The 3-factor model showed an arguable model fit. The Chi2 test was significant (χ2emp,WLSMV(168) = 199.912, p < .05), but the CFI and the RMSEA met an acceptable model fit (CFI = .990, RMSEA of .019, 90% CI[.003, .029]). Substantively, the three factors were defined as (1) Distractors and other symptoms, (2) Depressive symptoms, and (3) Pharmacological and psychotherapeutic depression treatment. Furthermore, there were significant differences in sum scores regarding the subgroup's gender, treatment for mental health problems, depression treatment, experience with depression, and different career fields. CONCLUSIONS: The D-Lit-R German scale is a time-efficient scale to assess some aspects of the depression literacy construct that can be easily applied. Since there was no perfect model fit, it is recommended to continue to revise the scale. Further evaluation studies could ask for knowledge of the etiological factors of depression. Future studies could then use this instrument to convey depression literacy. This instrument could assess the growth of knowledge after psychoeducational interventions in different settings. TRIAL REGISTRATION: This trial was preregistered at the platform osf.io ( https://osf.io/49xdh ). REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/49XDH Date of registration: 28 April 2022.

Measuring General Health Literacy in Chinese adults: validation of the HLS19-Q12 instrument.

BACKGROUND: Health literacy measurement lays a solid foundation to identify associations with health outcomes and monitor population health literacy levels over time. In mainland China, most existing health literacy instruments are either knowledge-based or practice-based, making health literacy results incomparable between China and other countries. This study aimed to examine the reliability and validity of the 12-item Health Literacy Population Survey (HLS19-Q12) in a general population of Chinese adults. METHODS: A cross-sectional study was conducted to recruit primary carers of students from 11 schools in Zhengzhou, Henan Province, using convenience cluster sampling. Participants completed an online self-administered survey that collected information on key sociodemographics, health literacy (HLS19-Q12 and a comparison tool: Health Literacy Questionnaire (HLQ)), and health-related outcomes. Using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist as a guideline, we tested internal consistency, test-retest reliability, content validity, structural validity, concurrent predictive validity, and convergent validity of the HLS19-Q12. RESULTS: Overall, 14,184 participants completed the full survey. The HLS19-Q12 showed excellent internal consistency (Cronbach's α = 0.93), moderate test-retest reliability (intra-class correlation coefficient = 0.54), satisfactory content validity (based on the 12-matrix health literacy model), and strong structural validity (comparative fit index = 0.94, Tucker and Lewis's index of fit = 0.93, root mean square error of approximation = 0.095). Concurrent predictive validity results showed health literacy was associated with both health determinants and health-related outcomes. The HLS19-Q12 had weak to strong correlations (coefficients = 0.24 to 0.42) with the nine scales of the HLQ. Respondents had an average score of 81.6 (± 23.0) when using the HLS19-Q12, with 35.0% and 7.5% having problematic and inadequate levels of health literacy, respectively. CONCLUSIONS: The HLS19-Q12 is a reliable and valid instrument to measure health literacy in our sample. Further validation is needed with a more nationally representative sample of Chinese adults. The HLS19-Q12 could be used as a comprehensive, skills-based, and easy-to-administer health literacy assessment tool integrated into population surveys and intervention evaluations.

Development and initial validation of the cannabis-related psychosis risk literacy scale (CPRL): a multinational psychometric study.

BACKGROUND: Public education efforts to address and reduce potential harms from cannabis use in Arab countries are either slow or inexistent, and do not follow the steadily increasing trends of cannabis use in Arab youth. Several decades of research on substance use, it can be suggested that being aware of, and knowing about, psychosis risk related to cannabis can at least limit the consumption of the substance. Motivated by a lack of measures specifically designed to measure literacy about cannabis-related psychosis risk in younger populations, and based on an extensive literature review, we aimed to create and validate a new self-report scale to assess the construct, the Cannabis-related Psychosis Risk Literacy Scale (CPRL), in the Arabic language. METHOD: A cross-sectional study was carried-out during the period from September 2022 to June 2023, enrolling 1855 university students (mean age of 23.26 ± 4.96, 75.6% females) from three Arab countries (Egypt, Kuwait and Tunisia). RESULTS: Starting from an initial pool of 20 items, both Exploratory Factor Analysis and Confirmatory Factor Analysis suggested that the remaining 8 items loaded into a single factor. The scale demonstrated good internal consistency, with both McDonald omega and Cronbach's alpha values exceeding 0.7 (omega = 0.85 / alpha = 0.85). The CPRL showed measurement invariance across gender and country at the configural, metric, and scalar levels. Concurrent validity of the CPRL was established by correlations with less favourable attitudes towards cannabis (r = -.14; p <.001). In addition, higher literacy levels were found in students who never used cannabis compared to lifetime users (4.18 ± 1.55 vs. 3.44 ± 1.20, t(1853) = 8.152, p <.001). CONCLUSION: The newly developed CPRL scale offers a valid and reliable instrument for assessing and better understanding literacy about cannabis-related psychosis risk among Arabic-speaking young adults. We believe that this new scale is suitable as a screening tool of literacy, as an instrument for measuring the effect of public education interventions aimed at promoting cannabis-related psychosis risk literacy among young people, and as a research tool to facilitate future studies on the topic with a wider application.

Impact of health education on promoting influenza vaccination health literacy in primary school students: a cluster randomised controlled trial protocol.

INTRODUCTION: Influenza is a major public health threat, and vaccination is the most effective prevention method. However, vaccination coverage remains suboptimal. Low health literacy regarding influenza vaccination may contribute to vaccine hesitancy. This study aims to evaluate the effect of health education interventions on influenza vaccination rates and health literacy. METHODS AND ANALYSIS: This cluster randomised controlled trial will enrol 3036 students in grades 4-5 from 20 primary schools in Dongguan City, China. Schools will be randomised to an intervention group receiving influenza vaccination health education or a control group receiving routine health education. The primary outcome is the influenza vaccination rate. Secondary outcomes include health literacy levels, influenza diagnosis rate, influenza-like illness incidence and vaccine protection rate. Data will be collected through questionnaires, influenza surveillance and self-reports at baseline and study conclusion. ETHICS AND DISSEMINATION: Ethical approval has been sought from the Ethics Committee of the School of Public Health, Sun Yat-sen University. Findings from the study will be made accessible to both peer-reviewed journals and key stakeholders. TRIAL REGISTRATION NUMBER: NCT06048406.

The roles of health literacy and social support in the association between smartphone ownership and frailty in older adults: a moderated mediation model.

BACKGROUND: Understanding the role of smartphones to promote the health status of older adults is important in the digital society. Little is known about the effects of having smartphones on physical frailty despite its positive effect on the well-being of older adults. This study aimed to explore the association between smartphone ownership and frailty in community-dwelling older adults and its underlying mechanism. METHODS: We used data from the Korean Frailty and Aging Cohort Study and analyzed 2,469 older adults aged 72-86 years. Frailty, health literacy, and social support were assessed by Fried's frailty phenotype, the Behavioral Risk Factor Surveillance System health literacy module, and the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, respectively. The mediation model and moderated mediation model were estimated, where the mediator was health literacy and the moderator was social support, to explore the relationship between smartphone ownership and frailty. RESULTS: Of our study participants, 58.9% owned smartphones, and 10.9% were classified as frail. Smartphone ownership was negatively associated with frailty (ß = -0.623, p < 0.001). Health literacy mediated the relationship between smartphone ownership and frailty (ß = -0.154, boot confidence interval [CI] = - 0.222, - 0.096), and social support moderated the mediation effect (ß = -0.010, Boot CI = - 0.016, - 0.004). CONCLUSIONS: Owning smartphones among older adults could reduce the risk of frailty. Promoting health literacy and social support among older adults with smartphones would be effective to prevent frailty.

eHealth literacy of migrant domestic workers in Hong Kong in the COVID-19 pandemic: A mixed methods study.

BACKGROUND: Health communication in the COVID-19 pandemic can be effectively implemented if all members of the populations, including marginalized population such as migrant domestic workers (MDWs), have good eHealth literacy. Lessons learned during this critical period may help improve planning and mitigation of the impacts of future health crises. METHODS: This study aimed to examine and explore the eHealth literacy levels of the MDWs in Hong Kong during the COVID-19 pandemic by using a convergent mixed methods research design. A total of 1156 Hong Kong MDWs participated in a paper-based survey using a multistage cluster random sampling design for the quantitative component. eHealth literacy was measured using an eHealth literacy Scale (eHEALS). For the qualitative component, a purposive sampling of 19 MDWs participated in face-to-face, semi-structured, in-depth interviews. Descriptive statistics and multiple regression analyses were used to carry out the quantitative analysis, while thematic analysis was used for the qualitative analysis. Both quantitative and qualitative data were merged and integrated for mixed-methods analysis. RESULTS: The meta-inferences of the quantitative and qualitative results mainly confirmed that MDWs in Hong Kong had good levels of eHealth literacy. The use of Instagram, YouTube and WhatsApp as the COVID-19 information sources, in addition to having an interest in the topic of the current spread of COVID-19 together with the Hong Kong government's policies related to COVID-19, were found to be associated with eHealth literacy. CONCLUSIONS: The eHealth literacy level of MDWs in Hong Kong was shown to be good and it was influenced by the use of popular social media platforms including Instagram, YouTube, and WhatsApp. It is realistic to suggest that such platforms should be harnessed for health communication during the pandemic. Yet, regulations to combat false information on these media are also urgently needed.

Realization path and connotation of the Healthy China strategy: macroscopic perspective of dietary structure and the entry of individual health consciousness.

BACKGROUND: Dietary rationality and health concept have certain influence on individual health level. This study aims to explore the characteristics and existing problems of Chinese residents' health behaviors from both macro and micro perspectives, and explore the feasibility and realization path of Healthy China strategy. METHODS: We utilized regression models to evaluate the correlation between diet and the risk of disease causes of death. By use of the linear regression analysis model, we distinguished the impact of each dimension on health literacy index at the individual level. Then, we explored the influential factors of the diet health index using the binary logit regression model. RESULTS: Increased consumption of animal-derived foods in China has contributed to the burden of non-communicable diseases. The individuals' health awareness is still weak, and the health literacy index is greatly affected by the diet, while the individual gender and age are positively correlated with the diet health index, and the individual body mass index (BMI) level is negatively correlated with the diet health index. CONCLUSIONS: This study provided a comprehensive understanding of existing problems of Chinese residents' health behaviors. We have proposed a path model for the implementation of the Healthy China strategy from the perspectives of "diet health, physical health, conceptual health and environmental health," which is also a great contribution to the world.

Assessment of health literacy in a French emergency department.

BACKGROUND: Health literacy (HL) has become a subject of major interest in public health worldwide. It is known to be linked to self-efficacy in care use and to global health status, and a non-negligible frequency of problematic or inadequate levels of HL in populations worldwide is reported. As this has yet to be evaluated in France, the present study aimed to evaluate the HL level of patients in a French emergency department (ED). METHODS: We conducted a descriptive, cross-sectional observational, single center study in the ED of the Lyon Sud hospital (Hospices civils de Lyon, Lyon, France). The primary endpoint was the HL level of the patients determined according to the score obtained using the 16-item European Health Literacy Survey Questionnaire. The secondary endpoint was the identification of sociodemographic factors associated with the HL level. RESULTS: A total of 189 patients were included for analysis. 10% (95% CI [3%; 17%]) of the patients had an inadequate HL, 38% (95% CI [31%; 45%]) had a problematic HL, and 53% (95% CI [46%; 61%] had an adequate HL. In multivariate analysis, age and perceived health status were independent predictors of the HL level; OR =0.82 (95% CI [0.69; 0.97]; p=0.026) for a 10-year increase in age, and OR =1.84 (95% CI [1.22; 2.82]; p=0.004]). CONCLUSIONS: The HL level of the patients in the ED studied herein was similar to that found in the population of France and other European countries and was influenced by age and perceived health status, which are both associated with care needs. It may be therefore interesting to explore in future studies how taking into consideration HL in the general population may lead to a better self-efficacy in care and optimize the use of the healthcare system.

The Text-Picture Integration Scale for Perspectives on Mental Illness: Development and Validation.

IMPORTANCE: Understanding the root cause of mental illness stigma is necessary to adopt effective management strategies. OBJECTIVE: To establish a stable and effective text-picture integration rating scale to predict public perspectives on mental illness and to examine its reliability and validity. DESIGN: Descriptive cross-sectional study using internet survey data. SETTING: Online. PARTICIPANTS: Two hundred volunteers. RESULTS: The 10-item the Text-Picture Integration Scale for Perspectives on Mental Illness was developed. The authors conducted data analysis using SPSS to evaluate the reliability and criterion-related validity of the Mental Health Literacy Scale (MHLS). The Text-Picture Integration Scale's item-level content validity index ranged from 0.83 to 1.00, and the scale-level content validity index was 0.97. The scale demonstrated acceptable reliability (Cronbach's α = .80). The mean value of individual items ranged from 3.18 to 4.48, and the mean total score was 39.44 (SD = 8.47). The Text-Picture Integration Scale exhibited satisfactory criterion-related validity with the MHLS (r = .76, p < .001). CONCLUSIONS AND RELEVANCE: Preliminary analyses support that the Text-Picture Integration Scale is a stable and effective rating scale to determine public perspectives on mental illness and is appropriate for evaluating destigmatization efforts. Plain-Language Summary: The study findings support the use of the Text-Picture Integration Scale as a stable and effective rating scale to determine public perspectives on mental illness. The scale is also appropriate for evaluating ways to address the stigmas that people associate with mental illness, which pose challenges for people in recovery. Occupational therapists can leverage their understanding of public perspectives on mental illness when choosing interventions to support the overall well-being of their clients with mental illness.

Health information-seeking behavior in patients with coronary artery disease: Activating methods.

INTRODUCTION: Coronary artery disease (CAD) has a high mortality rate worldwide, and continuous health behavior practice and careful management are required owing to risks such as rapid changes in symptoms and emergency hospitalization. The utilization of health-related information is an important factor for long-term disease management in patients with CAD. For this purpose, an understanding of health information-seeking behavior is needed first. METHODS: This study analyzed data from the 2021 Korea Medical Panel Survey, and logistic regression analysis was conducted to confirm the factors influencing the health information-seeking behavior of patients with CAD. RESULTS: The health information-seeking behavior of patients with CAD differed according to demographic characteristics, and differences in preferred information use were confirmed. Finally, it was identified that insufficient levels of health literacy were a major reason for CAD patients not engaging in health information-seeking behaviors (OR, 0.17; 95% CI, 0.09-0.33; p < 0.001). CONCLUSION: This study suggests that to improve health information-seeking behaviors, the application of education and intervention programs to increase the level of health literacy is necessary.

Relationship between health literacy and health-related quality of life in Korean adults with chronic diseases.

Inadequate health literacy is a risk factor for poor health outcomes and health-related quality of life (HRQoL). So far, the impact of health literacy on HRQoL has been examined for only a few chronic conditions. In this contribution, the relationship between health literacy and HRQoL in Korean adults with chronic conditions is examined using data of the cross-sectional Korea Health Panel Survey from 2021. Health literacy was measured with the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) and HRQoL with the European Quality of Life-5 Dimensions (EQ-5D). Multiple linear regression model was run for the EQ-5D index as the dependent variable. Multiple logistic regression models were implemented for responses to the individual EQ-5D items. 30.8%, 24.6%, and 44.6% of participants had inadequate, marginal, and adequate levels of health literacy, respectively. The EQ-5D index increases with marginal (B = 0.018, p<0.001) and adequate literacy (B = 0.017, p<0.001) compared to inadequate literacy. People with adequate or marginal literacy were more likely to report no problem with mobility (odds ration [OR] = 1.5; p<0.001), self-care (OR = 1.6; p<0.05), and usual activities (OR = 1.6 for adequate; OR = 1.4 for marginal; p<0.01) than those with inadequate literacy. Adequate health literacy was associated with an increased likelihood of having no problem with anxiety and depression (OR = 1.4; p<0.05). In conclusion, inadequate health literacy is prevalent among Korean adults with chronic diseases. Adequate health literacy is associated with better HRQoL and a protective factor for four dimensions of EQ-5D (mobility, self-care, usual activities, and anxiety/depression).

Assessing the Efficacy of Large Language Models in Health Literacy: A Comprehensive Cross-Sectional Study.

Enhanced health literacy in children has been empirically linked to better health outcomes over the long term; however, few interventions have been shown to improve health literacy. In this context, we investigate whether large language models (LLMs) can serve as a medium to improve health literacy in children. We tested pediatric conditions using 26 different prompts in ChatGPT-3.5, ChatGPT-4, Microsoft Bing, and Google Bard (now known as Google Gemini). The primary outcome measurement was the reading grade level (RGL) of output as assessed by Gunning Fog, Flesch-Kincaid Grade Level, Automated Readability Index, and Coleman-Liau indices. Word counts were also assessed. Across all models, output for basic prompts such as "Explain" and "What is (are)," were at, or exceeded, the tenth-grade RGL. When prompts were specified to explain conditions from the first- to twelfth-grade level, we found that LLMs had varying abilities to tailor responses based on grade level. ChatGPT-3.5 provided responses that ranged from the seventh-grade to college freshmen RGL while ChatGPT-4 outputted responses from the tenth-grade to the college senior RGL. Microsoft Bing provided responses from the ninth- to eleventh-grade RGL while Google Bard provided responses from the seventh- to tenth-grade RGL. LLMs face challenges in crafting outputs below a sixth-grade RGL. However, their capability to modify outputs above this threshold, provides a potential mechanism for adolescents to explore, understand, and engage with information regarding their health conditions, spanning from simple to complex terms. Future studies are needed to verify the accuracy and efficacy of these tools.

Health Literacy Among University Students in the COVID-19 Pandemic: A Systematic Review.

BACKGROUND: The purpose of this systematic review was to assess different studies that worked on university students' health literacy during covid19 pandemic and to make an overview of this issue to recognize possible determinants associated with health literacy. METHODS: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Four databases (Google Scholar, Web of Science, Pubmed, and Scopus) were used for searching cross-sectional works that assessed the health literacy of university students. We searched papers from December 1st, 2019 up to June 10th, 2022. English language articles were used. Studies were done in countries including; Iran, Pakistan, the USA, Vietnam, China, Colombia, Germany, and Indonesia. RESULTS: The systematic review contains 12 research studies involving 17773 students. There was a relationship between health literacy and some determinants. Positive determinants included age, female gender, Urban background, cognitive maturity, Higher educational qualification, information source (Health workers), number of semesters, and parental education. Some negative determinants were male gender, Rural background, smoking, drinking, being able to pay for medication, lower conspiracy beliefs, and higher fear of COVID-19. CONCLUSION: University students around the world should have courses about health literacy according to university disciplines. These courses should be available for students of different fields to enhance their effectiveness, and training should be associated with students' needs and their subgroup traits.

Why is health literacy an essential component of health of individuals with chronic kidney disease / Pourquoi la littératie en santé est une composante essentielle de la santé des individus ayant une maladie rénale chronique.

Health literacy (HL) is the ability of individuals to access, understand and use health information to improve their health. It is a multidimensional and contextual concept, whose definition has been enriched over time. Considered both as a health risk factor and a skill to be developed by individuals, HL also depends on the healthcare system in which patients have to navigate, and on healthcare professionals' awareness of this concept. In order to promote shared decision-making and thus individual empowerment in the healthcare, HL should be at the core of the concerns of nephrology care teams.

La littératie en santé (LS) est la capacité d'un individu à accéder à des informations en santé, à les comprendre et à les utiliser pour améliorer son état de santé. Il s'agit d'un concept pluridimensionnel et contextuel dont la définition s'est enrichie au fil du temps. Considérée à la fois comme un facteur de risque pour la santé et une aptitude à développer chez les individus, la LS dépend également du système de santé dans lequel les patients doivent naviguer et de la sensibilisation des professionnels de santé à ce concept. Afin de favoriser la décision partagée et ainsi l'émancipation des individus en matière de santé, la LS devrait être au cœur des préoccupations des équipes de néphrologie.

Measurement properties of the Mental Health Literacy Scale (MHLS) validation studies: a systematic review protocol.

INTRODUCTION: Mental Health Literacy (MHL) is important for improving mental health and reducing inequities in treatment. The Mental Health Literacy Scale (MHLS) is a valid and reliable assessment tool for MHL. This systematic review will examine and compare the measurement properties of the MHLS in different languages, enabling academics, clinicians and policymakers to make informed judgements regarding its use in assessments. METHODS AND ANALYSIS: The review will adhere to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews of patient-reported outcome measures and the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and will be presented following the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 checklist. The review will be conducted in four stages, including an initial search confined to PubMed, a search of electronic scientific databases PsycINFO, CINAHL, Scopus, MEDLINE, Embase (Elsevier), PubMed (NLM) and ERIC, an examination of the reference lists of all papers to locate relevant publications and finally contacting the MHLS original author to identify validation studies that the searches will not retrieve. These phases will assist us in locating studies that evaluate the measurement properties of MHLS across various populations, demographics and contexts. The search will focus on articles published in English between May 2015 and December 2023. The methodological quality of the studies will be evaluated using the COSMIN Risk of Bias checklist, and a comprehensive qualitative and quantitative data synthesis will be performed. ETHICS AND DISSEMINATION: Ethics approval is not required. The publication will be in peer-reviewed journals and presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42023430924.

The relationship between health literacy and health-related quality of life in Chinese older adults: a cross-sectional study.

Background: This study aimed to examine the relationship between health literacy and health-related quality of life in older adults. Methods: A cross-sectional survey design was used. We used a self-administered questionnaire to assess sociodemographic factors of older adults, the Chinese Citizen Health Literacy Questionnaire (HLQC) and the 36-item Chinese version of the Short Form 36 (SF-36) to measure health literacy and quality of life, respectively, among older adults. Between September 2011 and June 2012, information was collected from 1,396 older adults in 44 nursing homes in four cities through face-to-face interviews. Results: The mean health literacy level of older adults in nursing homes was relatively low (71.74 ± 28.35). Health-related quality of life scores were moderate (104.77 ± 16.92). There were statistically significant differences in the effects of health literacy, education level, former occupation (professional), marital status (widowed) and race on health-related quality of life. Conclusion: Improving health literacy is considered an important intervention to promote health-related quality of life in older adults in nursing homes.

Associations between Polish school principals' health literacy and implementation of the Health Promoting School approach during the COVID-19 pandemic.

The coronavirus pandemic has contributed to increasing the responsibility of school principals for the health of all school community members. Moreover, evidence confirms the significant role of school principals' health literacy (HL) for health promotion in schools. Therefore, the presented study aims to evaluate the associations between Polish school principals HL and the implementation of the Health Promoting School (HPS) approach in Polish schools. The present study was conducted as part of an international survey on the global COVID-HL network (www.covid-hl.eu) between June 2021 and December 2021. Three subscales of the HPS were considered and an exploratory analysis were used in this study. Associations between the median split of each subscale of HPS (outcome) and health literacy (predictor) were performed using logistic regression. Research results showed that the highest level of HPS implementation was directed at pupils. Principals perceived themselves as having the highest HL on the 'accessibility' subscale and these respondents had significantly higher odds of implementing learning opportunities for students. The study suggests that principals with adequate HL may be more likely to effectively implement HPS strategies in schools. This research could provide insights into the complex interplay between HL and the HPS approach and inform the development of more effective strategies for promoting health and HL in schools.

A large, multi-center survey assessing health, social support, literacy, and self-management resources in patients with heart failure.

BACKGROUND: Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the resources patients draw upon to effectively manage their health is fundamental to designing new practice models to improve outcomes in HF. We describe the rationale, conceptual framework, and implementation of a multi-center survey of HF patients, characterize differences between responders and non-responders, and summarize patient characteristics and responses to the survey constructs among responders. METHODS: This was a multi-center cross-sectional survey study with linked electronic health record (EHR) data. Our survey was guided by the Chronic Care Model to understand the distribution of patient-centric factors, including health literacy, social support, self-management, and functional and mental status in patients with HF. Most questions were from existing validated questionnaires. The survey was administered to HF patients aged ≥ 30 years from 4 health systems in PCORnet® (the National Patient-Centered Clinical Research Network): Essentia Health, Intermountain Health, Mayo Clinic, and The Ohio State University. Each health system mapped their EHR data to a standardized PCORnet Common Data Model, which was used to extract demographic and clinical data on survey responders and non-responders. RESULTS: Across the 4 sites, 10,662 patients with HF were invited to participate, and 3330 completed the survey (response rate: 31%). Responders were older (74 vs. 71 years; standardized difference (95% CI): 0.18 (0.13, 0.22)), less racially diverse (3% vs. 12% non-White; standardized difference (95% CI): -0.32 (-0.36, -0.28)), and had higher prevalence of many chronic conditions than non-responders, and thus may not be representative of all HF patients. The internal reliability of the validated questionnaires in our survey was good (range of Cronbach's alpha: 0.50-0.96). Responders reported their health was generally good or fair, they frequently had cardiovascular comorbidities, > 50% had difficulty climbing stairs, and > 10% reported difficulties with bathing, preparing meals, and using transportation. Nearly 80% of patients had family or friends sit with them during a doctor visit, and 54% managed their health by themselves. Patients reported generally low perceived support for self-management related to exercise and diet. CONCLUSIONS: More than half of patients with HF managed their health by themselves. Increased understanding of self-management resources may guide the development of interventions to improve HF outcomes.