BACKGROUND & AIMS: PURPOSE OF REVIEW:The following review summarizes contributions from rheumatology to the growing field of health literacy. RECENT FINDINGS:Arthritis related publications have primarily contributed to one strand of research in health literacy: assessments of print materials and considerations of the match between the reading grade level of materials and the reading skills of intended audiences. Unlike researchers addressing other chronic diseases such as diabetes, however, researchers and practitioners in rheumatology have yet to examine links between patients' literacy skills and health outcomes. In addition, only one early study reports on evaluation findings of an education program designed for audiences with low literacy skills. No other studies report on efforts to increase health literacy in arthritis, reduce the demands of print materials for education or research purposes, or on efforts to ameliorate the effects of limited literacy skills among patients. SUMMARY:Health literacy may well influence arthritis outcomes as well as recruitment efforts in arthritis research. The 2004 report on health literacy from the Institute of Medicine calls for additional studies focused on the links between health literacy and health outcomes.

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BACKGROUND & AIMS: BACKGROUND:We explored the association between health literacy and self-care behaviors among low-income patients with chronic kidney disease (CKD). METHODS:We used baseline data from the Kidney Awareness Registry and Education trial (n = 137 patients with CKD) and multivariable logistic regressions to cross-sectionally examine the association between health literacy, defined by a validated questionnaire, and healthy behaviors. RESULTS:Study participants had a mean age of 55 years, were racially diverse (6% White, 36% Hispanic, 43% Black, 15% Asian) and 26% had low health literacy. Over one-third (38%) had hypertension, 51% had diabetes, and 67% had CKD stage 3 or 4. Compared to individuals with adequate health literacy, those with low health literacy had non-statistically significant higher tobacco use (adjusted odds ratio [aOR] = 2.33; 95% CI 0.90-6.06) and lower consumption of sugary beverages (aOR = 0.50; 0.20-1.23) and statistically significant decreased fast food intake (aOR = 0.38; 0.16-0.93). Health literacy was not associated with differences in medication adherence (0.84; 0.38-1.89) or physical activity (aOR = 2.39; 0.54-10.53). CONCLUSIONS:Health literacy was not uniformly associated with all self-care behaviors important for CKD management. A more nuanced understanding of the association of health literacy and self-care may be necessary to promote participation in behaviors known to slow CKD progression.

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BACKGROUND & AIMS: ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION:Oral health literacy and associated oral conditions: A systematic review. Firmino RT, Ferreira FM, Palva SM, Granvlle-Garcia AF, Fraiz FC, Martins CC. JADA 2017; 148(8):604-13. SOURCE OF FUNDING:Government and foundation. This study was supported by the Brazilian Ministry of Education Coordination for the Improvement of Higher Education Personnel, the Minas Gerais State Research Foundation, and the Brazilian National Council for Scientific and Technological Development. TYPE OF STUDY/DESIGN:Systematic review.

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BACKGROUND & AIMS: OBJECTIVE:Non-adherence to pediatric regimens is a common concern. Low health literacy is correlated with poor outcomes in adults but is understudied in pediatrics. The current project aimed to determine the relationship between health literacy, adherence, and outcomes in pediatric liver transplant recipients. Hypotheses included a) parent and patient health literacy would be positively correlated; and b) low patient and/or parent health literacy would be negatively correlated with adherence and health outcomes. PATIENTS AND METHODS:Eligible participants were recruited during routine follow-up visits in a pediatric liver transplant clinic. Parents and patients (>13 years old) completed 2 measures of health literacy. Patients ≥18 years completed health literacy measures without corresponding parent surveys. Adherence variables and health outcomes were obtained from medical records. RESULTS:Seventy-nine patients across two sites completed the study. Variance in classification of health literacy between measures was observed; however, most parents (82%-100%) scored within an "adequate literacy" range. More adolescents scored in lower health literacy ranges relative to the parents. Markers of SES were positively correlated with health literacy. Parent health literacy was negatively associated with biopsy-proven rejection episodes and the number of hospitalizations; however, it was not associated with measures of tacrolimus adherence. There were no relationships observed between parent and adolescent health literacy. CONCLUSIONS:Health literacy is an important consideration in managing patient care; however, available measures demonstrate variability in capturing the skills of patients. Effective communication strategies may ameliorate admittedly small, but negative, impacts of limited health literacy on outcomes.

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BACKGROUND & AIMS: BACKGROUND:Patients with low health literacy experience difficulty in understanding their medications leading to worse health outcomes. Pharmacists need to use formal assessment tools to be able to identify these patients, so they can better tailor their patient education. The objective of the study was to characterize hospital pharmacists understanding of health literacy and their use of screening and counselling strategies before and after completion of an educational module and to identify barriers that hospital pharmacists perceive to exist that prevent them from using health literacy tools. METHODS:Pharmacists in three health authorities were administered a pre-survey and then given access to an online 11 min educational video. The post-survey was distributed 1 month later. Descriptive statistics were used to quantify survey responses with comparisons made between pre and post responses. The main outcome measure was pharmacists' understanding of health literacy and their current practice related to health literacy. RESULTS:There were 131 respondents for the pre-survey and 39 for the post-survey. In the pre-module survey, 84% of pharmacists felt they understood what health literacy was, but only 53% currently assessed patients for their health literacy status and 40% were aware of what strategies to use in low health literacy patients. Lack of time (74%) was the biggest barrier in assessing patients' health literacy. In the post-module survey, 87% felt they understood what health literacy was and 64% incorporated health literacy status evaluation into their clinical practice. The educational module was helpful to the clinical practice of 74% of respondents. CONCLUSION:As health literacy can affect a patient's ability to adhere to their medications it is important for pharmacists to assess this in their patients. While pharmacists self-reported a high degree of understanding of health literacy, they are not regularly assessing their patients' health literacy status and are unaware of what strategies to use for low literacy patients.

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BACKGROUND & AIMS: BACKGROUND:The role of one's social network in the process of becoming health literate is not well understood. We aim to explain the 'distributed' nature of health literacy and how people living with a long-term condition draw on their social network for support with health literacy-related tasks such as managing their condition, interacting with health professionals and making decisions about their health. DESIGN:This paper reports a longitudinal qualitative interview and observation study of the development and practice of health literacy in people with long-term health conditions, living in South Wales, UK. Participants were recruited from health education groups (n = 14) and community education venues (n = 4). The 44 interview transcripts were analysed using the 'Framework' approach. RESULTS:Health literacy was distributed through family and social networks, and participants often drew on the health literacy skills of others to seek, understand and use health information. Those who passed on their health literacy skills acted as health literacy mediators and supported participants in becoming more health literate about their condition. The distribution of health literacy supported participants to manage their health, become more active in health-care decision-making processes, communicate with health professionals and come to terms with living with a long-term condition. Participants accessed health literacy mediators through personal and community networks. CONCLUSION:Distributed health literacy is a potential resource for managing one's health, communicating with health professionals and making health decisions.

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BACKGROUND & AIMS: BACKGROUND:Maternal mental health including postpartum mental health is essential to women's health. This study aimed to develop a specific measure for assessing postpartum depression literacy and consequently evaluate its psychometric properties among a sample of perinatal women. METHODS:This investigation was composed of two studies: developing the measure, and evaluating of psychometric properties of the developed questionnaire. In development stage an item pool was created. Then, based on definition of mental health literacy and preliminary screening, an initial questionnaire was developed. The content and face validity of the questionnaire were then assessed. In the second study psychometric properties of the questionnaire were examined. Overall 692 perinatal women with the mean age of 27.63 years (ranging from 17 to 43) participated in the study. RESULTS:In all an item pool of 86 items was generated. Of these, 31 items were removed and the remaining 55 items subjected to content and face validity and further 16 items removed. In the second stage a 39-item questionnaire namely the Postpartum Depression Literacy Scale (PoDLis) was evaluated. In principal component factor analysis, 31 items were loaded indicating a 7-factor solution for the questionnaire. The factors designated the following constructs: ability to recognize postpartum depression, knowledge of risk factors and causes, knowledge and belief of self-care activities, knowledge about professional help available, beliefs about professional help available, attitudes which facilitate recognition of postpartum depression and appropriate help-seeking, and knowledge of how to seek information related to postpartum depression. Finally performing the confirmatory factor analysis, the Postpartum Depression Literacy Scale with 31 items was supported for the structures suggested by theoretical model and findings from the exploratory factor analysis. The Cronbach's alpha coefficient for the scale was .78 and it ranged from .70 to .83 for each factor lending support to the internal consistency of the questionnaire. CONCLUSION:The findings suggest that the Postpartum Depression Literacy Scale (PoDLiS) is a reliable and valid instrument for measuring the postpartum depression literacy and now can be used in studies of mental health literacy in women.

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BACKGROUND & AIMS: BACKGROUND:The eHealth Literacy Scale (eHEALS) is the most widely used instrument in health studies to measure individual's electronic health literacy. Nonetheless, despite the rapid development of the online medical industry and increased rural-urban disparities in China, very few studies have examined the characteristics of the eHEALS among Chinese rural people by using modern psychometric methods. This study evaluated the psychometric properties of eHEALS in a Chinese rural population by using both the classical test theory and item response theory methods. OBJECTIVE:This study aimed to develop a simplified Chinese version of the eHEALS (C-eHEALS) and evaluate its psychometric properties in a rural population. METHODS:A cross-sectional survey was conducted with 543 rural internet users in West China. The internal reliability was assessed using the Cronbach alpha coefficient. A one-factor structure of the C-eHEALS was obtained via principal component analysis, and fit indices for this structure were calculated using confirmatory factory analysis. Subsequently, the item discrimination, difficulty, and test information were estimated via the graded response model. Additionally, the criterion validity was confirmed through hypothesis testing. RESULTS:The C-eHEALS has good reliability. Both principal component analysis and confirmatory factory analysis showed that the scale has a one-factor structure. The graded response model revealed that all items of the C-eHEALS have response options that allow for differentiation between latent trait levels and the capture of substantial information regarding participants' ability. CONCLUSIONS:The findings indicate the high reliability and validity of the C-eHEALS and thus recommend its use for measuring eHealth literacy among the Chinese rural population.

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BACKGROUND & AIMS: :The concept of information literacy may be new to some perioperative nurses; however, embracing this concept will help nurses identify situations that necessitate gaining more information, locate and access information sources, evaluate and analyze data, and cite information in compliance with copyright and fair use laws. The culture of health care is continually changing as a result of new technology and new methods to improve patient care, and this creates an information explosion. Perioperative educators should add information literacy as a strategic goal for obtaining Magnet status because it is foundational to evidence-based practice. Administrators also should advocate to obtain resources that will enable nurses to access information that addresses current patient care issues.

背景与目标： : 信息素养的概念对于一些围手术期护士来说可能是新的; 但是，接受这一概念将有助于护士识别需要获得更多信息的情况，定位和访问信息源，评估和分析数据，并引用符合版权和合理使用法律的信息。由于新技术和新方法改善了患者护理，医疗文化不断变化，这造成了信息爆炸。围手术期教育者应将信息素养作为获得磁铁状态的战略目标，因为它是循证实践的基础。管理员还应倡导获得资源，使护士能够访问解决当前患者护理问题的信息。

BACKGROUND & AIMS: OBJECTIVES:Low literacy is highly prevalent among UK adults. This study assessed functional health literacy among family planning clinic clients and whether this was associated with sexual health knowledge and behaviours. It also assessed the readability of patient leaflets. METHODS:505 female family planning clinic attendees aged 16-35 years were interviewed about their sexual behaviour and knowledge. Their reading age was assessed using a validated test (REALM). The readability of leaflets on contraception supplied to clinic users was measured. RESULTS:All respondents had a reading age of 12 years and above, 221 (43.8%) between 12 and 14 years and 284 (56.2%) greater than 14 years. Those in the lower literacy group were significantly more likely to have been aged under 16 years at time of first sexual intercourse, and significantly less likely to know the most fertile time of the menstrual cycle, to identify sexually transmitted infections and to know that sexual infections can be transmitted through oral and anal sex. The reading age of information leaflets in the clinics ranged from 11 to 17 years. Thus, clients with a reading level of 12-14 years would have difficulty in understanding some of the leaflets. CONCLUSIONS:Functional health literacy is related to sexual behaviour and knowledge. Written information should be prepared with this in mind and other routes of communication considered.

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BACKGROUND & AIMS: BACKGROUND:The ability to understand instructions on drug bottles, appointment slips and medical education brochures could be affected by patients' health literacy. Healthcare providers need to be aware of, hence, assess patients' literacy before they develop effective educational strategies for these patients. Many validated instruments have been used to evaluate literacy of diabetic patients in the English language, only a limited number is available in Arabic. OBJECTIVE:To translate and culturally-adapt the Simplified Diabetes Knowledge Test (DKT), the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT) for potential use in Arabic-speaking countries. METHODS:A formal process based on the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines was adopted in translating and culturally adapting the three tools. An expert panel reviewed forward and backward translations of the tools. Ten diabetic patients participated in the cognitive debriefing process to evaluate the tools for clarity, simplicity, and comprehensiveness, and to assess their cultural equivalence. RESULTS:Only minor changes were introduced in tools' design, appearance, and instructions. However, issues identified during the expert panel review and cognitive debriefing led to modifying the tools resulting in item re-wording, addition, deletion or re-arrangement. Terms such as glycosylated hemoglobin, carbohydrates, and infection were adapted to cumulative sugar, starch and microbial inflammation respectively. Issues related to cultural and conceptual equivalence were resolved by replacing words such as kilo instead of pound, and supper instead of dinner, or adding diacritics to the Arabic word for "kidney". The original 43 items of the DNT were reduced to 26, eliminating questions with the same mathematical calculations within each tool domain. CONCLUSIONS:A Culturally equivalent version of the Simplified DKT, LAD and DNT have been developed in the Arabic language available to be used in research and clinical practice in the Arabic speaking countries.

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BACKGROUND & AIMS: :Health literacy (HL) is a concept that concerns individuals, as well as health systems and health professionals. This study was conducted to determine health literacy and affecting factors of nursing students. A descriptive-cross sectional design was used. First and fourth year nursing students were included in the study (n = 303). A questionnaire and the Adult Health Literacy Scale were used for collection of the data. Most (84.8%) of the students were female and 60.4% were studying in their first year. The mean Adult Health Literacy Scale score of the student nurses was 15.9 ± 3.2. The fourth year nursing students who have health insurance, have chronic disease, use drugs regularly, and have difficulties in reading had higher mean Adult Health Literacy Scale scores (p < 0.05). Although this study indicates that the HL level of the nursing students was found as adequate, it is thought that the higher HL level acquired in the undergraduate education the more competent nursing workforce. The HL concept should be integrated into the nursing curriculum to improve the HL levels of the nursing students. Nurse educators should emphasize the importance of health literacy and patient empowerment in the curriculum.

背景与目标： : 健康素养 (HL) 是一个涉及个人以及卫生系统和卫生专业人员的概念。本研究旨在确定护生的健康素养和影响因素。使用描述性横截面设计。研究包括第一和第四年的护理学生 (n   =   303)。使用问卷和成人健康素养量表收集数据。大多数 (84.8%) 学生是女性，60.4% 在第一年学习。学生护士的成人健康素养量表平均得分为15.9   ±   3.2。有医保、慢性病、经常用药、阅读困难的四年级护生，其成人健康素养量表平均得分较高 (p  <  0.05)。尽管这项研究表明，护理专业学生的HL水平已足够，但人们认为，在本科教育中获得的HL水平越高，护理人员的能力就越高。应将HL概念纳入护理课程，以提高护理学生的HL水平。护士教育者应在课程中强调健康素养和患者赋权的重要性。

BACKGROUND & AIMS: :Health literacy has gained popularity as a useful concept to promote and protect health. Even though health literacy research has been prolific it has also been fragmented, facing challenges in achieving its empowerment and social justice-related aims. Crucial limitations make the application of its principles to the health of vulnerable and underrepresented groups problematic, even though these groups are disproportionately affected by ill health. Efforts to refine and make the concept more relevant have tended to expand health literacy models and situate health literacy 'in context' to reflect environmental and social factors shaping health literacy. Context-related factors however, have not been consistently embedded in operationalisation and measurement efforts.This paper argues for health literacy to be re-conceptualised through a capabilities approach lens. It proposes that the capabilities approach can uniquely address the conceptual and methodological criticisms applied to health literacy, whilst encompassing its critical conceptual understandings of health. The advantage of this approach over and above other developments in health literacy theory and practice is its focus on both people's opportunities or freedoms to achieve desired health-related aims, and their ability to do so. It enables shifting the focus away from health literacy as individual skills and competencies and towards the enabling or inhibiting factors shaping health literacy. A participatory approach is seen as essential for realising this conceptual shift.

背景与目标： : 健康素养已成为促进和保护健康的有用概念。尽管健康素养研究是多产的，但它也支离破碎，在实现其赋权和社会正义相关目标方面面临挑战。关键的限制使得将其原则应用于脆弱和代表性不足的群体的健康成为问题，尽管这些群体受到健康不良的不成比例的影响。完善和使这一概念更加相关的努力倾向于扩大健康素养模型，并将健康素养置于 “背景”，以反映影响健康素养的环境和社会因素。然而，与上下文相关的因素并没有始终嵌入到操作和测量工作中。本文主张通过能力方法的视角来重新概念化健康素养。它提出，能力方法可以独特地解决应用于健康素养的概念和方法批评，同时涵盖其对健康的批判性概念理解。与健康素养理论和实践的其他发展相比，这种方法的优势在于它关注人们实现期望的健康相关目标的机会或自由，以及他们这样做的能力。它可以将重点从个人技能和能力的健康素养转移到影响健康素养的促成或抑制因素上。参与性方法被视为实现这一概念转变的关键。

BACKGROUND & AIMS: INTRODUCTION:Teachers are frontline professionals who have daily contact with children and are therefore most likely to have the biggest impact on their students. Findings in this study should inform the development of teacher training programs, and more broadly, assist in the success of a strategic plan addressing mental health in classrooms. This study aims to assess mental health literacy among teachers with focus on their knowledge of depression. METHODS:The study was a cross-sectional descriptive survey conducted among teachers in five secondary schools (high school) in southeast Nigeria. All consenting teachers were recruited, making a total of 120 participants. The participants were presented with a questionnaire designed to elicit the participants' recognition of the disorder depicted in two vignettes and their recommendation about the appropriate source of help seeking. One vignette was of a clinically depressed case while the other vignette was about a girl undergoing normal life crisis. RESULTS:Out of the 120 teachers recruited into the study, 104 questionnaires were adequately completed indicating a response rate of 86.7%. A total of 16.3% (n = 17) participants correctly identified and labeled the depression vignette. Only 14 teachers (13.5%) recommended professional help from a psychiatrist or psychologist. Diminished ability to concentrate was the most identified symptom of distress for depression (30.8%). Counsellors were the most recommended source of help. DISCUSSION:Mental health literacy was poor among the teachers surveyed. There is an urgent need to improve mental health literacy among teachers in Nigeria.

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BACKGROUND & AIMS: PURPOSE:The common causes for misunderstanding prescription drug warning labels (PWLs) among adults with low literacy were studied. METHODS:A total of 74 patients reading at or below the sixth-grade level and receiving care at the primary care clinic at the Louisiana State University Health Sciences Center in Shreveport were recruited to participate in structured interviews. Patients were asked to interpret and comment on eight commonly used warning labels found on prescription medications. Correct interpretation was determined by expert panel review of patients' verbatim responses. Qualitative methods were employed to code responses and generate themes regarding the misunderstanding of these PWLs. RESULTS:Among this sample of patients with low literacy skills, rates of correct interpretation for the eight warning labels ranged from 0% to 78.7%. With the exception of the most basic label, less than half of all patients were able to provide adequate interpretations of the warning label messages. Five themes were derived to describe the common causes for misunderstanding the labels: single-step versus multiple-step instructions, reading difficulty of text, use of icons, use of color, and message clarity. Labels were at greater risk for being misunderstood if they included multiple instructions, had a greater reading difficulty, included unfamiliar terms, or used confusing icons that were discordant with text messages. Participants also frequently imposed an incorrect meaning on label colors, which led to further confusion. CONCLUSION:Patients with low literacy skills demonstrated a lower rate of correct interpretation of the eight most commonly used PWLs than did those with higher literacy skills. Multiple-step instructions, reading difficulty of text, the use of icons, the use of color, and message clarity were the common causes of label misinterpretation.

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