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Purpose: The purpose of this study is to examine parental Functional Health Literacy and their child’s subsequent utilization of dental services. Methods: This was a prospective cohort study of children (n=1175) enrolled in the Child Health Investment Partnership of Virginia (CHIP). Descriptive statistics and separate multivariate logistic regressions were used to determine the relationship between functional health literacy measures; 1) Health Care Literacy (HCL), 2) Personal Health Literacy (PHL), and 3) LSP 22 scale, with utilization as measured as number of dental visit/s. Results: Descriptive analysis of the cohort reveals: 45% black, 40% white, 10% Hispanic, 5% other, 41% of parents not having a high school diploma or GED, >75% were enrolled in CHIP by the age of one, 90% had Medicaid, 80% lived in Roanoke City, 87% had a normal birth weight, 86% were term pregnancies, and 91% did not have asthma. All literacy measures, PHL, HCL, LSP 22, and LSP 22 Target Range were positively associated with having dental utilization. Hispanic race had a less likely chance of having multiple dental visits even when within target range of LSP 22. Conclusion: Parents of children enrolled in CHIP with higher levels of functional health literacy as measured by the Life Skills Progression Instrument demonstrated an increased likelihood of dental utilization for their children.

ABSTRACT Many older African American adults have inadequate health literacy and are more likely to have chronic illnesses needing medication therapy. African Americans continue to experience significant health disparities in the incidences of cardiovascular disease and diabetes. It was postulated that ethnic disparities in medication compliance are related to a dynamic interplay between low health literacy and health locus of control. Thirty older African Americans taking at least one prescription medication were interviewed. Although the vast majority was well-educated, only 53% displayed adequate health literacy. Most of the participants believed they controlled their health, and over half were noncompliant with their medications. Poor health literacy and health locus of control appeared to influence medication compliance in older African Americans.

ABSTRACT Many older African American adults have inadequate health literacy and are more likely to have chronic illnesses needing medication therapy. African Americans continue to experience significant health disparities in the incidences of cardiovascular disease and diabetes. It was postulated that ethnic disparities in medication compliance are related to a dynamic interplay between low health literacy and health locus of control. Thirty older African Americans taking at least one prescription medication were interviewed. Although the vast majority was well-educated, only 53% displayed adequate health literacy. Most of the participants believed they controlled their health, and over half were noncompliant with their medications. Poor health literacy and health locus of control appeared to influence medication compliance in older African Americans.

MASTER OF SCIENCE (2017), McMaster University, Hamilton ON (Department of Global Health) TITLE: A comprehensive approach to health literacy: validating the all aspects of health literacy scale (AAHLS) in a representative sample of Arabic-speaking adult Syrian refugees AUTHOR: Raafia Siddiqui, BSc Hons. (York University, 2014) SUPERVISOR: Dr. K. Bruce Newbold NUMBER OF PAGES: vii, 92 / The purpose of this study is to quantify current health literacy levels amongst a segment of the Syrian refugee population in Canada by translating and validating an existing comprehensive health literacy assessment tool, the All Aspects of Health Literacy Scale (AAHLS) into Arabic. This study (1) determined functional, communicative and critical health literacy levels amongst Syrian refugees. Functional and critical health literacy was comparatively low but respondents seemed able to effectively communicate with their providers and access supports to read and fill in health documents. Significant correlates of low health literacy were presence of long-term health conditions and place of origin (country versus refugee camp). This study also validated the AAHLS in Arabic-speaking Syrian refugees, with a Cronbach’s alpha of 0.67 for the overall scale and 0.63 for health literacy items. The overall scale had high content validity. The feasibility of this instrument as a self-administered screening tool in clinical or community settings was demonstrated with a high response rate of 0.86. / Thesis / Master of Science (MSc) / Health literacy looks at an individual's ability to read, understand and interpret health information and ultimately use it to exert greater control over their health. The purpose of this study is to understand the factors that influence health literacy levels amongst a segment of the Syrian refugee population in Canada by translating and validating an existing comprehensive health literacy assessment tool, the All Aspects of Health Literacy Scale (AAHLS) into Arabic. This study (1) determined functional (reading and filling in health documents), communicative (speaking to health providers) and critical health (assessing the relevance and appropriateness of health information) literacy levels amongst Syrian refugees. Functional and critical health literacy was comparatively low but respondents seemed able to effectively communicate with their providers and access supports to read and fill in health documents. Low health literacy was associated with having a long-term health conditions and staying in a refugee camp. This study found the translated AAHLS to be reliable, with a Cronbach’s alpha of 0.67 for the overall scale and 0.63 for health literacy items. The overall scale had high content validity. The feasibility of this instrument as a self-administered screening tool in clinical or community settings was demonstrated with a high response rate of 0.86.

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Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-08-22T18:42:20Z No. of bitstreams: 1 tatianaresendecarvalho.pdf: 1506183 bytes, checksum: b3c7a483a60aa885fc2e59931d92b8b0 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-08-28T13:13:59Z (GMT) No. of bitstreams: 1 tatianaresendecarvalho.pdf: 1506183 bytes, checksum: b3c7a483a60aa885fc2e59931d92b8b0 (MD5) / Made available in DSpace on 2018-08-28T13:13:59Z (GMT). No. of bitstreams: 1 tatianaresendecarvalho.pdf: 1506183 bytes, checksum: b3c7a483a60aa885fc2e59931d92b8b0 (MD5) Previous issue date: 2018-03-21 / Estudo transversal realizado com 340 usuários hipertensos, acompanhados pela Estratégia Saúde da Família do município de São João del-Rei, selecionados a partir do registro das fichas de acompanhamento dos agentes comunitários de saúde, por amostragem aleatória simples. Os objetivos do estudo foram analisar a associação entre letramento funcional em saúde e adesão ao tratamento medicamentoso da HAS; descrever os níveis de letramento funcional em saúde da população de estudo; estimar a prevalência da não adesão ao tratamento medicamentoso da HAS e analisar os fatores associados à não adesão ao tratamento medicamentoso da HAS. A coleta de dados ocorreu entre os meses de junho à setembro de 2017 e foi realizada através de um formulário com questões estruturadas acerca dos fatores socioeconômicos, relacionados ao paciente, à doença, ao tratamento, à equipe e ao serviço de saúde. A avaliação da adesão ao tratamento medicamentoso foi feita através da Escala de Adesão Terapêutica de oito itens de Morisky (MMAS-8) e o nível de letramento funcional em saúde foi medido pelo B-TOFHLA. As análises estatísticas foram feitas utilizando-se o teste qui-quadrado e modelos de regressão de Poisson para estimar as razões de prevalência brutas e ajustadas, os respectivos intervalos de confiança (IC95%) e p-valor. A prevalência de não adesão ao tratamento farmacológico da HAS foi de 24,1% (IC 95%: 19,7 – 28,5). Os fatores associados à não adesão à terapia medicamentosa foram a credibilidade na importância dos medicamentos para o tratamento da HAS, a frequência na tomada dos medicamentos para a doença por dia, a compreensão das orientações e explicações dadas pelos profissionais de saúde e a dificuldade em conversar com os profissionais. Baixo letramento funcional em saúde foi encontrado em 80,2% dos hipertensos entrevistados. A proporção de usuários não aderentes ao tratamento com baixo letramento funcional em saúde foi 77% superior à proporção de usuários não aderentes à terapia medicamentosa com letramento funcional em saúde adequado (RP=1,77; IC95%:0,93 – 3,75). Os resultados mostram que mudanças baseadas na complexidade do regime terapêutico, uma adequada assistência à saúde, baseada nas particularidades de cada indivíduo, levando-se em conta a influência que o mesmo recebe do meio que o cerca podem contribuir para o aumento da adesão ao tratamento medicamentoso da HAS. É possível supor ainda que, identificando-se as limitações apresentadas pelos usuários em relação ao acesso e à compreensão das informações e orientações que lhe são repassadas, a equipe de saúde pode elaborar estratégias que favoreçam o processo de comunicação entre profissionais de saúde e usuários do sistema, compensando assim os baixos níveis de letramento funcional em saúde, fazendo com que as informações e orientações necessárias ao manejo e ao acompanhamento da doença sejam mais facilmente compreendidas pelos usuários. / This is a cross-sectional study performed with 340 hypertensive users who have been monitored by the Family Health Care Service from the city of São João del-Rei. They have been selected based on the follow-up records of the community health agents by simple random sampling. The aim of the study is to analyze the association between Functional Health Literacy and the adherence to the medical treatment for HAS (hypertension); to describe the levels of functional health literacy in the evaluated population; to estimate the predominant non-adherence to the drug treatment for hypertension and to analyze the factors that are connected to the non-adherence to the medical treatment for hypertension. Data collection has happened between June and September 2017 and it was carried out by using a questionnaire with questions about socioeconomic factors related to the patient, to their disease, to their treatment, the team who have assisted them and the health care service itself. The evaluation in order to measure the adherence to the drug treatment was carried out via the 8-item Morisky Medication Adherence Scale (MMAS-8) and the Functional Health Literacy level was measured by the B-TOFHLA. Statistical analyzes have been performed using the chi-square test and Poisson regression models in order to estimate crude and adjusted prevalence ratios, confidence intervals (IC95%), and p-value. The predominance of non-adherence to the pharmacological treatment for HAS was 24.1% (IC95%: 19.7-28.5). The main factors associated with the non-adherence to the drug therapy were: trustworthiness regarding the importance of drugs for the treatment of HAS, the frequency the user takes the prescribed medicine per day, the understanding of the instructions and explanations given by the health care professionals, and the struggle in talking to the professionals. Low functional health literacy has been found in 80.2% of the hypertensive patients who have been interviewed. The non-adherence ratio among patients with low functional health literacy is 77% higher than the proportion of non-adherence among patients with adequate functional health literacy (PR = 1.77, IC 95%: 0.93-3.75). The results have shown that changes based on the complexity of the therapeutic regime and an adequate health care provision based on the specificities of each individual, taking into account the influence that the patient gets from the environment he comes from can contribute to raise the levels of medication adherence for HAS. It is also possible to assume that, by identifying the patients limitations regarding the access and the overall comprehension of the information and instructions that are passed on to them, it allows the healthcare team to prepare and implement strategies that may favor the communication process between the healthcare professionals and users of the system, thus compensating for the low levels of functional health literacy and making the information and general guidelines that are necessary for the management and follow-up of the disease more easily understood by its users.