Background: One significant predictor of health practices and outcomes is health literacy. Health literacy is an individual's ability to search, understand, appraise, and apply health information. Much research has occurred on health literacy (HL), ehealth literacy (eHL), subjective well-being (SWB), and COVID-19 health-related behaviours; however, few studies have explored the association between these variables, particularly within Canada. Understanding university students' HL and eHL levels would yield beneficial information on a group that impacts their community, particularly in a pandemic setting where students gather in large groups. Methods: An online survey was administered to 336 university students via Google Forms from April 2022 - December 2022. The survey used the Computer Adaptation of Newest Vital Sign to measure HL, eHEALS to measure eHL, a modified COVID-19-Related Health Behaviors questionnaire, and the Satisfaction with Life Scale to measure SWB. Data analysis was analyzed using Pearson correlation and hierarchical regression analysis on SPSS. Results: Most participants were, on average, 26.1 years and 76.7% identified as female. The statistical analysis revealed that eHL significantly predicted COVID-19-related health behaviours, whereas SWB and HL were not statistically significant predictors of COVID-19-related health behaviours. Overall, the results suggest that individuals with higher eHL levels may engage in less healthy behaviours related to COVID-19. Conclusion: Although this study found that eHL predicted COVID-19 related health behaviours, HL and SWB did not seem to have a significant relationship with COVID-19 related health behaviours. This suggests that other interdisciplinary factors are involved in understanding the relationship between HL, eHL, SWB, and COVID-19 health-related behaviours among Canadian university students. Cultural beliefs and values, political alignment, fear and anxiety, misinformation, and disinformation are reasons HL may not be a strong predictor of COVID-19 related health behaviours. Future research should continue to explore a more interdisciplinary approach to public health practice geared towards researching the factors that affect health behaviours on college campuses will improve future health and well-being outcomes among this population.

Class of 2011 Abstract / OBJECTIVES: To compare pharmacists’ perceptions of patients’ health literacy levels to their measured health literacy levels. METHODS: This was descriptive study that included thirty patients from two independent pharmacies where they were administered a health literacy survey at random during their routine visit to the pharmacy. Each participant’s health literacy assessment was scored and assigned to a corresponding literacy level. Pharmacists from each store were then surveyed as to what they perceived each patient’s health literacy level to be. RESULTS: Twenty-eight of the thirty participants (93%) obtained the highest literacy score possible in the assessment. Two participants scored lower literacy levels and were both non-whites who were currently taking six or more medications and over the age of 50. No significant differences with respect to age, gender, education level, number of previous conversations with the pharmacist, or number of current medications were found as compared to measured literacy level. Actual literacy scores as well as perceived literacy levels between sites were also found to be insignificant (p=0.17 and p=0.58 respectively). With respect to race, there was a significant difference between whites vs. non-whites relative to REALM scores (p<0.001). Analysis of the difference between actual literacy scores and perceived scores were unable to be determined.       CONCLUSION: Based on the two participants who had lower literacy levels, this may suggest a disparity in health literacy with respect to race, age, and number of concurrent medications. However, due to lack of study variability, the significance of the difference was unable to be determined and conducting a larger study with more diverse settings, demographics, and larger sample size is suggested.

Cardiovascular diseases are major causes of mortality and hospitalization for adult Indigenous peoples. Historical, socio-economic, environmental and cultural risk factors have been identified in the literature and new evidence is emerging regarding culturally relevant health promotion approaches for Indigenous peoples at risk of developing or currently experiencing cardiovascular disease. Self-management of care is considered a central component to effective cardiovascular disease management. This approach requires a working knowledge and understanding of cardiovascular disease medications, and an ability to effectively communicate with healthcare practitioners. Another important associated risk factor for Indigenous peoples with heart disease, is the gap between patient - practitioner understanding of heart disease. The biomedical perspective supported by Western scientific evidence, makes little room for Indigenous knowledge. Indigenous peoples may wish to include Indigenous knowledge and/or Traditional Medicine in their self-care approach. The findings of this research demonstrates that Indigenous peoples primarily have a biomedical understanding of their heart disease and most are unaware of how various socio-historical and socio-cultural factors such as the negative inter-generational impact of residential school and contemporary experiences of oppression and discrimination are linked to their heart disease. This situation can be attributed to an Indigenous knowledge diaspora experience that includes the severance of access to Indigenous knowledge and Indigenous languages during the residential school period and the dominance of biomedicine in health care delivery. The concept of ‘diaspora health literacy’ is critically discussed as a potential tool to address the Indigenous knowledge diaspora barrier. It is proposed that Indigenous peoples with heart disease can enhance their self-care when culturally relevant health literacy approaches are available to them. In turn, healthcare practitioners can broker an ‘Indigenous therapeutic relational space’ with their Indigenous patients by initiating a culturally relevant health literacy assessment and a harmonized implementation model. / Dissertation / Doctor of Philosophy (PhD)

Thesis (Ed.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / With increasing complexities in the health care system, including new technologies, density of health information, and a rise in medical errors, the literature has demonstrated links between communication and health literacy and patient/client safety, adherence to health protocols, and satisfaction with health providers. The purpose of this study was to understand the current level of knowledge of health communication and health literacy among doctoral (OPT) students and experienced physical therapists, and to explore related professional literature, documents, competencies, and industry standards to further inform this research. In addition to a qualitative research approach that included semi-structured participant interviews, open-ended questioning, coding, and analysis, the Design for Learning Model of instructional design was incorporated as a parallel methodology to develop a course template for communication and health literacy instruction. Participants were selected and interviewed at a national conference, and in academic, practice, and home settings. Based upon, and in response to, the data collected from fifteen physical therapist informant interviews, industry consultants, document sources, and pilot testing of units on health literacy and pharmaceutical advertising in the American health care system, respectively, a systematic, competency-based communication and health literacy course template was developed for use in physical therapist education. Findings suggest that, although patient-practitioner communication is embedded into physical therapy courses, there is a need to broaden the definition to incorporate more extensive communication topics, including health literacy and health informatics, cultural- and age-sensitivity, and alternative patient education methods to address related issues in health care settings, home, and workplace. Recommendations for the future include development of more specific communication and health literacy education for both student and experienced physical therapists in academia, clinical education, practice settings, and professional development arenas. Additionally, physical therapists are urged to collaborate with other health and non-health disciplines, including policymakers, educators, communications experts, and instructional designers to promote health literacy awareness, competencies, and commitment within the profession, and beyond. This study further underscores the health professional's responsibility for both delivery and comprehension of health information by patients/clients, especially those who may be challenged by low health literacy. / 2031-01-02

Background: In Canada, as acute ischemic stroke treatment advances and the population ages, more individuals are surviving stroke and returning home with minor deficits. Self-management education tailored to one’s health literacy level is a critical and overlooked aspect in minor ischemic stroke survivors’ recovery. During the first month after minor ischemic stroke, when the risk of recurrence is highest, minor ischemic stroke survivors experience numerous transitions and report unmet health information needs that place them at risk for poor health outcomes. Although minor ischemic stroke-specific data is lacking, American data suggests 59% of stroke survivors have marginal to inadequate health literacy at the time of hospital discharge. Low health literacy in stroke survivors has been associated with poor education retention; issues with medication administration, adherence and self-efficacy; reduced physical functioning; and depression. Increasingly it is recognized that health literacy should be considered a contextual entity. There is a need to better understand the level of health literacy and contextual factors associated with health literacy in minor ischemic stroke survivors to prevent poor health outcomes and health disparities. Purpose: This project aimed to determine the level of health literacy and contextual factors associated with health literacy in recent minor ischemic stroke survivors who were predicted to return to the community within 30 days after their stroke. Methods: This cross-sectional survey was grounded by Sorensen’s Integrated Model of Health Literacy (2012) and employed the HLS19-Q12 to measure health literacy. Contextual factors were assessed using a survey developed from a comprehensive literature review. Forty-two minor ischemic stroke survivors were recruited from the acute stroke unit and stroke rehabilitation unit and completed the questionnaires. Statistical analyses were completed in SPSS. Summary statistics of the HLS19-Q12 scores in minor ischemic stroke survivors were reported and compared with HLS19-Q12 scores of the general population published in the2019-2021 Health Literacy Population Survey. Contextual factors were reported as summary statistics and associations with health literacy were analyzed using Spearman correlation, Kruskal-Wallis tests, Mann-Whitney U tests and multiple linear regression. Results: The average HLS19-Q12 score was 76.3 and similar to the results obtained in the 2019-2021 Health Literacy Populations Survey. The need for information about financial support, a higher number of total barriers to health literacy and issues related to health care provider continuity, feeling uncomfortable asking a health care provider to explain something you didn’t understand (stigma) and memory were associated with lower levels of health literacy in recent minor ischemic stroke survivors. Discussion: Although the average level of health literacy was similar to that of the general population, many participants reported problematic (26.2%) or inadequate (16.7%) health literacy. This thesis is unique in its use of a contextual perspective to explore health literacy in minor ischemic stroke survivors. This perspective enabled the identification of personal, situational and societal/environmental factors that may be critical in promoting optimal health of recent minor ischemic stroke survivors. The results of this study suggest care continuity, the patient-health care provider relationship and financial support may be critical factors. Conclusion: This data can be used to inform future equity-focused research designs and holistic interventions to support recent minor ischemic stroke survivors with lower levels of health literacy who return to the community. These interventions have the potential to reduce the risk for poor health outcomes after a minor ischemic stroke / Thesis / Master of Science in Nursing (MSN)

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.

Low health literacy levels put patients at greater risk for poorer compliance and access to care, which leads to worse patient outcomes. Nurses must understand health literacy to improve health literacy for their medical surgical patient population. It is necessary for a formal education program on this topic. The purpose of this project was to increase medical surgical nurses' awareness and knowledge of the importance of health literacy and to introduce the REALM-SF tool to assess a patient's literacy level, allowing a nurse to better individualize the education provided to the patient. Lewin's change management theory was key in the development of this project with attention to his three stages of change acceptance. The practice focus question was, "Will medical-surgical nurses show an improvement in their knowledge of health literacy when comparing measurement of knowledge pre education and immediately post education?" The HL-SF12 for registered nurses tool was used to collect data for this project as a pre- and post-implementation knowledge assessment. Thirty-one medical surgical nurses participated in this education session. The results of this analysis show that there is a significant gap in medical-surgical nurses' knowledge of health literacy. However, all participates showed a significant increase in their scores from pretest to posttest after the educational module, which signifies that this education program was successful. Assessing health literacy is a major step towards improving the delivery of patient education by nurses and assists the patients in the management of their medical problems. All of this leads to positive social change by making sure that the education provided by the nurses is understood and received well by the patients and their families.

Background: Adolescents need to develop health literacy skills to participate in making decisions about their health care. Organizational health literacy facilitates patient understanding of health information, care access, and self-management. Methods: A literature review and qualitative case study were conducted to explore adolescent health literacy within an organizational context of an adolescent scoliosis program. Results: Adolescent health literacy is more nuanced than numeracy and reading levels. Yet, little is known about how organizations (including clinicians) support adolescent health literacy. Interviews with health care professionals in a pediatric tertiary hospital related health literacy to scoliosis patient education but did not address other factors associated with adolescents’ ability to navigate health systems. Organizational documents did not adequately support healthcare professionals in promoting the health literacy of adolescent scoliosis patients. Conclusion: Organizational supports are needed to build health literacy capacity amongst adolescents receiving scoliosis care and clinicians need help to leverage the supports that are in place.

Podium presentation on health literacy and interprofessional telehealth considerations.

BACKGROUND:Health literacy (HL) is an important public health issue. Current measures have drawbacks in length and/or acceptability. The US-developed Newest Vital Sign (NVS) health literacy instrument measures both reading comprehension and numeracy skills using a nutrition label, takes 3 minutes to administer, and has proven to be acceptable to research subjects. This study aimed to amend and validate it for the UK population.METHODS:We used a three-stage process / (1) a Delphi study with academic and clinical experts to amend the NVS label to reflect UK nutrition labeling (2) community-based cognitive testing to assess and improve ease of understanding and acceptability of the test (3) validation of the NVS-UK against an accepted standard test of health literacy, the Test of Functional Health Literacy in Adults (TOFHLA) (Pearson's r and the area under the Receiver Operating Characteristic (ROC) curve) and participant educational level. A sample size calculation indicated that 250 participants would be required. Inclusion criteria were age 18-75 years and ability to converse in English. We excluded people working in the health field and those with impaired vision or inability to undertake the interview due to cognitive impairment or inability to converse in English.RESULTS:In the Delphi study, 28 experts reached consensus (3 cycles). Cognitive testing (80 participants) yielded an instrument that needed no further refinement. Validation testing (337 participants) showed high internal consistency (Cronbach's Alpha = 0.74). Validation against the TOFHLA demonstrated a Pearson's r of 0.49 and an area under the ROC curve of 0.81.CONCLUSIONS:The NVS-UK is a valid measure of HL. Its acceptability and ease of application makes it an ideal tool for use in the UK. It has potential uses in public health research including epidemiological surveys and randomized controlled trials, and in enabling practitioners to tailor care to patient need.