Orientador: Alessandro Ferrari Jacinto / Resumo: Introdução: Indivíduos com baixos níveis de alfabetismo em saúde têm menor conhecimento das suas próprias condições de saúde, pior manejo de doenças crônicas e aumentam os custos dos serviços. Os cuidadores desenvolvem papel fundamental na vida dos idosos, pois os auxiliam em atividades no dia a dia, como higiene pessoal, uso de medicações e até mesmo na tomada de decisão em saúde. Existem poucos estudos que avaliam os níveis de alfabetismo em saúde em cuidadores de idosos. Objetivos: Avaliar o desempenho de cuidadores de idosos no instrumento S-TOFHLA (Short Test of Functional Health Literacy in Adults) que é uma ferramenta validada no Brasil para este objetivo. Métodos: Estudo transversal em que foram aplicados a 80 cuidadores de idosos atendidos rotineiramente por médicos de duas unidades da rede básica de saúde do município de Botucatu-SP os seguintes instrumentos: S-TOFHLA, questionário sociodemográfico, o Mini Exame do Estado Mental e o “The Patient Health Questionnaire (PHQ) 2”. A análise estatística das variáveis categorizadas foi realizada por meio do teste do qui-quadrado e as variáveis contínuas por meio do teste t de student. A análise multivariada utilizou modelo de regressão logística ordinal tendo como variável dependente os escores do teste S-TOFHLA. O nível de significância estatística adotado foi de 0,05. Resultados: Os indivíduos apresentaram idade média de 54,6(±11,7) anos sendo 87,5% do sexo feminino; 27% dos cuidadores avaliados apresentaram índices de n... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Individuals with low health literacy have less knowledge of their own health condition, poor self-management of chronic diseases, delayer on diagnosis and increases the costs of the services. Caregivers have a key role in elderly's daily living activities, assisting them on the daily activities such as personal hygiene, use of medication and health decision-making. There are few studies on health literacy among elderly’s caregivers. Aims: To evaluate the performance of elderly's caregivers on S-TOFHLA (Short Test of Functional Health Literacy in Adults), which is a validated tool in Brazil for that purpose. Methods: Cross-sectional study. The S-TOFHLA, a sociodemographic instrument, the Mini Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 elderly’s caregivers. The elders were routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, SP. Statistical analysis of categorized variables was performed using the chi-square test and the continuous variables using the t-student test. The multivariate analysis used ordinal logistic regression model with the tests scores as the dependent variable. The level of statistical significance adopted was 0,05. Results: The individuals had a mean age of 54,6 (±11,7) years and 87,5% were female; 27% of the caregivers evaluated had no adequate levels in health literacy. There was a statistically significant difference (p<0,001) in the distribution of schooling levels among ... (Complete abstract click electronic access below) / Mestre

Bakgrund: Generellt sett har utrikes födda individer sämre hälsa jämfört med individer födda i Sverige. Utrikes födda kvinnor rapporterar lägre självskattad hälsa samt en låg grad av sysselsättning. Utbildning är en friskfaktor och arbetslöshet är en riskfaktor för hälsan. Kvinna in i Sverige[KIIS] är ett projekt som syftar till att integrera utrikes födda kvinnor i samhället samt få de att närma sig arbetsmarknaden eller studier.  Syfte: Syftet med denna studie var att undersöka projektarbetares uppfattning om projektet Kvinna in i Sverige och hur projektet kan öka utrikes födda kvinnors möjligheter att komma närmare arbete eller studier.  Metod: En kvalitativ metod tillämpades för att besvara studiens syfte och fem semistrukturerade telefonintervjuer hölls med projektarbetare som arbetar i KIIS i Västmanlands län. För att analysera intervjudata tillämpades en manifest innehållsanalys. Resultat: KIIS innefattar ett flertal insatser som uppfattas främja deltagares hälsa samt få dem närmare arbete eller studier och det finns uppfattningar om att projektet har en positiv påverkan. Vidare uppfattas det finnas både möjligheter och hinder för att deltagarna ska komma in i Sverige.  Slutsatser: KIIS kan ge goda förutsättningar för att utrikes födda kvinnor ska komma närmare studier och arbete samtidigt som projektet uppfattas främja deltagares hälsa och språkfärdigheter.

The thesis analyses the healthcare system in Germeny after the 1990s. The aim is to analyse the changes in the positions of insured persons within the system, as well as both internal and external factors which resulted in these changes. The role of insured persons is different than in the 1990s. Reforms and their impacts with regard to key players, especially patients are described in each chapter. The analysis is devided into four chapters, which are dedicated to the systém of insurance as such, the health care providers and the role of informations for the insured persons, subsequently. At the end, the influence of reunification is analysed. The thesis formulates conditions on which more responsibility and more decision-making opportunities are given to insured persons or taken away from them. Moreover, the role of external factors is described (e. g. the pharmaceutical industry, the development of media or macroeconomic development). Information sources used for the analysis derive from sickness funds, sickness fund unions, expert recommendations, legislation or programmes of political parties. The thesis concludes that the role of sickness funds has been strengthened, but the utilization is not as rational as it seems and is inhibited by some other factors. In a broader context, the conclusions...

Purpose: Health literacy and obesity are major global issues. Vulnerable populations, such as those with low health literacy, have the highest rates of obesity. Native Hawaiian and other Pacific Islander (NHOPI) nations have the highest prevalence of obesity in the world. This study describes the relationship between health literacy and demographic variables in a sample of NHOPI caregiving adults. Methods: We conducted a correlational study of 364 NHOPI adults. Each was a caregiver of at least one NHOPI child. Data were collected at grocery stores and a preschool in two Hawaiian Islands (n=209) and at NHOPI events in Utah (n=155). Our questionnaire included demographics, the Newest Vital Sign, and questions about caregivers' food-serving and activity promotion. Results: 45% of the sample had limited health literacy. There was no significant difference between participants' health literacy in Hawaii and Utah. Other demographic variables (gender, age, income, BMI, and education) had a significant relationship with health literacy. Conclusions: Many NHOPIs have limited health literacy. This is concerning as limited health literacy can reduce an adults' ability to use health-related materials including nutrition facts labels.Implications for Practice: Health care providers should not assume NHOPIs understand nutrition facts labels. Instruction on nutrition facts labels should be available in schools and communities. Future research should examine effective interventions for this population.

The covid-19 pandemic has resulted in millions of lost lives, hundreds of millions ill, and an unwelcome interruption in our lives and in the world order. During the pandemic, we have been fed with massive amounts of information and regulations on how to act to reduce the spread of the virus. To properly make use of the information we receive, health literacy is needed. Health literacy is the basic reading and writing skills that enable us to obtain health-related information. However, the information we are given often requires advanced reading skills, contextual knowledge, and capabilities to process and adapt the information to personal situations. These are requirements that can prove challenging for individuals with little or no previous education. This study seeks to answer how health literacy impacts the capability to access and process information, and how accessible information regarding the covid-19 pandemic is. The study focuses on refugees, with little or no education studying at Swedish For Immigrants (SFI) track 1. Refugees are relevant to study as refugees are more socio-economically vulnerable, have been seen to be disproportionately affected by the covid-19 pandemic, and can be argued to face greater challenges in accessing information. The study is done through a small number of interviews with individuals from the focus group. The results indicate that the respondents have good knowledge of common symptoms and measures to avoid spreading the virus. However, the findings do show that the information material available on the Swedish authorities’ websites is too difficult to understand for someone with limited reading skills. This also applies to material that is claimed to be easy to read. Yet, the respondents do grasp the overall content due to pictures and illustrations. The findings are compared to a survey of information during the pandemic among non-fluent Swedish speakers conducted by MSB. The comparison shows support for certain findings from the interviews.

Background: Migration adds particular dimensions to social determinants of health, as being a migrant can make a person more vulnerable to negative health effects. Like in other crises, migrants are vulnerable to both direct and indirect impacts of COVID-19.  Aim: To examine migrants’ opinions about COVID-19 information in Region Uppsala, with regard to comprehensiveness, importance and possibility to follow.  Method: A descriptive cross-sectional study was conducted based on secondary data obtained from Uppsala County Council. The sample consisted of n=855 participants aged between 15 and 70 years. Data were retrieved between September and October 2020. Descriptive analysis was used to explore migrants’ opinions, and non-parametric analysis was used to investigate the association between age and migrants’ opinions about COVID-19 information.  Results: Migrants were using different sources for COVID-19 information, with the majority seeking information via school, TV and social media. The migrants’ opinions about the COVID-19 information with regard to comprehensiveness, importance and possibility to follow differed. Most of the migrants knew where to find information regarding COVID-19; however, nearly half of the migrants reported that the recommendations from the authorities should be more extensive. Age differences were detected when it came to wanting the information to be less extensive, and having the necessary information about the authorities work so far and the situation globally. Differences were found between the age groups when it came to the importance of the COVID-19 recommendations, with the younger group indicating a lower level of importance. There were also age differences when it came to the possibility of following the recommendations of staying at home if you are sick and keeping distance, with the younger group indicating a lower possibility to follow the recommendations.  Conclusions: Migrants’ opinions about COVID-19 information in Region Uppsala differed. The results indicate that interventions can be of use, in order to improve migrants’ health information seeking and literacy and an approach tailored by age could be helpful.

Bakgrund: Diabetes är en vanlig dödsorsak världen över och diabetes typ 2 är den diabetesform som ökar mest i världen. Patientens förmåga att kunna använda ny tillförd hälsofrämjande kunskap är avgörande för egenvård vid diabetes. Låg hälsolitteracitet kan vara ett hinder för positiv hälsoutveckling. Syfte: Syftet var att belysa hur sjuksköterskan kan arbeta med hälsolitteracitet för att stödja egenvård hos patienter med diabetes typ 2. Metod: En allmän litteratursökning utfördes genom systematiska sökningar i databaser. Resultatartiklarna granskades via kvalitativ innehållsanalys. Bärande begrepp och textenheter kodades och innehållet sorterades i huvudkategorier eller underkategorier. Resultat: Tio kvalitativa artiklar bearbetades. Två huvudkategorier samt fem underrubriker identifierades. Första huvudrubrik var “Patientens stödjande relationer”. Underkategorierna innefattade vårdrelationen mellan patient och sjuksköterska samt det sociala nätverket som resurs. Andra huvudrubriken var: “Sjuksköterskans pedagogiska strategier”. Underkategorierna innefattade att tillgodose patientens behov av motivation, praktiska tillvägagångssätt för inlärning samt individanpassad information. Slutsats: Studien visar att strategier kan användas av sjuksköterskor för att stärka patientens hälsolitteracitet vid diabetes typ 2. När patientens hälsolitteracitet stärks främjas egenvården. / Background: Diabetes is a common cause of death worldwide and diabetes type 2 is the fastest growing form of diabetes in the world. The patient's ability to use new added health-promoting knowledge is crucial for self-care in diabetes. Low health literacy can be an obstacle to positive health outcomes. Aim: The aim was to illustrate how nurses can work with health literacy to support self-care in patients with diabetes type 2. Method: A general literature search was performed through systematic searches in databases. The result articles were reviewed through qualitative content analysis. Core concepts and text units were coded and sorted into main categories and subcategories. Results: Ten qualitative articles were processed. Two main categories and five subcategories were identified. The first main category was "The patient’s supportive relationships". The subcategories included the care relationship between patient and nurse and the social network as a resource. The second main category was: "Nurses pedagogical strategies". The subcategories included meeting the patient's needs for motivation, pedagogical strategies and customize information and education. Conclusion:The study shows that strategies can be used by nurses to strengthen health literacy in patients with type 2 diabetes. When the patient's health literacy increases, self-care improves.

Low or marginal health literacy affect nearly 90 million citizens in the United States, compromising health outcomes, including oral health. Oral health literacy has been studied in diverse populations, yet the assessments used were developed and validated for English-speaking populations. A validated Spanish-language oral health literacy assessment was needed to help researchers and practitioners evaluate oral health literacy in the Hispanic population. Using the oral health literacy framework, the purpose of this study was to translate, culturally adapt, and validate a Spanish version of a previously validated English-language oral health literacy. A translation-back-translation process was applied to the English version of the REALD-30. Face and content validity were established using a panel of dental and health literacy experts. The Spanish version was field tested among Spanish-speaking community health center patients (N=114), and included a random subsample (N=11) to check for test-retest reliability. The results showed that the Spanish REALD-30 has a good internal reliability (=r=.687) and an acceptable convergent reliability (r =.857), when assessing health literacy against the SAHLSA-50. This study's implications for positive social change include providing the dental profession and research community with an assessment tool for oral health literacy. This tool may allow oral health professionals to understand the dynamics and challenges among Hispanics regarding oral health literacy, while the study fills an existing gap in scholarly literature.

Patient compliance and health care communication are impacted by health literacy. Poor health choices, frequent hospital visits, noncompliance with health regimens, and higher health costs are all associated with low health literacy. The purpose of this cross-sectional study was to determine whether there was an association between health literacy as measured by primary language spoken in the home (Creole vs. English) and hypertension self-management as measured by regular use of medication and cutting down on foods high in salt, and whether there was an association between Haitian men, women, their education level, or level of poverty in relation to health literacy as measured by the primary language spoken at home (English or Creole) and hypertension self-management as measured by regular use of medication and cutting down on foods high in salt. The conceptual framework used for the study was the second language acquisition theory. Strategic sampling was used to identify 318 Haitian participants; however, only 36 respondents qualified as Haitian immigrants with a relatively high propensity of hypertension. Logistic regression was used to analyze the data. The results showed no statistically significant relationship between language spoken at home and hypertensive medical compliance within the New York Haitian immigrant community. The other variables age and household income proved to be statistically significant, however gender and education did not appear to have as much of an influence on hypertensive medical compliance observed in the participants. The social change implications include the need for health care staff to be aware of the roles that age, gender, income, language, culture, and education may play in regard to health literacy and hypertension medical compliance.

The United States dedicates greater than 17% of its gross national product to healthcare. This percentage is expected to go up to 20% by 2018. Despite the high cost of care, the health care system remains inefficient and ineffective. Barriers include reduced access to care related to low health literacy. Complicating low health literacy is the high readability score of patient education materials. The high readability score is in part due to tools that are not standardized and measure different aspects of education materials creating varying readability scores. The purpose of this quality improvement project was to adopt a tool, the Clear Communication Index, which is evidence-based and standardized using the federal Plain Language Guidelines, to assess the reading score of educational materials in a 62-bed acute long-term care facility. The plan, do, study, and act model was used as a translational framework to guide this project, and the theory of goal attainment served as the theoretical support for the project. The Clear Communication Index worksheet was used to assess the readability of documents given to patients at discharge. Any score below 90% was considered difficult to understand and required revision. One month after implementation, patient satisfaction scores on 2 metrics showed improvement. The score for 'When I left the hospital, I clearly understood the purpose for taking each of my medications?' increased from 58.2% to 90.7%. The 2nd patient satisfaction survey metric, 'During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?,' increased from 73.1% to 83.3%. The results may promote social change by providing equal care access to all through readable educational materials.