Health literacy is the ability to understand and act on health information and is linked to health outcomes. It is unclear how health literacy skills are developed in patients with complex conditions, such as cardiovascular disease and diabetes. The purpose of this grounded theory study was to gain perspectives of both patients and healthcare professionals on how health literacy skills were developed in patients with cardiovascular disease or diabetes. The research questions addressed how knowledge and skills were acquired, the role of digital tools, instructional strategies used by healthcare professionals, and how the instructional strategies of the healthcare professionals matched the learning preferences and needs of the patients. A social ecological framework was used, which underscored the importance of understanding health literacy from multiple sources. Semistructured interviews were conducted on 19 healthcare professionals and 16 patients. Emergent key themes included: (a) social support plays an important role as a learning opportunity; (b) many patients get their information from internet searches; (c) instructional strategies should be personalized, interactive, social, and relevant; and (d) patients are self-directed learners. Linking of these themes led to the development of the health literacy instructional model, which is a 3-step approach, including an emotional support, behavioral approach, and instructional strategy. Social support was the common element in all 3 phases and was perceived to be key to developing health literacy skills, resulting in the key implication for social change. Recommendations are to consider social support in the development of health literacy instructional strategies.

The United States has experienced an increase in older workers as individuals born between 1946 and 1964 have remained in the labor force. Preventive health screening education, such as an immunization flyer, is necessary to avert preventable illness among older workers. Based on previous research, there is a gap regarding age-specific methods for educating the older worker about preventive health. Therefore, the purpose of this study was to explore the relationship between various media providing preventive health screening information and the assessed health literacy of the older worker. Based on the health belief model, a quantitative, cross-sectional method was used. A population of older workers (n = 159), starting at age 45, of diverse racial groups and job types, was surveyed to determine their health literacy, preventive health screening knowledge, and frequency of exposure to diverse types of media that facilitate preventive health education. Analysis of variance was used to evaluate the relationship between the various media providing preventive health screening used by the older worker and the health literacy of the older worker. According to the study, the 45-54 age group had the lowest health literacy scores, and all age groups possessed comparable knowledge of preventive health screening education. Finally, 2 types of media 'television and radio' were effective in improving health literacy by exposure, and 4 types of media 'television, radio, newspaper, and Internet' were perceived effective in providing preventive health education. Implications for positive social change included age-specific methods for educating the older worker about preventive health, which could, in turn, reduce morbidity and mortality caused by preventable diseases such as cancer and heart disease.

This study sought to identify the level of oral health literacy held by people who live in transitional and distressed Kentucky Appalachian areas and if this effects how often they are using oral hygiene techniques. Data were also collected to describe the attitudes Kentucky Appalachian adults hold toward oral hygiene and oral health status. Current documentation shows that poor oral health remains a public health threat in this population despite efforts such as school-based sealant programs and increased dental insurance coverage. This study followed a quantitative design and 99 participants were polled using a survey specifically developed for this study's use. Composite median scores and Spearman's correlation values established the existence of a low oral health literacy level across the participant pool, an also documented that oral hygiene techniques are not used in frequencies recommended for proper oral health. A poor self-efficacy towards the ability to utilize these techniques properly was also identified. Using the Mann-Whitney U test, responses were compared based on county designation and few significant differences were found. These findings show that oral health status and related beliefs are similar across the region and not just isolated to the economically poorest areas as the currently available literature suggests. Applying the health belief model it is predicted that Kentucky Appalachians are unlikely to adopt proper oral hygiene habits until their self-efficacy is improved. A recommendation of this study is that public health officials should promote personal control when designing public health programs geared towards improving the oral health status of this population. To do so would introduce a positive social change in that people with good oral health are less likely to experience the pain, malnutrition, and negative social stigma that is associated with poor oral health.

Bakgrund: Psykisk ohälsa ökar bland ungdomar. Skolan har en unik möjlighet att bidra i det hälsofrämjande och förebyggande arbetet. Lärare har, genom en slags gatekeeperfunktion, möjlighet att tidigt upptäcka och initiera åtgärder för elever med psykiska besvär. Syfte: Att undersöka dels lärares självskattade kunskap om, dels lärares upplevda förutsättningar att agera och initiera åtgärder vid misstanke om, psykisk ohälsa hos elever. Metod: En kvantitativ enkätundersökning med tvärsnittsdesign genomfördes bland 96 grundskolelärare. Data redovisades deskriptivt samt som skillnader (Fischers exakta test) ochsamband (Spearman’s Rho). Resultat: Knappt hälften av respondenterna (n=43) angav sig ha kunskap i form av specifik utbildning gällande psykisk ohälsa hos unga, medan en större andel angav goda kunskaper i att upptäcka elever i risk (n=64) och att bedöma tecken på psykisk ohälsa (n=75). Majoriteten av lärarna upplevde goda förutsättningar att agera och initiera åtgärder vid befarad psykisk ohälsa. Vid jämförelse mellan grupperna med respektive utan specifik utbildning framkom statistiskt signifikanta skillnader avseende både förmåga att upptäcka och upplevda förutsättningar att agera vid befarad psykisk ohälsa hos elever. Sambandsanalyser visade att variabler för kunskaper hade statistiskt signifikanta positiva samband med variabler för upplevda förutsättningar. Slutsatser: Även om majoriteten av lärarna upplever sig ha såväl kunskaper som förutsättningar att agera och initiera åtgärder så stödjer föreliggande studie teorin om att specifik utbildning om psykisk ohälsa hos unga ökar lärares förmåga att både upptäcka elever med psykisk ohälsa och förutsättningarna att agera och initiera åtgärder. / Background: Mental illness increases among adolescents. The school has a unique opportunity to contribute to promotion and prevention. Through a gatekeeper function, teachers can detect and initiate measures for students with mental health problems early on. Aim: To investigate partly teachers’ self-estimated knowledge of, partly teachers' perceived conditions to act and initiate measures in case of suspicion of, mental illness in students.  Method: A quantitative survey with cross-sectional design was conducted among 96elementary school teachers. Data were reported descriptively, as differences (Fischer’s exact test) and as correlations (Spearman’s Rho).  Results: About half of the respondents (n=43) indicated possessing knowledge in form of specific education, slightly more indicated possessing knowledge to spot students at risk (n=64) and to assess signs of mental illness (n=75). The majority indicated experiences of good conditions to act and initiate measures in case of suspected mental illness. When comparing the groups with and without specific education, statistically significant differences emerged regarding both abilities to detect and perceived conditions to act in the event of suspected mental illness in students. Correlation analyzes showed that variables for knowledge had statistically significant positive correlations with variables for perceived conditions.  Conclusions: Although most teachers indicate having both the knowledge and the conditions to act and initiate measures, the present study supports the theory that specific education on mental illness in young people increases teachers’ ability to both detect students with mental illness and the conditions to act and initiate measures.

This thesis investigates the potential of Mobile Augmented Reality (MAR) for improving medication adherence. Empirical research was conducted by interviewing patients, pharmacists, and a homecare worker. Based on insights and findings, an onboarding concept called MedinAR was developed through sketching and prototyping, with the aim of refining the idea and understanding the user experience. MedinAR leverages MAR to offer new ways of accessing and consuming medication information, making it more accessible to users. The concept, explored through four prototypes, focuses on onboarding for new medication regimes, providing an interaction flow for users to scan pill bottles, receive digital information in the physical space, and finally receive guidance on the appropriate placement of medication in the pillbox according to their medication regime. Further research is required to assess the technology's meaningful adoption, but the study's results underscore the importance of further exploring new supportive tools for medication adherence.

The early diagnosis of hearing loss can be a life-changing event for families. Parents are required to make several prompt decisions where they might be overwhelmed with all the information being shared with them. Patient education materials (PEMs) are often provided by clinical health professionals – yet these materials are often written above the average reading level of adults in the United States, thus presenting an additional challenge to many parents. The purpose of this study was to examine the ease of reading cochlear implant (CI) brochures that are provided to parents who are making informed decisions about the management of their child's hearing loss. The CI brochures analyzed include those from three Food and Drug Administration (FDA)-approved CI manufacturers: Advanced Bionics, Cochlear Americas, and MED-EL. Reading grade levels were analyzed using a commercially-available computer software program, applying six readability formulas commonly used to examine PEMs. Analyses revealed that the readability of the three CI brochures exceed the fifth- to sixth-grade reading levels recommended by health literacy experts. Audiology-focused PEMs continue to be created without full consideration of their reading grade level despite health literacy initiatives. Researchers should consider the health literacy skills of the reader when creating or revising PEMs such as CI brochures.

Objective The central Appalachian region of the United States is disproportionately burdened with cardiovascular disease (CVD); however, the level of literacy about CVD among residents has not been well studied. This study aimed to examine the prevalence and factors of CVD health literacy (HL) among a sample of patients/caregivers, providers/professionals, and community stakeholders. Methods In 2018, data were collected from central Appalachian residents in six states: Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. CVD HL status was determined by assessing correct responses to five interrelated questions about basic knowledge of CVD. Multiple logistic regression analyses were used to examine the associations between potential factors and CVD HL status. Results Of the total respondents (N = 82), <50% correctly answered all 5 CVD HL questions. Multiple logistic regression analyses showed that compared with respondents with advanced college degrees, those with a college degree or less were more likely to have low HL for "typical symptom of CVD,""physical exercise and CVD,""blood pressure and CVD,"and "stress and CVD."In addition, compared with respondents younger than 50 years, those 50 years and older were 3.79 times more likely to have low HL for "physical exercise and CVD."Conclusions These results suggest the incorporation of CVD HL into CVD care and that educational attainments should be part of CVD policies and programs in the region.

Objective: Transfer from pediatric care into the adult health care system is known to be a vulnerable phase in the lives of youth with special health care needs (YSHCN). Recommendations from the literature favor assessment of transition readiness rather than simply pass over YSHCN from pediatric to adult-centered care by the age of 18. Nevertheless, no validated and disease neutral assessment instrument in German exists to date. Hence, our aim was to cross-culturally adapt and to pilot-test a German version of the Transition Readiness Assessment Questionnaire (TRAQ 5.0). We wanted to provide a tool that can be applied broadly during the health care transition (HCT) process of YSHCN. Methods: The development included translating and adapting TRAQ 5.0 to German and conducting a pilot-study with 172 YSHCN between the ages of 14 and 23. Results: Cross-cultural adaptation resulted in the TRAQ-GV-15. Exploratory factor analysis led to a 3 factor-structure. Internal consistency for the overall score was good with a Cronbach’s alpha of 0.82. Age, in contrast to sex, had a significant effect on the TRAQ scoring. The administration of the TRAQ-GV-15 was well received and demonstrated good feasibility. Conclusion: The TRAQ-GV-15 is an easily applicable and clinically usable instrument for assessing transition readiness in German speaking YSHCN prior to HCT.

Despite high rates of suicide and mental health concerns (Duldulao, Takeuchi, & Hong, 2009; Kisch, Leino, & Wilverman, 2005; Lee, Park, Lee, Oh, Choi, & Oh, 2018; World Health Organization, 2019), many Asian Americans including Koreans and Korean Americans do not seek mental health services (Lam & Zane, 2004; Lee, Hanner, Cho, Han, & Kim, 2008; Markus & Kitayama, 1991; Sue, Cheng, Saad, & Chu, 2012). Especially for Koreans and Korean Americans, stigma (Masuda & Latzman, 2011) as well as cultural values (e.g., Cheng, Leong, & Geist, 1993; Cheong & Snowden, 1990; Kim & Omizo, 2003; Tracey, Leong, & Glidden, 1986) can prevent them from seeking appropriate services. The current study compares Korean, Korean American, and non-Korean emerging and young adults’ mental health literacy (Jorm, Korten, Jacomb, Christensen, Rodgers, & Pollitt, 1997), specifically mental health knowledge, confidence in finding appropriate mental health services, and attitudes towards mental disorders and treatment. A pilot study was conducted to tailor the Mental Health Literacy Scale (O’Connor & Casey, 2015) to answer the main research questions and examine internal consistency and validity. Analysis of variance (ANOVA) was used to assess the differences among the sociocultural groups (i.e., Koreans, Korean Americans, and non-Asians) and investigate individual and contextual influences (e.g., age, gender, citizenship). The results demonstrated that (1) non-Asians have significantly higher mental health knowledge scores, higher self-efficacy, and less negative attitudes towards mental disorders compared to Koreans and Korean Americans and (2) there were no significant differences in the scores between Koreans and Korean Americans. The discussion section describes the importance of enhancing mental health literacy and increasing help seeking behavior for Koreans and Korean Americans and suggests cultural factors to consider in creating culturally appropriate outreach programs.

Health literacy handlar om att som individ ha kunskap, motivation och kompetens att få tillgång till, förstå, bedöma och tillämpa hälsoinformation och fatta hälsosamma och hållbara beslut. Hälsofrämjande arbete är en förutsättning för att stärka health literacy. Kommunen spelar en nyckelroll i hälsofrämjande arbete eftersom den samlar olika aktörer med gemensamma mål. Därför är strategier och förankring inom kommunen nödvändiga för att möta utmaningar inom detta område. Syftet med studien är att belysa hur kommunanställda hälsoutvecklare beskriver att de arbetar hälsofrämjande med health literacy samt hur arbetet kan utvecklas i framtiden.Semistrukturerade intervjuer genomfördes med 14 hälsoutvecklare i skildakommuner. Resultatet visade att de använde sig av anpassade verktyg och strategier för att skapa lärtillfällen för individer och grupper. Resultatet visade även att tvärsektoriellt arbete är en nyckel för framgång. Vidare visade resultatet att reflektion och kritiskt tänkande var betydande verktygsamt att möjliggöra aktiviteter, som utöver det fysiska, främjade flera aspekter av hälsan. Utvecklingsmöjligheter ansågs bland annat vara mer integrerat hälsofrämjande arbete och resurser för att möjliggöra insatser.Slutsatsen som drogs var att ytterligare anpassade strategier och verktyg behöver utformas för att underlätta hälsoutvecklares arbete med health literacy, därigenom ges fler möjlighet att stärka sin och andras hälsa.