Développer la compréhension de la « littératie en santé » (ou « health literacy ») est devenu une préoccupation croissante pour les professionnels de la santé et les chercheurs en santé publique. Se définissant comme l’opérationnalisation, par l’entremise de mesures et de modèles, de la capacité des individus à obtenir, comprendre et utiliser de l’information pour prendre soin de leur santé, la littératie en santé est rapidement devenue un enjeu de santé publique à l'échelle internationale. La littératie en santé – comme domaine de recherche et comme enjeu de santé publique – progresse sur l’agenda public, grâce à la mobilisation et au travail de différents groupes d'acteurs qui interagissent dans le domaine de la santé publique et la médecine. En partie à cause de sa nature interdisciplinaire, la littératie en santé a engendré un bon nombre de définitions, apportant avec elles des perspectives très différentes sur la littératie en santé et sur les systèmes de santé eux-mêmes. Plusieurs études ont mis l'accent sur le développement d'un consensus autour de la définition, de la conceptualisation et de la mesure de la littératie en santé, essayant de créer une notion qui soit commune à tous les acteurs. Toutefois, peu nombreuses sont les études qui discutent des différentes perspectives des groupes d’acteurs, de manière à mettre en évidence autant les éléments de consensus que les points de divergence. Explorer les différentes idées qui s’expriment sur le rôle du patient et celui des professionnels de la santé, sur la manière de concevoir l’autonomie et « l’empowerment » et sur le développement d’une action publique enrichit notre compréhension de la littératie en santé. L’expression de points de vue opposés sur la littératie en santé, particulièrement entre les États-Unis et l’Europe, et la manière dont ces points de vue soutiennent le débat scientifique permettent de saisir la complexité du développement de ce concept ainsi que certains conflits d’idées qu’il révèle.

Low health literacy is a public health crisis, currently, there is limited research on social worker engagement with the low health literate patient. The research questions for this study examined health literacy knowledge in medical social workers and how their MSW curricula built their knowledge of health literacy. It also explored challenges that arise when discharge planning for patients with low health literacy. It also asked what social workers can do to aid patients with limited health literacy during the discharge planning process. This basic qualitative research study used criterion sampling and was informed by the socioecological model. Data collection used 2 focus groups of 12 medical social workers comprised of 11 females and 1 male. Data analysis occurred by categorizing the data then classifying the data into themes based on the research question. Key findings include: (a) social workers have a medium to high level of health literacy; (b) MSW curricula would benefit from health literacy knowledge; and (c) challenges occur in discharge planning with people with low health literacy that include overall knowledge and attitudes of health literacy, sociodemographic variables, and lack of preventative health. Recommendations include standardizing healthcare social worker roles and providing educational opportunities in MSW curricula on health literacy. Implications for social change include improved health outcomes, empowering individuals to take personal responsibility for their healthcare which in the long run can help them overcome chronic disease and other health related anomalies. Social change may be seen with hospital health literacy screening to reduce hospital readmissions decreasing individual healthcare costs and reduce societal healthcare costs.

Chronic health conditions in youth have increased over the last several decades. It is estimated that within the United States there are between 15% to 18% of youth who are living with a chronic health condition (Centers for Disease Control and Prevention [CDC], 2010). The CDC defines a chronic health condition as an illness that lasts for three months or longer that can be managed, but not cured (CDC, 2010). Although there is some research on youth living with chronic illnesses, there are minimal studies that assess the constructs of health literacy, resiliency, and support/advocacy within this population. The current investigation was a validity study of the Health Literacy and Resiliency Scale (HLRS). This is a newly developed 37-item measure that assesses the level of health literacy, resiliency, and support/self-advocacy among chronically ill youth (Bradley-Klug, Shaffer-Hudkins, Lynn, DeLoatche, & Montgomery, 2017). Specifically, the study correlated the construct of resiliency in the HLRS with the resiliency construct from the Child Youth and Resiliency Measure (CYRM; Ungar & Liebenberg, 2011). This measure is a 28-item measure that assesses levels of resiliency among youth and young adults. The goals for this study included: 1) determining the extent to which the results of the factor analysis from the current study are consistent with the three-factor model from the original study, 2) assessing the relationship between the HLRS and the CYRM, and 3) determining the reliability (internal consistency) of the scores of the HLRS. More importantly, since there have only been preliminary analyses conducted on the psychometric properties for the HLRS, this study was the first step towards providing validation for this measure. Participants were recruited through several methods including community-based organizations and online outlets. There were a total of 226 participants, with 54% identifying as White, 31% African American, and the remaining identifying as other. Sixty-one percent were female. The participants were English-speaking with a diagnosis of a chronic health condition given at least six months prior. Some of the conditions that were frequently identified among the sample included: diabetes, HIV, lupus, cystic fibrosis, ADHD, and asthma. Individuals were asked to complete the HLRS, CYRM, and a demographic survey online. The results indicated that the reliability of the values of the three factors in the HLRS ranged from acceptable to excellent. The results also included a correlation between the scores from the HLRS and CYRM. For the HLRS there were strong correlations between the resiliency and support/self-advocacy factors and health literacy and support/self-advocacy factors. For the CYRM, there was a strong correlation (r =.954) with the resiliency factor indicating that the resiliency factor within the HLRS aligns with the resiliency construct that is measured in the CYRM. Some items on the HLRS loaded on more than one factor indicating the need for further consideration of particular items on that scale. Overall, these data provide additional support for the HLRS scale and suggest that the scale may be a step closer to being utilized in applied settings.

BACKGROUND: Obesity is an understudied, but important issue for Chinese-American children. While overall rates of child obesity among Chinese-Americans are lower than in other racial/ethnic minority populations, about 1 in 4 low-income school-aged Chinese-American children are classified as overweight or obese, with the prevalence among male children as high as 40%. Despite the need to address obesity prevention, especially among younger, pre-school-aged Chinese-American children, strategies to prevent obesity early in life have not been well-studied for this population. OBJECTIVE: To examine activity and screen time related behaviors in a low-income Chinese-American population, before and after implementation of an early childhood obesity prevention intervention (Greenlight) in a primary care setting serving predominantly low income families. METHODS: This was a pre-, post-intervention analysis of physical activity- and screen time- related outcomes associated with the implementation of the Greenlight intervention, a health literacy-informed early child obesity prevention program, which was culturally adapted for low-income Chinese-Americans, and implemented in a federally qualified health center in New York City’s Chinatown. Greenlight consists of: 1) low literacy handouts and “tangible tools” (e.g. portion size bowls) given at each well-child check (WCC), 2) physician communication training (e.g. use of written handouts to support verbal counseling, teach-back, goal-setting), and 3) 1:1 health educator encounters in waiting room. Pre-implementation parent-child dyads were consecutively enrolled at their 6- or 12-month well-child check (WCC) (n=70 and n=74 respectively). The cohort of post-implementation parent-child dyads was consecutively enrolled between 0-3 months of age (n=200) and followed at their 6-month (n=159) and 12-month (n=146) WCCs. Inclusion criteria for the dyads included: parent spoke Cantonese, Mandarin or English; parent/child of Chinese descent; and child born full term (≥37 weeks gestation). Primary outcome variables were: 1) meeting physical activity recommendations (>30 minutes of tummy time at 6 months of age; >60 minutes of active time (crawling, scooting, active play) at 12 months of age; based on American Academy of Pediatrics (AAP) recommendations), 2) meeting screen time recommendations (0 minutes of screen time, based on AAP recommendations at 6 and 12 months of age). Multiple logistic regression analysis was performed, adjusting for child age, child gender, use of out of home daycare, parent age, primary language at home, and education. RESULTS: Six-month olds in the post-implementation period had a 5-fold increased odds of meeting the physical activity recommendation compared to pre-implementation (pre vs. post: 30.3 vs. 63.0%, p<0.001; AOR=5.0[2.5-10.1]. Twelve-month olds in the post-Greenlight implementation period had a nearly 20-fold increased odds of meeting the physical activity recommendation compared to pre-implementation (pre vs. post: 76.5 vs. 98.6%, p<0.001; AOR=19.4 [4.1-91.7]). Overall, screen time minutes were low in the pre- and post-implementation periods, with median television screen time <5 minutes at 6 months and <10-15 minutes at 12 months. There were no statistically significant differences by pre- vs. post-implementation status related to meeting the AAPs screen time recommendation of no screen time, in both unadjusted and adjusted analyses. CONCLUSION: At 6 and 12 months, implementation of Greenlight was associated with parent ability to meet physical activity-related recommendations. Overall use of screen time was low, and no differences were seen in parent ability to meet screen time recommendations. Further study is needed to identify additional strategies to address screen time use in infants.

Background: Low health literacy is a significant problem affecting our country.  While the associations between low health literacy and poorer health outcomes have been well documented (Berkman et al., 2011), the literature lacks evidence of effective strategies to address health literacy in the context of health behaviors such as diet and physical activity (PA). Likewise, few interventions have reported on how health literacy status influences performance and engagement in the intervention. Two potential intervention strategies include the teach back method or teach to goal approach and interactive voice response (IVR) technology. These strategies hold promise as a means of improving health literacy and reaching vulnerable, low health literate populations, but these strategies have not been widely explored in the literature (Paasche-Orlow et al., 2005; Baker et al., 2011; Schillinger et al., 2009; Bennett et al., 2012; Piette et al., 1999). Primary Aims: This research was embedded in a larger trial, Talking Health, which is a 6-month, 2 group randomized controlled trial to determine the effects of a health behavior intervention on reducing sugar-sweetened beverage (SSB) consumption in Southwest Virginians. The primary aims of this study were to examine the associations between health literacy status and 1) number of rounds of teach back needed to reinforce key concepts, 2) proportion of correct answers on the first round of teach back, 3) level of intervention engagement (i.e., completion rates for teach back call, IVR calls, and small group classes), and 4) perceptions of the intervention components. Methods: The data reported represent the first 3 cohorts of the Talking Health trial including participants in Lee, Giles, and Pulaski Counties. Eligibility requirements included being 18 years or older, English speaking, consuming at least 200 calories per day from SSB, able to participate in moderate intensity PA, and having reliable access to a telephone. Data were collected at baseline and at the 6-month follow-up assessment. Health literacy was assessed using the validated Newest Vital Sign. Participants were randomized to a behavioral intervention aimed at decreasing SSB consumption (SipSmartER) or to a matched-contact control group targeting PA (Move More). Both groups participated in 3 small group education sessions, received a live teach back call, and 11 supportive IVR calls. Participants completed a summative evaluation at the 6-month follow-up, which captured their perceptions of the intervention components. ANOVAs were used to measure differences in outcomes by health literacy status, randomized condition, and interactions. Results: Of the 125 enrolled participants, 92.0% were Caucasian, 76.8% were female, 29.6% had d high school education, 64.0% had <$25,000 annual household income, and 32.8% had low health literacy skills. Eighty-five participants (68.0%) completed the teach back call. The overall model when looking at the degree to which health literacy status and randomized condition predicted the number of rounds of teach back needed to reinforce key concepts was significant (F= 8.323, p < 0.001). Out of 3 possible teach back attempts, participants in the low health literacy category required a significantly higher number of teach back attempts as compared to those with high health literacy (F= 16.769, p <0.001), and participants randomized to Move More required a significantly higher number of teach back attempts compared to SipSmartER participants (F=7.296, p= 0.008). Similarly, the overall model when looking at the degree to which health literacy status and randomized condition predicted the proportion correct on the first round of teach back was significant (F= 9.836, p<0.001), such that those with higher health literacy status  (F= 19.176, p< 0.001) and those randomized to SipSmartER condition answered a significantly higher proportion of questions correct (F= 9.783, p= 0.002). Intervention engagement including completion of the small group education sessions, the live teach back call, and the IVR calls did not vary significantly across randomized condition or literacy levels. Low health literate participants had a significantly higher overall perceived satisfaction with the IVR, as compared to high health literate participants (F= 5.849, p= 0.020). However, perceptions of other intervention components (e.g., small group sessions, teach back call, personal action plans, drink diaries/exercise logs,) were similar among participants with low and high health literacy status and across randomized conditions.   Conclusion: These data confirm the importance for multiple teach back opportunities and additional exposure to health information to ensure participant comprehension of key intervention content"in particular for those with lower health literacy. This research also supports that IVR is an effective approach to reaching vulnerable, low health literate populations. Future research should investigate the efficacy and cost-effectiveness of utilizing teach back methods delivered using automated technologies. Future research also is needed to determine how teach back performance are related to other study factors such as retention, engagement, and health outcomes. / Master of Science

Bakgrund: Karies är idag ett folkhälsoproblem hos förskolebarn och studier visar att andelen kariesfria 6-åringar minskar. Det övergripande ansvaret för den förebyggande munhälsan ligger på tandvården men för att en god munhälsa hos förskolebarn ska kunna främjas krävs ett nära samarbete med barnhälsovården. Detta medför goda förutsättningar att engagera samt stödja föräldrarna men ökar även chanserna att tidigt hitta de barn som har en ökad risk för att utveckla karies. Syfte: Var att undersöka BHV-sjuksköterskors erfarenheter av att främja en god munhälsa hos barn. Metod: Metoden var av kvalitativ design där data samlades in via semistrukturerade intervjuer med BHV-sjuksköterskor. Insamlade data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Studiens resultat ledde fram till ett tema som var ”Se familjers individuella behov för att självständigt och tillsammans med andra bidra till en jämlik munhälsa” samt fyra kategorier vilka var ”Den egna förmågan och kompetensen har betydelse”, ”Erbjuda universella insatser till barn och föräldrar”, ”Erbjuda anpassade insatser vid behov” och ”Samarbeta med tandvården”. Utöver dessa kategorier bildades totalt nio underkategorier. Slutsats: I de flesta fall kände sig BHV-sjuksköterskorna trygga i samtalet om munhälsa men det fanns tillfällen där de kände att deras kunskap var otillräcklig. Genom att inhämta kunskap från olika källor stärkte de sin egen empowerment samt health literacy för att därmed kunna bidra till att stärka barn och föräldrar i deras. BHV-sjuksköterskorna hade positiva erfarenheter av att använda pedagogiskt material för att tillgängliggöra information till alla och för att göra barnen delaktiga i samtalet. BHV-sjuksköterskorna var uppmärksamma på de olika riskfaktorer som kunde påverka att barnen i större utsträckning riskerade att drabbas av karies och erbjöd anpassade insatser efter familjens identifierade behov och förutsättningar för att bidra till en jämlik vård. Erfarenheten av att samarbeta med tandvården varierade men samtliga ansåg att ett samarbete endast hade varit positivt.

The U.S. health care system is evolving from medical centric to patient centered, augmenting the importance for patients to comprehend and process medical information. The Department of Education indicated that 77 million Americans have a basic or below basic health literacy proficiency and 12% register as health literacy proficient. Animation is a time-tested device for improving health by enhancing comprehension. Chronic constipation (CC) complexity entails physiological, anatomical, and environmental mechanisms. Using the cognitive theory of multimedia learning and dual-channel auditory and visual processing, the primary research question addressed whether an animated educational video improved health literacy for CC more than a traditional written educational pamphlet. A secondary dataset of 100 CC subjects from the University of Michigan was collected using a cross-sectional study design with a convenience sampling strategy of CC patients who underwent anorectal functional testing. Dependent variables were CC Pretest Quiz and CC Posttest Quiz scores, and independent variables included CC education intervention, demographics, health literacy proficiency, and environmental learning variables. Descriptive and analytical statistical methods were employed for data summarization and comparison. The animated educational video had minimal impact (p = 0.20) on improving health literacy; however, pretest scores (p -?¤ 0.001), age (p = 0.03) and highest level of education achievement (p = 0.03) influenced the largest variance between quiz scores. Enhancing health literacy influences social change by empowering individuals with CC to improve quality of life metrics, increase work productivity, and decrease health care utilization costs.

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study is to examine the informed consent (IC) procedure as it was experienced by patients who had undergone a de novo transjugular intrahepatic portosystemic shunt (TIPS), chemoembolization (TACE), or radioembolization (TARE) procedure in an Interventional Radiology (IR) Department. The three main study aims and a fourth exploratory aim are as follows: (1) Describe how patients who underwent a de novo TIPS, TACE, or TARE procedure in an IR Department described the IC procedure; (2) Describe what information patients who underwent a de novo TIPS, TACE, or TARE procedure in an IR Department recalled being told during the IC procedure; (3) Describe the satisfaction of patients who underwent a de novo TIPS, TACE, or TARE procedure in an IR Department with the IC procedure; and (4) Explore how the IC experiences of patients who underwent a de novo TIPS, TACE, or TARE procedure in an IR Department differed according to their levels of health literacy. Using a qualitative descriptive design, participants were recruited from an IR department that performed these procedures. A total of 14 participants were interviewed about their IC experiences and the Newest Vital Sign (NVS) Health Literacy assessment was administered. The participants described the IC procedure by discussing the staff they encountered, their feelings during the visit, the support persons who accompanied them, and the decisions they made about the procedure. The participants recalled being told about how their procedure would be performed, the care they would need, and the benefits and risks of the procedure. Most were satisfied with the information received during the IC procedure and found the information consistent with how they experienced the procedure. A few participants would have liked more visual materials, addition details about the procedure, simpler language, or more explanation of the medical terminology. No apparent differences in the IC experience could be attributed to health literacy. These findings suggest that persons’ experiences during the IC process are multi-faceted and affected by their emotions and concerns and the nature of their encounters with their healthcare providers.

No description available.

This body of work aspires to explore the avenues by which medical professionals can leverage adolescents' current and historic high social media usage to increase their health literacy. In order to accomplish this, several types of health literacy and the ethical implications of inadequate health literacy are discussed, specifically with adolescents in mind. Next, trends in media and social media usage by adolescents and its effects on this population are determined, and examples of interventions using these means in the literature are analyzed. Finally, the work discusses my personal experience using social media to disseminate health information, challenges our collaborative faces, and future directions for our project. / Urban Bioethics