The current patient-centred healthcare approach encourages individuals to assume greater roles in decisions about their health. The premise is that patients who are well informed about healthcare options are more likely to adhere to prescribed treatments and achieve better health outcomes. This approach assumes that patients have an adequate level of health literacy. While a range of definitions exist, health literacy is commonly defined as an individual’s ability to seek, understand and utilise health information to make appropriate health decisions. / Health literacy is increasingly recognised as a complex multi-dimensional concept which involves interactions between individual abilities and broader environmental factors. However across definitions, there has been little consultation with patients to understand what is important to effectively seek, understand and utilise health information. The lack of a consensual understanding has led to debate as to what health literacy represents and how it should be measured. A range of measures exist with the predominant approach being the testing of individual literacy abilities. However measures do not assess the range of attributes described in definitions. Thus a considerable gap exists between how health literacy is defined and how it is measured. This thesis focused on addressing this gap. The objectives were to: (i) critically appraise existing health literacy measures (ii) develop a conceptual framework from the patient perspective and (iii) use this framework to develop a comprehensive measure of health literacy. / A multi-method qualitative and quantitative approach was used: / (1) Systematic review and appraisal of the content, development and psychometric properties of health literacy measures. / (2) In-depth consultations with patients across healthcare and disease continuums to develop a conceptual framework. / (3) Development of a new health literacy measure based on the conceptual framework using a classical test theory approach. / A critical appraisal of the literature revealed that the majority of health literacy measures are not based on a conceptual framework and none appeared to adequately measure a person’s ability to seek, understand and utilise health information. Content focussed primarily on reading, comprehension and numeracy skills and scoring was poorly defined. Only five of the 19 measures had evidence of acceptable reliability. / The conceptual framework of health literacy from the patient perspective identified 17 key elements: six individual abilities and 11 broader contextual factors that are important to seek, understand and utilise health information and expanded previous conceptualisations of health literacy. This informed the development of the Health Literacy Management Scale (HeLMS) which measures six generic and potentially modifiable abilities and three specific broader social factors. Overall the HeLMS measures an individual’s ability to seek, understand and utilise health information within the healthcare setting. The HeLMS consists of 29 items across eight domains. Rigorous psychometric testing demonstrates that it possesses strong construct validity and high reliability (coefficient α >0.80 for all eight domains). / This research provides unique contributions to the conceptualisation and measurement of health literacy. Limitations in the content and psychometric properties of previously developed measures have been identified through a systematic process. A conceptual framework derived from the patient perspective identifies a range of components that provide new insight into: (i) constructs that should be incorporated to measure health literacy and (ii) areas that need to be addressed to improve health literacy. The development of the HeLMS now allows for a more comprehensive assessment of health literacy. Information from the conceptual framework and the HeLMS are likely to be useful tools to inform the development of public health initiatives to enhance patient participation in the management of their health.

Limited English Proficient (LEP) patients are subject to low patient health outcomes due to limited health literacy. Cultural and linguistic barriers prohibit the obtainment and comprehension of health information and services. This systematic review will present the complications of healthcare experienced by LEP patients and will provide an analysis of interventions and policies that will be a gateway to better health outcomes for the LEP patient population.

Introduction: Colorectal cancer is the third leading cause of cancer among Canadians and the second leading cause of cancer deaths. In this age of chronic disease and shared decision-making, individuals are encouraged and expected to contribute to decisions about healthcare. Increasingly, Canadians rely on the Internet as an access point to healthcare information. Health literacy, particularly adequate numeracy skill, occupies a central role within cancer care communication and is requisite to meaningful participation in risk-based decision-making. Despite this, numeracy has attracted little research attention. Consequently, the primary objective of this study was to investigate the influence of health numeracy skills, health prose literacy, math anxiety, attained education, and context of information on participant ability to comprehend Internet based colorectal cancer risk information. Method: Demographic details were collected on 140 older Canadian volunteers. Health literacy (prose and numeracy), and math anxiety scores were also obtained. Prose literacy was measured by the STOFHLA whereas numeracy was assessed using three instruments (general context numeracy, health context numeracy, and the STOFHLA). Math anxiety was measured by the Abbreviated Math Anxiety Scale (AMAS). The assessment of participant risk comprehension was based on two web pages of colorectal cancer information. The two web pages were chosen from the Canadian Cancer Society; one represented ‘common’ information and the other represented ‘uncommon’ information. Multiple regression analysis was employed to determine the influence of explanatory variables on participant risk comprehension. Results: The majority of older adults (91%) in this convenience sample had ‘adequate’ functional health literacy as measured by the STOFHLA. Participants revealed wide variation of numeric competency with high STOFHLA numeracy scores, moderate levels of health context numeracy and math anxiety, but poorer general context numeracy skill. The mean score for participant comprehension of colorectal cancer risk was 16.8/22. There was a significant difference between risk comprehension scores on ‘common’ (9.14/11) and ‘uncommon’ (7.64/11) web-based cancer information with better comprehension of the ‘common’ information. Approximately 60% of the variation in participant risk comprehension scores was explained by the prose health literacy, general context numeracy, health context numeracy, STOFHLA numeracy, math anxiety, and level of education. Additional regression modeling highlighted the significance of health context numeracy skill for both ‘common’ and ‘uncommon’ cancer information and the need for the combined skills of prose health literacy and numeracy for comprehension of ‘uncommon’ web-based cancer risk information. Conclusion: Adequate health numeracy skill is a necessary component for understanding online cancer information. A spectrum of health numeracy skill ranging from basic to more advanced proficiency is needed for comprehension of cancer risk information. For comprehension of less familiar subject matter, ‘content’ knowledge or enhanced prose health literacy skill, jointly with health numeracy skill, is required. This research underscores the need for continued investigation of the role of health literacy (prose and numeric) in the comprehension of online cancer information among diverse groups of healthcare consumers. These findings highlight the need for continued research directed at concept clarification and concept modeling of prose health literacy and numeracy. Research focusing on the development of a comprehensive health numeracy assessment instrument is recommended. Also, these findings have important implications for health educators in designing online cancer information. Cancer information specialists and web designers are encouraged to exploit the versatility of the Internet in order to construct web-based cancer information to accommodate the continuum of health literacy/numeracy skill that currently exists.

Although the prevalence of mental pathology is high, public’s mental health literacy (i.e. knowledge about mental disorders) has not been examined to a great extent. The main purpose of this study was to examine mental health literacy concerning depression and schizophrenia in a setting of adolescents in Sweden. A secondary aim was to explore stigmatizing attitudes towards mentally ill and levels of altruism among adolescents regarding help-seeking behavior. The present study employed qualitative methodology and data were collected through vignettes. A total of 426 high school students living in Stockholm formed the respondents and content analysis showed that among teenagers recognition of both depression and schizophrenia was poor. Moreover, friends and informal sources of help were regarded as best types of help. Furthermore, results indicated stigmatizing beliefs about mental disorders and low levels of altruistic behavior. These results are supported from other similar studies and suggest awareness campaigns to increase mental health literacy among adolescents. Recommendations for future research are also discussed.

Introduction: Colorectal cancer is the third leading cause of cancer among Canadians and the second leading cause of cancer deaths. In this age of chronic disease and shared decision-making, individuals are encouraged and expected to contribute to decisions about healthcare. Increasingly, Canadians rely on the Internet as an access point to healthcare information. Health literacy, particularly adequate numeracy skill, occupies a central role within cancer care communication and is requisite to meaningful participation in risk-based decision-making. Despite this, numeracy has attracted little research attention. Consequently, the primary objective of this study was to investigate the influence of health numeracy skills, health prose literacy, math anxiety, attained education, and context of information on participant ability to comprehend Internet based colorectal cancer risk information. Method: Demographic details were collected on 140 older Canadian volunteers. Health literacy (prose and numeracy), and math anxiety scores were also obtained. Prose literacy was measured by the STOFHLA whereas numeracy was assessed using three instruments (general context numeracy, health context numeracy, and the STOFHLA). Math anxiety was measured by the Abbreviated Math Anxiety Scale (AMAS). The assessment of participant risk comprehension was based on two web pages of colorectal cancer information. The two web pages were chosen from the Canadian Cancer Society; one represented ‘common’ information and the other represented ‘uncommon’ information. Multiple regression analysis was employed to determine the influence of explanatory variables on participant risk comprehension. Results: The majority of older adults (91%) in this convenience sample had ‘adequate’ functional health literacy as measured by the STOFHLA. Participants revealed wide variation of numeric competency with high STOFHLA numeracy scores, moderate levels of health context numeracy and math anxiety, but poorer general context numeracy skill. The mean score for participant comprehension of colorectal cancer risk was 16.8/22. There was a significant difference between risk comprehension scores on ‘common’ (9.14/11) and ‘uncommon’ (7.64/11) web-based cancer information with better comprehension of the ‘common’ information. Approximately 60% of the variation in participant risk comprehension scores was explained by the prose health literacy, general context numeracy, health context numeracy, STOFHLA numeracy, math anxiety, and level of education. Additional regression modeling highlighted the significance of health context numeracy skill for both ‘common’ and ‘uncommon’ cancer information and the need for the combined skills of prose health literacy and numeracy for comprehension of ‘uncommon’ web-based cancer risk information. Conclusion: Adequate health numeracy skill is a necessary component for understanding online cancer information. A spectrum of health numeracy skill ranging from basic to more advanced proficiency is needed for comprehension of cancer risk information. For comprehension of less familiar subject matter, ‘content’ knowledge or enhanced prose health literacy skill, jointly with health numeracy skill, is required. This research underscores the need for continued investigation of the role of health literacy (prose and numeric) in the comprehension of online cancer information among diverse groups of healthcare consumers. These findings highlight the need for continued research directed at concept clarification and concept modeling of prose health literacy and numeracy. Research focusing on the development of a comprehensive health numeracy assessment instrument is recommended. Also, these findings have important implications for health educators in designing online cancer information. Cancer information specialists and web designers are encouraged to exploit the versatility of the Internet in order to construct web-based cancer information to accommodate the continuum of health literacy/numeracy skill that currently exists.

Hälsolitteracitet innebär patientens kognitiva förmåga att förstå och tillämpa hälsoinformation. Enligt Hendersons omvårdnadsteori bör sjuksköterskan förstå och assistera när patienten inte har tillräcklig motivation, kunskap eller styrka för att självständigt uppnå hälsa. Syftet med studien var att beskriva distriktsköterskans förhållningssätt till hälsolitteracitet i bemötandet av patienter på en vårdcentral. Studien är en kvalitativ intervjustudie med induktiv ansats. Fem distriktssköterskor från tre olika vårdcentraler intervjuades utifrån en intervjuguide med semi-strukturerade frågor. En kvalitativ innehållsanalys genomfördes och ett övergripande tema framkom; Distriktssköterskan skapar delaktighet hos patienten genom ett engagerat förhållningssätt till hälsolitteracitet. Tre kategorier identifierades; strävar efter förtroendefulla relationer, anpassar sig efter patienten samt uppmuntrar till empowerment. Distriktssköterskorna menade att de strävade efter att skapa insikt och motivation hos patienterna för att åstadkomma delaktighet. Ingen av distriktssköterskorna i denna pilotstudie hade hört talas om begreppet hälsolitteracitet. Trots detta beskrev de att de arbetade utifrån en förståelse att patienterna hade olika möjligheter att förstå och tillämpa informationen. Pilotstudien kan ligga till grund för en fullskalig studie om distriktssköterskors förhållningssätt till hälsolitteracitet, anpassad till svensk hälso- och sjukvård. / Health literacy is the patient's cognitive ability to understand and apply health information. According to Henderson's nursing theory the nurse should understand and assist the patient who does not have sufficient motivation, knowledge or strength to independently achieve health. The aim of this study was to identify the district nurses' attitude to health literacy in their treatment of patients at a medical centre. The study was a qualitative interview study with an inductive approach. Five district nurses from three medical centres were interviewed using an interview guide based on semi-structured questions. A qualitative content analysis was performed and revealed the following theme; the district nurse encouraged patient participation through an approachable and committed approach to health literacy. Three categories were identified; strive for trust, adapt to the patient and encourage empowerment. The district nurses described that they strived to create insight and motivation to encourage them to participate in their own health care. None of the district nurses in this pilot study were familiar with the term health literacy. Despite this, they described that they understood that their patients had differing abilities in understanding and applying information. This pilot study offers a basis for a full-scale study of district nurses application of health literacy, customized to Swedish health care system.

Cancer is the leading cause of death for Hispanics, and cervical cancer incidence is higher (64%) for Hispanics than for non-Hispanic whites. In Texas Hispanic women 50 and older are the lowest screened and present with higher incidence of invasive cervical cancer as compared to non-Hispanic white women. They are diagnosed at a peak age of 65-74, which suggests that Hispanic women need to be screened past the recommended screening age. An estimated 90 million people in the U.S. lack basic literacy skills and low literacy may contribute to low screening. Few studies have addressed the relationship between low health literacy and cervical cancer screening among older women of Mexican-American ancestry. This study sought to uncover the cervical cancer screening beliefs, practices, health literacy, knowledge, and experiences of English and/or Spanish-speaking older women of Mexican-American ancestry. Thirty women participated in focus group or individual interviews in English and/or Spanish. Women 50 years of age or older living in the community were recruited from senior centers in South Texas from a purposeful convenience sample. Data collection was conducted through audio-taped semi-structured interviews following a moderator guide developed using Zarcadoolas, Pleasant, and Greer’s (2005) health literacy model. Data were transcribed, analyzed in original language, translated for meaning, aggregated for analysis using qualitative content analysis; matrices were developed and analyzed individually, and then data were aggregated. The Newest Vital Sign, a health literacy tool, was used to partially assess fundamental literacy. Major themes elucidated were (a) Reasons “I don’t go” [fundamental literacy], (b), Prevention of cancer and “everything else” [science literacy], (c) We are different,[cultural literacy], (d) There is always “consejos” (advice, messages) [civic literacy], and media literacy, (e) Telenovelas (soap-operas) teach a lot, and (f) Learning from Internet brochures. The study supports a multidimensional model of health literacy and focus group research, accounting for the group’s cultural norms, language, and educational preferences. It adds information for nurse clinicians about providing holistic care, for nurse educators regarding communication strategies for diverse older populations, and for researchers to continue developing strategies that improve health literacy and health outcomes for minority older women. / text

Aim: The aim of this project was to find the level of oral health literacy of parents of preschool age children regarding their child’s oral health. The primary objective was to improve the oral health status of preschoolers and to prevent early childhood caries. Methods: 117 participants (parents of preschoolers) completed a self-administered oral health literacy questionnaire. Data obtained from the study was analysed using a statistical package (SPSS). Firstly, descriptive analysis was undertaken generating tables and graphs of sociodemographic variables. Later, associations between oral health literacy and sociodemographic variables were identified and also relation between parents’ oral health literacy and their attitude towards water fluoridation in Christchurch was identified using bivariate and multivariate analysis. Psychometric analysis was generated to test validity and reliability of the oral health literacy questionnaire. Results: In the total sample, 38% of participants had poor oral health literacy regarding their child’s oral health. The results also indicated that there were associations present between parents’ oral health literacy and socio-demographic variables such as ethnicity, education and family income. Nearly half of the parents opted for water fluoridation in Christchurch. A strong association between parents’ oral health literacy and their attitude towards water fluoridation was identified. In the total sample, 40% of parents were not aware of need for first dental visit before the school age. Reliability was good for the developed oral health literacy instrument. Conclusions: This study of parents’ oral health literacy in Christchurch, New Zealand identified association of oral health literacy and socio-demographic variables which gives future guidance to improving oral health status of New Zealand children. The relation 6 between parents’ oral health literacy and their attitude towards water fluoridation was shown in this study. This result might be used in future water fluoridation surveys. Future studies are needed to examine health care provider’s perspective in improving parents’ oral health literacy and to tailor more effective public health interventions to improve parents’ oral health literacy.

Health communications providers strive to increase the health literacy of patients and care takers. Basic health literacy is a measure of a person’s ability to understand and act according to appropriate health information. The rise in the number of people attaining basic health literacy increases the amount of positive health behavior in the aggregate. Therefore, health communication providers can create a direct impact on tangible health results in a given population. The introduction of new technology has led to new ways of distributing health information, specifically through online media. Along with a new method of communication comes a need for a new way of evaluating it. As new media emerge and proliferate in the marketplace, different populations’ levels of health literacy become shaped in previously unpredictable ways. Current research suggests that significant differences in wealth and pervasive cultural features account for why distinct populations respond to these developments differently. Thus, the task of determining health communications’ success overall just got harder. It is now necessary to reassess health communications providers’ efficiency and effectiveness with regard to particular minority populations such as Hispanic/Latino adults. Throughout this paper, I refer to the Hispanic/Latino population’s unique characteristics as a case study for the derivation and application of universal health communication values. Thus, the purpose of this report is, based on current findings, to expose the primary values that describe and prescribe the efficacy of online health communication geared towards minorities such as Hispanic/Latino adults residing in the United States. This report concludes that the effectiveness of health information online is a function of three elements: access, quality, and communication strategy. Access represents the extent to which the intended user can search online for the sought-after health information, employ techniques to locate the intended information, and benefit from the search and comprehend the content. The quality prong of the health related Web content represents the useful indicia of accuracy and completeness of the information provided. The first two factors are a sine qua non for a robust health communication campaign. The communication strategy determines the audience reach and the relevance of the health message; both of which ultimately are the driving force for achieving lasting health behavior modification. Health information providers must periodically assess their services along the model’s benchmarks in order to achieve the highest possible levels of health literacy in their target populations and overall. Providers may engage in self-evaluation in order to gauge their own effectiveness, make improvements wherever necessary, and thereby ensure continued conformity to the aforementioned values. If/when these market players are unable or unwilling to adhere to this rubric, the public sphere may need to enforce it as a last resort. This paper does not investigate the merits of either public or private systems of governance; no matter how compliance is achieved, the modern promotion of optimal health literacy in minority communities (and hence, overall) requires that all three elements comprise a new, uniform model for online health communication initiatives. / text

Is it possible for a student to create an information resource that helps someone in need? In a two month span, the student author conducted research into the availability of environmental articles and collected over 250 academic papers and grey literature. Library tools and services provided by The University of Arizona Libraries on Southwestern Environmental and Health Issues specifically targeting Native American communities were used to near exclusivity. Locating articles for the database was done quicker than expected by a Library Science student (the author) who had some previous familiarity with academic databases such as PubMED™ and Web of Science™. The database itself was designed in Drupal as a Deep Web (not public) Internet project and completed before schedule. Over the course of this research it was discovered that by properly utilizing library resources its possible for motivated students at the collegiate level to create a database of articles that could aid underserved groups with their understanding of desired specialized issues.