Introduction: To improve comprehension of medical care, the Joint Commission recommends that patient education materials (PEMS) be written at a fifth-grade reading level or below. Objectives: The purpose of this study was to evaluate the compliance of commonly used tertiary drug references to Joint Commission standards. Methods: PEMs for the top 100 most prescribed medications in 2017 were obtained from commonly used drug information tertiary references (Lexi-comp patient drug information, Micromedex Care Notes, Micromedex Med Essential Fact Sheets, Medline Plus, and Drugs.com) to evaluate readability. The grade reading level of each medication-related PEM was evaluated using the Flesch-Kincaid Grade Level test and compared with a one-way analysis of variance using correlated samples and Tukey's post-hoc test for significance between groups. Results: The mean grade reading levels of Lexi-comp, Micromedex Care Notes, Micromedex Med Essential Fact Sheets, Medline Plus, and Drugs.com were 4.2, 7.5, 7.8, 9.3, and 10.4, respectively. Lexi-comp achieved a reading level at or below fifth grade for 99% of medications while Micromedex Med Essential Fact sheets was the next highest at 33%. No other reference contained drug information at or below a fifth-grade reading level. Conclusion: Lexi-comp patient drug information consistently met the Joint Commission recommendation for medical information at or below a fifth-grade reading level, whereas Micromedex Med Essential Fact Sheets met this recommendation approximately one-third of the time. When providing drug information resources to patients, health-care providers should be diligent in selecting sources that meet the Joint Commission recommendations.

Medical Assistance in Dying (MAID) was legalized in Canada in 2016. In 2021, an update in legislation included changes to MAID eligibility and procedural safeguards. Guided by the Ottawa Decision Support Framework (ODSF), the overall aim was to describe how Canadian patients considering MAID are being supported in making the decision about end-of-life care. Eleven articles were included in the literature review. ODSF themes are evident in MAID literature. Nurses play key roles in end-of-life decision-making. Environmental scan of publicly available MAID resources identified 58 eligible resources. Sixty-nine percent of MAID resources were updated with 2021 legislation. None met the International Patient Decision Aid Standards criteria. Thirty met Patient Education Materials Assessment standard for adequate understandability and 11 for actionability. Although patient decision aids are effective for supporting health care decisions, none exist for MAID and current resources are inadequate for supporting people of lower health literacy.

Background: The Hispanic community has historically faced high rates of vaccine hesitancy when compared to their non-Hispanic white counterparts. This not only poses a threat to their individual health, but also to their community. In a population that is disproportionately affected by COVID-19 infections, it is critical to address vaccine uptake concerns to control the pandemic and prevent future spread of infections. Objective: This study aims to explore Spanish speakers' vaccination decisions and to explore whether improving health literacy would be an effective approach in increasing vaccination rates. The secondary objective is to describe the role of physicians in decreasing vaccination hesitancy within the Hispanic community. Methods: A review of literature was conducted using articles from 2000 to 2022 focusing on the relationship between the Hispanic community and vaccines, as well as the Hispanic community's health literacy levels. Multiple databases were utilized, and research included the effects of improving health literacy for the Hispanic community in the United States and reasons for vaccine hesitancy in the Hispanic population. From the literature review, 40 articles met the inclusion criteria and were used to determine whether improving health literacy is an effective avenue for increasing vaccination rates in the Hispanic community. Results: A gap of research exists examining the relationship between health literacy and vaccine hesitancy in the Hispanic populations. Studies suggest three main reasons for reduced vaccine uptake for Latinos: the lack of knowledge about vaccines, the need for provider recommendations, and the inability to access healthcare. The studies also ii identified different methodologies in improving both vaccine hesitancy and health literacy. Conclusions: Health literacy may be able to address each of the three main concerns for vaccine hesitancy in the Hispanic population. Thus, research in the future should explore the relationship between health literacy and vaccine hesitancy. Keywords: health literacy, Hispanic, vaccine, vaccine hesitancy

The present study systematically reviewed and statistically summarized the current body of literature on the relationship between maternal health literacy and maternal sensitivity, and the effect of these two variables on mothers' care and decision making on distal attachment outcomes. In so doing, a systematic review of the extant peer-reviewed, published literature examining the effectiveness of interventions in effort to improve health literacy and maternal sensitivity, with a focus on increasing the quality of mother-preterm infant attachment outcomes, was undergone. This was followed by four multilevel random effects meta-analyses. Results indicated that mothers who participated in health literacy (maternal sensitivity) interventions had, on average, higher attachment quality, in comparison to those who did not participate. Additionally, maternal age was found to be a statistically significant predictor of the overall average effect size. This suggests that maternal health literacy may be a yet unexplored correlate of mother-preterm infant attachment outcomes.

Health literacy is the skill needed to acquire, read, understand, and use health related information to make informed healthcare decisions. It is also the skill needed to follow and maintain a treatment plan. Having a high or adequate health literacy level is important because possessing poor health literacy skill can have a negative impact on one's overall health. This research is important because there are few studies available on the health literacy levels of undergraduate college students. The majority of health literacy studies focus on at risk or underserved populations with low education. Previous studies have shown that education is not a strong indicator of good health literacy skill. The aim of this study is to evaluate the health literacy rate of students at the University of Central Florida (UCF), and to analyze the health information seeking behavior. Students were given the Test of Functional Health Literacy in Adults (TOFHLA) to assess the levels of health literacy among undergraduate students. The Health Seeking Information Behaviors (HSIB) survey was also given to analyze common information seeking behaviors among college students. Additional questions were included to collect demographic information to compare differences in health literacy levels among different subgroups of students. The survey questionnaires were built into "Qualtrics, an online survey system, and shared with undergraduate students at UCF for participation. Survey results were downloaded into SPSS software version 25. Data analysis included one-way ANOVA to assess possible associations between student demographics and level of health literacy skill and health information seeking behavior among participants. Survey results showed that students at UCF had very high health literacy skills among all demographics. The study results suggest the need for development of a survey tool measuring health literacy skills of an educated population be designed and validated to assess the health literacy skills of an educated population.

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Low health literacy in the United States has numerous negative impacts on health outcomes. Efforts to equip physicians with the ability to better identify patients with low health literacy have consistently shown lackluster and transient results. The transient nature of these results closely mirror those seen in the implicit bias literature, implying that health literacy may be better addressed if considered a type of coded bias among clinicians. In this paper, a review of the literature is presented which includes the impact of health literacy on patient outcomes, physician understanding and ability to screen for low health literacy, past interventions aimed at improving physician ability to identify and assist low health literacy patients, and the existing literature involving implicit bias among physicians. This review allows for the argument that interventions aimed at helping physicians better identify low health literacy patients would be more effective if designed to address unconscious biases rather than a knowledge deficit. Finally, the ethical imperative to address these biases in the healthcare setting is described. / Urban Bioethics

Low health literacy is highly prevalent in the United States and can significantly impact health outcomes for patients. Prior research has shown that communication is a major mediator between health literacy and health outcomes. However, there has been limited investigation into the quality of communication of patients who attend clinics staffed by medical residents. The patient population attending the resident clinic at Temple University Hospital is made up mostly of African Americans from lower-income neighborhoods of North Philadelphia. This investigation aims to gather data regarding the relationship between health literacy and communication in this previously under-studied patient population. Using a rapidly self-administered health literacy screening tool, the quantitative data reveals a high prevalence of low health literacy in this patient population. Additionally, using a semi-structured interview with a two-staged coding process, the qualitative data describes several ways in which limited health literacy can diminish optimal patient-provider communication. The patients in this study population express a high desire for information about their health status, as incomplete communication was a potential source of anxiety. Suggestions from patients in this population focus on increasing active participation in clinic visits. Study subjects agreed that interventions targeted towards medical residents would help to improve communication with low health literacy patients. Novel approaches to educating medical trainees about health literacy should be investigated in the future. / Urban Bioethics

Low health literacy in parents has been linked to increased obesity risk for their children. When providing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended, but no studies have examined the degree to which TB/TTG strategies can be implemented with fidelity in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of childhood obesity learning objectives; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into a 5 A's approach. Research partners (n=2) delivered all calls in Wave 1. During Waves 2 and 3, community staff (n=5) delivered a majority of calls with training and support from research staff. ). Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this trend was not significant. Both research and community partners adhered to call scripts with high fidelity (97% versus 98%). A significant main effect of health literacy level on TB/TTG performance was found for Call 1 and Call 3 during Wave 1 and for Call 1 during Waves 2 and 3 of iChoose (p<0.05, 0.01, and 0.05). An interaction effect of health literacy level and question number was found for Call 3 during Wave 1 only (p<0.05). For all calls in which TB/TTG performance differed significantly by health literacy level, participants with adequate health literacy were found to have better performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls (9.1 (2.0) and 9.5 (1.2) on a 10-point scale), while agreeing that calls helped improve their eating and PA habits (8.1 (2.6) and 7.5 (2.7)) and helped them learn class material better (8.1 (2.7)). Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently. / Master of Science

The 2014 Agricultural Act (Economic Research Division) (aka: The Farm Bill) was an important limelight shone on the issue of access to healthy foods, food education and the correlation between an increasingly unhealthy population and proximity to fresh, healthy food. Further legislation such as the Urban Agricultural Production Act of 2017 has been introduced to leverage the Farm Bill's financial incentives to promote urban agricultural programs and transform vacant land into agricultural use. Specifically, this has become increasingly common in many lower income and disadvantaged communities affected by a lack of access to fresh food stores. Additionally, in response many public schools have pro-actively sought funds to transform their schoolyards into gardens and teaching classrooms (Gamson) in order to provide food literacy and education however, this practice remains the exception. Many children still face a lack of healthy food options or the availability of any fresh food outside of their school environment. What if the standard education facility could be used as a tool to confront not only the architecture of the learning space, but a school-as-ecosystem, representing a neighborhood catalyst to teach through action – addressing comprehensive global issues brought on by food desert environments and a child's perspective about their own health? This thesis explores the possibility of casting the urban ecological net wide- envisioning a timescale for transforming public spaces and school grounds using green infrastructure practices, biological remediation, planning for changes in transportation technology and the expectations of a public education and child's perception about their environment. Emphasizing a broad focus on all of the potential sites for food production in the city (including the school, schoolyard and what they represent to the community), surfaces a multi-functioning methodology encompassing community identity, amenity, ecology, infrastructure and beauty envisions what could become of urban areas in the future. The primary goal is to educate future generations in the value of the food network and to give them the kind of direct hands-on experience that educators emphasize while concurrently nourishing urban communities through development of a project carried out in common, one that has health benefits for the population, that engenders a sense of long-term pride, and that empowers people to make change in their environment, even in modest or temporary ways. The idea that school design can encourage and facilitate, hinder and inhibit behaviors at school, and the architectural symbolism of schools can have a profoundly wider impact on children and their behaviors in and outside of school (Tucker). There is a significant psychological difference in learning about the environment, for the environment and in the environment (Malone). Creating public space focused on individual learning and the physical and mental health of the individual aims to balance the scales of social economic injustices. It is going to take every effort from the hyper-localized to city-wide and even regional scales to make significant urban changes to create a taxonomy of spaces to support the growth of our cities while simultaneously educating young minds on the value of understanding our ecological relationship to the city and surrounding environment. / Master of Science / The 2014 Agricultural Act (Economic Research Division) (aka: The Farm Bill) was an important limelight shone on the issue of access to healthy foods, food education and the correlation between an increasingly unhealthy population and proximity to fresh, healthy food. Further legislation such as the Urban Agricultural Production Act of 2017 has been introduced to leverage the Farm Bill’s financial incentives to promote urban agricultural programs and transform vacant land into agricultural use. Specifically, this has become increasingly common in many lower income and disadvantaged communities affected by a lack of access to fresh food stores. Additionally, in response many public schools have pro-actively sought funds to transform their schoolyards into gardens and teaching classrooms (Gamson) in order to provide food literacy and education however, this practice remains the exception. Many children still face a lack of healthy food options or the availability of any fresh food outside of their school environment. What if the standard education facility could be used as a tool to confront not only the architecture of the learning space, but a school-as-ecosystem, representing a neighborhood catalyst to teach through action – addressing comprehensive global issues brought on by food desert environments and a child’s perspective about their own health? This thesis explores the possibility of casting the urban ecological net wide- envisioning a timescale for transforming public spaces and school grounds using green infrastructure practices, biological remediation, planning for changes in transportation technology and the expectations of a public education and child’s perception about their environment. Emphasizing a broad focus on all of the potential sites for food production in the city (including the school, schoolyard and what they represent to the community), surfaces a multi-functioning methodology encompassing community identity, amenity, ecology, infrastructure and beauty envisions what could become of urban areas in the future. The primary goal is to educate future generations in the value of the food network and to give them the kind of direct hands-on experience that educators emphasize while concurrently nourishing urban communities through development of a project carried out in common, one that has health benefits for the population, that engenders a sense of long-term pride, and that empowers people to make change in their environment, even in modest or temporary ways. The idea that school design can encourage and facilitate, hinder and inhibit behaviors at school, and the architectural symbolism of schools can have a profoundly wider impact on children and their behaviors in and outside of school (Tucker). There is a significant psychological difference in learning about the environment, for the environment and in the environment (Malone). Creating public space focused on individual learning and the physical and mental health of the individual aims to balance the scales of social economic injustices. It is going to take every effort from the hyper-localized to city-wide and even regional scales to make significant urban changes to create a taxonomy of spaces to support the growth of our cities while simultaneously educating young minds on the value of understanding our ecological relationship to the city and surrounding environment.