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.

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.

While limited health literacy has been associated with poorer health decisions and poorer health outcomes, there remains a gap in the literature related to the influence of health literacy on weight and weight-related behaviors. The primary aim of this study is to examine the influence of child and parent health literacy status on childs body mass index (BMI) and health behaviors, within an adapted evidence-based family-based childhood obesity intervention, iChoose, implemented in the medically underserved Dan River Region (DRR). Previously developed measures were used to assess health literacy and health behaviors. iChoose consisted of 101-parent-child dyads. Using the New Vital Sign (NVS), 46% of children and 13% of parents had low to limited health literacy levels at baseline. Younger children and parents who were African American, had no high school diploma, and earned <$25,000/year were significantly more likely to have low health literacy when compared to their counterparts. Health literacy levels for these individuals ranged between 0 to 3, which is considered low to limited health literacy. Health literacy levels were further examined between health outcomes. However, BMI, fruit and vegetable intake, sugar-sweetened beverages (SSB), minutes of moderate to vigorous physical activity, and screen time did not differ by health literacy levels at baseline. Among children, improvements in the NVS was significantly correlated with decreases in SSB consumption (r = -.275, p < .05), but with no other outcomes. There were no significant correlations among changes in parent NVS score and changes in child health behaviors. Results from this study fill a gap in understanding the associations in health literacy and weight and weight-related behavioral outcomes in children. It also provides insights into the opportunities and challenges in measuring health literacy among children. Future research is needed to explore further health literacy measurement issues among children and the influence of both child and parent health literacy in family-based childhood obesity treatment efforts. Additional efforts are also needed to assist community and health care providers in finding more effective strategies to guide children with low health literacy to better health outcomes. / Master of Science

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, and Wagner's chronic care model guided the development and implementation of this project. The practice-focused question for this project asked whether evidence informs a CPG intended to assess health literacy and numeracy assessment and promote an enhanced individualized education intervention in an outpatient HF population. A literature review using 20 articles from 2006-2018 was completed. Five articles were selected to review levels of evidence, and three articles were chosen to support the development of the CPG. The CPG was reviewed, refined, and validated by an expert panel of HF nurses and physicians. The CPG might support a positive social change in the practice setting by improving the tools for nurses to assess health literacy in the HF patient population and provide individualized education to influence self-care interventions.

Health numeracy is a necessary skill for accessing health services. Immigrants have lower levels of health numeracy compared to host populations which constrains their access to health information necessary to make quality health decisions. Factors contributing to immigrants??? low health numeracy skills include language and mathematics self-efficacy. Language is associated with how people acquire and process numeric information. Some languages have more numeric concepts than others. Speakers of languages that lack one or more numeric concepts may be constrained in the comprehension of health information that contains such concepts. Moreover, they may lack the self-efficacy to engage in numeric tasks containing such concepts. Therefore, the overall objectives of this study were: 1) to investigate the effect of primary language and 2) mathematics self-efficacy on its speakers??? comprehension of numeric health information presented in a different language; and also 3) to investigate how speakers of low and high numeric concept languages process numeric health information when the information is presented in a language which is not their primary or first language. The study involved sixty Kikuyu (a low numeric concept language) and sixty Mandarin (a high numeric concept language) speaking immigrants to Canada. Demographic data was collected from the 120 participants using a general information questionnaire. Numeracy was assessed using a context-free numeracy tool (French Kit). Short test of functional literacy in adults (S-TOFHLA) and the newest vital signs (NVS) were used to assess health numeracy and literacy, and self-efficacy was measured with the Mathematics Self-Efficacy Scale (MSES) and the Subjective Numeracy Scale (SNS). Processing of numeric health information was assessed qualitatively using the think-aloud method. Descriptive statistics were generated for performance in numeracy, health numeracy and literacy, and in mathematics self-efficacy. Multiple regression analysis was conducted to determine the predictors of numeracy and health numeracy. Protocol analysis was conducted for the verbal information obtained from the think-aloud process. Results, interpretations and implications for public health practice and research are discussed.

Probabilities, an essential dimension of risk communication, can be presented in various formats including frequencies (e.g., 1 in 10), percentages (e.g., 10%), or verbal phrases (e.g., unlikely); the literature is mixed concerning which format best supports comprehension. Additionally, it is not well understood how people who vary in their level of numeracy understand those probabilities. The goal of the present three-phase within-participant study was to understand how the factors of format and numeracy influence comprehension and mental representations of probabilities for younger and older adults. Overall, the results of this research clearly indicated that comprehension and mental representation of health risk probabilities are influenced by format, age, and numeracy. To best support comprehension and comparison of health risk probabilities for younger adults and healthy older adults with varying numeracy, percent format should be used.

No description available.

BACKGROUND: Low health literacy and numeracy are significant problems facing the United States. Recent research focuses heavily on the role health literacy and numeracy play in perception of disease risk, health care costs, all-cause mortality, and access to care; however, there has been relativity little emphasis on the relationships between health literacy or numeracy with health promotion behaviors, such as nutrition or physical activity. As our nation continues to face challenges with the high prevalence of obesity and other chronic diseases, it is increasingly important to understand the role that health literacy and numeracy play in nutrition and physical activity behaviors, as well as in the prevalence and control of chronic disease. PRIMARY AIMS: The proposed research is embedded within a larger randomized-control trial, Talking Health, which is a 2-arm behavioral trial targeting residents in eight counties in southwest Virginia with sugar-sweetened beverage (SSB) consumption as the primary outcome. The primary aims of this cross-sectional study, using baseline Talking Health data, are to 1) examine correlations among health literacy and numeracy measures, namely the Newest Vital Sign (NVS), separated by reading (NVS Reading) and math (NVS Math) scores, the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Subjective Numeracy Scale (SNS); 2) explore the relationships between demographic factors and the NVS, REALM, and SNS scores; 3) determine the relationships between the NVS, REALM, and SNS and dietary quality [i.e. Health Eating Index (HEI) scores], physical activity behaviors, and anthropometric and biological variables (body mass index, blood pressure, fasting blood lipids, and fasting blood glucose); and 4) determine if NVS, REALM, and SNS scores predict metabolic syndrome (MetS), while controlling for relevant demographic factors. METHODS: Eligibility requirements for the study include being 18 years of age or older, having reliable access to a telephone, drinking ≥200 kilocalories of SSB per day, and being a resident of Southwest Virginia. Using previously validated instruments and standardized data collection protocol, a variety of baseline variables was collected on 264 participants. Health literacy was measured using the NVS and REALM and health numeracy was measured using the SNS. Dietary intake was measured via three 24-hour dietary recalls and HEI scores were calculated. Physical activity behaviors were assessed using the Godin Leisure Time Exercise Questionnaire. Weight was measured using a calibrated digital Tanita scale (Model: 310GS), height was measured using a portable research-grade stadiometer, blood pressure measurements were made with an OMRON automated oscillometric device (Model: HEM-907XL), and fasting blood samples were obtained via a finger stick and the CardioChek PA system was used to assess blood glucose, cholesterol, and triglycerides. MetS scores were determined based on an adaptation of the National Cholesterol Education Program guidelines. Statistical analysis included descriptive statistics, simple correlations (Pearson bivariate), one-way ANOVAs, and regression models. RESULTS: Of 264 enrolled participants (mean age 41.1 + 13.5 years; 92.0% Caucasian; 81.8% female; 30.6% > high school education; 42% > $15,000 annual income), 33.7% were classified as having a high probability of low health literacy or possibility of low health literacy as measured by the NVS, 19.7% had less than a high school reading level as measured by the REALM, and 45.4% had low health numeracy as measured by the SNS. Additionally, 78.8% were overweight or obese and 29.0% meet the criteria for metabolic syndrome. Nine of the ten correlations between the NVS Total, NVS Reading, NVS Math, REALM, and SNS were statistically significant (p < .01, two-tailed). NVS scores were found to be significantly different by age (F = 2.36, p = .05), race (F = 4.49, p = .03), education level (F = 20.97, p < .001), and income (F = 13.88, p < .001); while REALM scores were only significantly different by race (F = 3.74, p = .05), education level (F = 21.06, p < .001), and income (F = 6.80, p < .001). SNS scores were significantly different by gender (F = 12.40, p = .001), education level (F = 11.01, p < .001), and income (F = 14.45, p < .001). Only systolic blood pressure, diastolic blood pressure, and strength training activity was found to be significantly different by health literacy and/or numeracy level; however, when controlling for hypertension medication use and/or demographic variables, only the relationship between health literacy (i.e, NVS) and strength training activity remained significant (R2 = 0.09, p = .01). Finally, health literacy and numeracy were not found to be predictive of metabolic syndrome while controlling for demographic variables. DISCUSSION: Although numerous demographic factors were related to baseline health literacy and numeracy levels, anthropometric/biological variables, physical activity behaviors, and diet quality did not differ by health literacy and health numeracy level, with the exception of systolic blood pressure and strength training activity. This research helps to fill the gaps in the literature surrounding the prevalence of health literacy, health numeracy, and health promoting behaviors and chronic disease among rural residents in medically underserved counties in southwest Virginia. While few cross-sectional relationships were found, future research from this RCT should examine if health literacy and health numeracy moderates or mediates intervention changes in anthropometric/biological variables, physical activity behaviors, diet quality, and metabolic syndrome scores. / Master of Science

No description available.