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Special Issue "Health Literacy in Context—Settings, Media, and Populations"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 April 2018)

Special Issue Editors

Guest Editor
Prof. Dr. Don Nutbeam

School of Public Health, University of Sydney, Sydney, Australia
Website | E-Mail
Interests: social and behavioural determinants of health, the development and evaluation of public health interventions
Guest Editor
Prof. Dr. Diane Levin-Zamir

Department of Health Education and Promotion, Clalit Health Services, Tel-Aviv, Israel & University of Haifa School of Public Health, Israel
Website | E-Mail
Guest Editor
Prof. Dr. Gill Rowlands

Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
Website | E-Mail

Special Issue Information

Dear Colleagues,

We have been invited to plan and edit a Special Issue on “Health Literacy in Context” for the International Journal of Environmental Research and Public Health (IJERPH). Health literacy has been defined and conceptualized in multiple ways, but almost all definitions have the same core elements describing the skills that enable individuals to obtain, understand and use information to make decisions and take actions that will have an impact on their health. These health literacy skills can be applied to the full range of determinants of health (personal, social and environmental). Previous research has established that these skills and abilities are mediated by environmental demands and situational complexities.

To date, most published health literacy research has focused on assessing and improving personal skills and abilities. This Special Issue will examine more closely current progress in understanding “Health Literacy in Context”, and welcomes papers that improve our understanding of the mutual impact of a range of social, economic, environmental, and organisational influences on health literacy.

We especially encourage submission of papers that report on:

  • the relationships between physical and social environments and health literacy;
  • interventions to reduce environmental demands and complexity, including for example interventions to reduce organisational and administrative complexity of health services;
  • health literacy interventions that are responsive to cultural preferences; and
  • health literacy interventions using the preferred media of disengaged populations.

We encourage prospective authors to submit a 350 word abstract by 15 December 2017 for consideration and feedback by the Guest Editors. Authors whose abstracts are accepted will be invited to submit a full manuscript. Subject to the decision of the Special issue editors, up to 5 manuscripts accepted through this process will receive a waiver of the normal Journal publication fee. In addition, authors may submit their paper through the normal journal submission process and the usual journal processing fee of 1600 CHF will apply. All manuscripts will be subject to the journal’s normal peer review process.

Closing date for full manuscript submissions (through either process) is the 30 April 2018.

IJERPH is an established, open access, peer-reviewed journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. Its impact factor is 2.101 (2016); 5-Year Impact Factor: 2.540 (2016). For detailed information on the journal, we refer you to http://www.mdpi.com/journal/ijerph

Prof. Dr. Don Nutbeam
Prof. Dr. Diane Levin-Zamir
Prof. Dr. Gill Rowlands
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Culture
  • Determinants of health
  • Health disparities
  • Health education
  • Health literacy
  • Health interventions
  • Health promotion
  • Organizational change
  • Social disadvantage
  • Social environment

Published Papers (9 papers)

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Research

Open AccessFeature PaperArticle Is It Possible to “Find Space for Mental Health” in Young People? Effectiveness of a School-Based Mental Health Literacy Promotion Program
Int. J. Environ. Res. Public Health 2018, 15(7), 1426; https://doi.org/10.3390/ijerph15071426
Received: 27 March 2018 / Revised: 2 July 2018 / Accepted: 5 July 2018 / Published: 6 July 2018
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Abstract
Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion
[...] Read more.
Lack of knowledge regarding, and the stigma associated with, mental disorders have been identified as major obstacles for the promotion of mental health and early intervention. The present study aimed to evaluate the effectiveness of a school-based intervention program focused on the promotion of mental health literacy (MHL) in young people (“Finding Space for Mental Health”). A sample of 543 students (22 classes), aged between 12 and 14 years old, participated in the study. Each class of students was randomly assigned to the control group (CG; n = 284; 11 classes) or the experimental group (EG; n = 259; 11 classes). MHL was assessed using the Mental Health Literacy questionnaire (MHLq), which is comprised of three dimensions—Knowledge/Stereotypes, First Aid Skills and Help Seeking, and Self-Help Strategies. The scores on these dimensions can also be combined to give an overall or total score. Participants from the EG attended the MHL promotion program (two sessions, 90 min each) delivered at one-week intervals. Sessions followed an interactive methodology, using group dynamics, music, and videos adapted to the target group. All participants responded to the MHLq at three points in time: pre-intervention assessment (one week prior to the intervention), post-intervention assessment (one week after the intervention) and follow-up assessment (six months after the intervention). The intervention effectiveness and the differential impact of sociodemographic variables on the effectiveness of the program were studied using a Generalized Estimation Equation (GEE). Results revealed that participants from the EG demonstrated, on average, significantly higher improvement in MHL from pre-intervention to follow-up when compared to participants from the CG. Different sociodemographic variables affected the effectiveness of the program on distinct dimensions of the MHLq. Overall, “Finding Space for Mental Health” showed efficacy as a short-term promotion program for improving MHL in schools. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
Open AccessArticle Conditions and Dynamics That Impact Maternal Health Literacy among High Risk Prenatal-Interconceptional Women
Int. J. Environ. Res. Public Health 2018, 15(7), 1383; https://doi.org/10.3390/ijerph15071383
Received: 28 April 2018 / Revised: 21 June 2018 / Accepted: 25 June 2018 / Published: 2 July 2018
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Abstract
The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development
[...] Read more.
The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development (LCHD) Model, conditions were risk and protective factors that impacted health. Dynamics drove the complex, epigenetic relationships between risk and protective factors. Maternal health literacy promotion helped participants address conditions and dynamics to create positive life changes. This research was a retrospective, mixed methods study of women’s service records documenting care from prenatal admission to 24 months post-delivery. The Life Skills Progression Instrument (LSP) was scored to measure maternal health literacy progression. Ethnographic content analysis of visit notes triangulated with quantitative data enabled specificity of critical data elements. Subsequently, a complementary focus group was conducted with the Registered Nurse Case Managers (RNCM). Severe social conditions included devastating poverty, low educational achievement, transient housing, unstable relationships, incarceration, lack of continuous health insurance, and shortage of health care providers. Dynamics included severe psycho-social stressors, domestic violence, lack of employment, low income, low self-esteem and self-expectations, and social/family restraints upon women’s intended positive changes. An important protective factor was the consistent, stable, evidence-informed relationship with the RNCM. Findings from the focus group discussion supported content analysis results. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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Open AccessArticle Mental Health Literacy in Young Adults: Adaptation and Psychometric Properties of the Mental Health Literacy Questionnaire
Int. J. Environ. Res. Public Health 2018, 15(7), 1318; https://doi.org/10.3390/ijerph15071318
Received: 30 April 2018 / Revised: 9 June 2018 / Accepted: 18 June 2018 / Published: 23 June 2018
PDF Full-text (436 KB) | HTML Full-text | XML Full-text
Abstract
Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous
[...] Read more.
Mental health literacy (MHL) is considered a prerequisite for early recognition and intervention in mental disorders, and for this reason, it has become a focus of research over the past few decades. Assessing this construct is relevant for identifying knowledge gaps and erroneous beliefs concerning mental health issues, to inform the development of interventions aimed at promoting mental health literacy as well as the evaluation of these interventions. Recently, we developed a new self-reporting measure (MHLq) for assessing mental health literacy in young people (12–14 years-old), meeting the need to assess MHL from a comprehensive perspective of the construct instead of focusing on a restricted number of mental disorders or specific dimensions (e.g., knowledge concerning specific disorders; stigma). The present study aimed to adapt the MHLq for the young adult population and to examine its psychometric properties, according to the following steps: (1) item adaptation, using a think aloud procedure (n = 5); (2) data collection (n = 356, aged between 18 and 25 years old; and (3) psychometric analyses (exploratory factor analysis and internal consistency analysis). The final version of the questionnaire included 29 items (total scale α = 0.84), organized by four dimensions: (1) knowledge of mental health problems (α = 0.74); (2) erroneous beliefs/stereotypes (α = 0.72); (3) help-seeking and first aid skills (α = 0.71); and (4) self-help strategies (α = 0.60). The results suggest that the MHLq-adult form is a practical, valid, and reliable screening tool for identifying gaps in knowledge, beliefs, and behavioral intentions related to mental health and mental disorders, planning promotion programs, and evaluating intervention effectiveness. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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Open AccessArticle Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model
Int. J. Environ. Res. Public Health 2018, 15(6), 1268; https://doi.org/10.3390/ijerph15061268
Received: 30 April 2018 / Revised: 6 June 2018 / Accepted: 12 June 2018 / Published: 15 June 2018
PDF Full-text (1517 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We
[...] Read more.
Low health literacy (HL) is associated with many negative health outcomes, and is a major challenge in public health and healthcare. Interventions to improve outcomes associated with HL are needed. In this paper, we aim to develop a comprehensive HL intervention model. We used a multimethod approach, consisting of (1) a literature review of articles listed in MEDLINE, presenting HL intervention models, (2) online consultation of international HL experts, and (3) two consensus meetings with members (n = 36 and 27) of a consortium studying HL among older adults (50+) in Europe. In our literature review, we identified twenty-two HL models, only a few of which focused explicitly on interventions. Sixty-eight health literacy experts took part in the online survey. The results from all three methods came together in a comprehensive HL intervention model. This model conceptualized interventions as potentially targeting five factors affecting HL outcomes: (1) individuals’ personal characteristics, (2) individuals’ social context, (3) communication between individuals and health professionals, (4) health professionals’ HL capacities, and (5) health systems. Our model is the first comprehensive HL model focused specifically on interventions. The model can support the further development of HL interventions to improve the health outcomes of people with low HL. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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Open AccessArticle A Qualitative Study of the Development of Health Literacy Capacities of Participants Attending a Community-Based Cardiovascular Health Programme
Int. J. Environ. Res. Public Health 2018, 15(6), 1157; https://doi.org/10.3390/ijerph15061157
Received: 20 April 2018 / Revised: 17 May 2018 / Accepted: 30 May 2018 / Published: 2 June 2018
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Abstract
Health literacy is a critical determinant of health, which can empower individuals and lead to engagement in collective health promotion action and is also a crucial component in the self-management of illness. The current study moves beyond a focus on functional health literacy
[...] Read more.
Health literacy is a critical determinant of health, which can empower individuals and lead to engagement in collective health promotion action and is also a crucial component in the self-management of illness. The current study moves beyond a focus on functional health literacy and presents findings from a longitudinal qualitative (LQ) study consisting of three phases. This paper presents findings from the second phase of the study, which assessed the development of health literacy capacities of individuals attending a structured cardiovascular risk reduction programme in Ireland. The study objectives were to: explore perceptions of changes in interactions and information exchange within health consultations; identify the facilitators associated with changes in health literacy capacities; assess developments in engagement with broader contexts for health literacy capacities. A LQ study design was undertaken, which employed repeat interview methodology with 19 participants (aged 36–76 years) 12 weeks after beginning a structured cardiovascular risk reduction programme. Health literacy levels were assessed using the HLS-EU 47 item instrument in phase 1 (68% limited health literacy (HL), 32% adequate health literacy). A semi-structured interview guide, (informed by Sørensen’s conceptual model of health literacy), was used to explore the development of health literacy and to identify changes in knowledge, attitudes and experiences over time. Thematic analysis was used, informed by aspects of Saldaña’s framework for longitudinal qualitative data analysis. All participants reported having acquired increased understanding of issues relevant to their health and self-care. Participants described health literacy capacities that incorporate aspects of all levels of health literacy (functional, interactive and critical). Core themes were identified corresponding to changes in these levels: re-engagement with health information and increased understanding of risk and protective factors (changes in functional health literacy); changes in interactions with healthcare providers (HCP) (changes in interactive health literacy); enhanced psychological insights and understanding the broader determinants of health (changes in critical health literacy). Findings support the development of health literacy capacities across the functional, interactive and critical health literacy domains. Participants are capable of locating responsibility for health beyond the individual level and are making sense of knowledge within their own social contexts. Individuals, regardless of their initial health literacy levels, are capable of engaging with broader issues that can impact on their health and can be supported to develop these critical health literacy capacities. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
Open AccessArticle Understanding of Information about Medicines Use among Parents of Pre-School Children in Serbia: Parental Pharmacotherapy Literacy Questionnaire (PTHL-SR)
Int. J. Environ. Res. Public Health 2018, 15(5), 977; https://doi.org/10.3390/ijerph15050977
Received: 9 March 2018 / Revised: 4 April 2018 / Accepted: 16 April 2018 / Published: 14 May 2018
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Abstract
Parental health literacy plays an important role in children’s health. Experiences from pharmacy practice show that is necessary to check if parents understand instructions about use of medicines for children. This study aimed to assess pharmacotherapy literacy of parents of pre-school children and
[...] Read more.
Parental health literacy plays an important role in children’s health. Experiences from pharmacy practice show that is necessary to check if parents understand instructions about use of medicines for children. This study aimed to assess pharmacotherapy literacy of parents of pre-school children and to examine association of parental pharmacotherapy literacy level with parent’s socio-demographic characteristics. The study was cross-sectional, conducted among parents of pre-school children (1–7 years of age), in kindergartens in several municipalities of Belgrade, Serbia, during regular parents meetings, from May to October 2016. Functional health literacy was measured by the Serbian version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Parental pharmacotherapy literacy was assessed with newly constructed PTHL-SR questionnaire with good psychometric characteristics (Parental pharmacotherapy literacy questionnaire—Serbian). Overall, 813 parents participated in the study, mostly females (81.30%), between 30 to 40 years of age (70.85%) with two children (56.70%). Almost all of our study participants (99%) had adequate health literacy as assessed by S-TOFHLA. Mean score on PTHL-SR was 72.83% (standard deviation was 13.37), with better results among females than males (72% of women were in the group of highest PTHL-SR results). Our study showed that many parents (76.5%) knew the appropriate usage of non-prescription medicine for children, 57.2% parents were able to correctly calculate the dose of oral syrup for a child, and only 43.3% were able to interpret non-prescription dosage information written on the package. The majority of parents (61.3%) would make a dosage to child based on age and not on their weight. Every fifth parent with adequate functional health literacy measured by S-TOFHLA test, achieved the lowest results measured by PTHL-SR. Higher performance of the PTHL-SR was significantly correlated with education (p < 0.001), female sex (p < 0.001), married parents and those living in common-law (p < 0.001), older parents (p < 0.05) and parents who have more children (p < 0.05), and are non-smokers (p < 0.05). These results provide evidence that limitations in understanding common information about use of medicines are widespread among parents of pre-school children and encourage efforts for further investigation. PTHL-SR questionnaire may be a useful tool for identification of parents who need more instructions and assistance from healthcare providers, above all in providing better communication, written or spoken at community pharmacy settings. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
Open AccessArticle Do Low Income Youth of Color See “The Bigger Picture” When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign
Int. J. Environ. Res. Public Health 2018, 15(5), 840; https://doi.org/10.3390/ijerph15050840
Received: 3 February 2018 / Revised: 19 April 2018 / Accepted: 20 April 2018 / Published: 24 April 2018
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Abstract
As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as
[...] Read more.
As Type 2 diabetes spikes among minority and low-income youth, there is an urgent need to tackle the drivers of this preventable disease. The Bigger Picture (TBP) is a counter-marketing campaign using youth-created, spoken-word public service announcements (PSAs) to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement and norm change. Methods: We examined whether and how TBP PSAs advance health literacy among low-income, minority youth. We showed nine PSAs, asking individuals open-ended questions via questionnaire, then facilitating a focus group to reflect upon the PSAs. Results: Questionnaire responses revealed a balance between individual vs. public health literacy. Some focused on individual responsibility and behaviors, while others described socio-environmental forces underlying risk. The focus group generated a preponderance of public health literacy responses, emphasizing future action. Striking sociopolitical themes emerged, reflecting tensions minority and low-income youth experience, such as entrapment vs. liberation. Conclusion: Our findings speak to the structural barriers and complexities underlying diabetes risk, and the ability of spoken word medium to make these challenges visible and motivate action. Practice Implications: Delivering TBP content to promote interactive reflection has potential to change behavioral norms and build capacity to confront the social, economic and structural factors that influence behaviors. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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Open AccessArticle The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis
Int. J. Environ. Res. Public Health 2018, 15(4), 798; https://doi.org/10.3390/ijerph15040798
Received: 13 March 2018 / Revised: 8 April 2018 / Accepted: 16 April 2018 / Published: 19 April 2018
PDF Full-text (518 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was
[...] Read more.
This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was measured using the 47-item HLS-EU questionnaire (HLS-EUQ47) and the Newest Vital Sign (NVS). The two measures stood in significant correlation to the outcomes of the sub-discipline of the Euro Health Consumer Index (r = 0.790 for HLS-EUQ47; r = 0.789 for NVS). The HLS-EUQ47 also stood in correlation to the percentage of population with post-secondary education (r = 0.810), the reading performance for 15-year-old students (r = 0.905), the presence of a national screening program for breast (r = 0.732) or cervical cancer (r = 0.873). The NVS stood in correlation with the unemployment rate (r = −0.778), the Gross Domestic Product (r = 0.719), the Gini coefficient (r = −0.743), the rank of the Euro Patient Empowerment Index (r = −0.826), the expenditure on social protection (r = 0.814), the Consumer Empowerment Index (r = 0.898), the percentage of adults using the internet for seeking health information (r = 0.759), the prevalence of overweight individuals (r = −0.843), the health expenditure (r = 0.766), as well as the percentage of individuals using the internet for interacting with public authorities (r = 0.755). This study provides some preliminary considerations regarding alternative means by which to study HL and proposes new methods for experimentation. The methods and the results could offer a means by which the relationship between society and overall healthcare protection could be strengthened. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
Open AccessArticle Effective Partnership in Community-Based Health Promotion: Lessons from the Health Literacy Partnership
Int. J. Environ. Res. Public Health 2017, 14(12), 1550; https://doi.org/10.3390/ijerph14121550
Received: 16 October 2017 / Revised: 14 November 2017 / Accepted: 30 November 2017 / Published: 11 December 2017
Cited by 1 | PDF Full-text (259 KB) | HTML Full-text | XML Full-text
Abstract
This paper aims to explore key elements needed to successfully develop healthy partnerships and collaborative working in community-based health promotion. It draws upon the lessons learned from a case study with the Health Literacy Partnership in Stoke-on-Trent, UK in developing the health literacy
[...] Read more.
This paper aims to explore key elements needed to successfully develop healthy partnerships and collaborative working in community-based health promotion. It draws upon the lessons learned from a case study with the Health Literacy Partnership in Stoke-on-Trent, UK in developing the health literacy strategy in the area. The process was underpinned by respect for diverse yet complementary perspectives and skills from the grassroots up. This involved engagement with key stakeholders, development and support for community projects, and sharing of good practice with other national and local organizations. Stakeholders involved in developing the strategy also had a keen interest in health literacy and a strong commitment to promoting health and well-being in the area. Through patience, perseverance, and continuous open communication and learning, the health literacy strategy in Stoke-on-Trent, UK is beginning to have a ripple effect into local practice, and will potentially influence policy in the future. Full article
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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