Special Issue "Routes to Improve Health Literacy during the Life-Course"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (29 February 2020).

Special Issue Editors

Dr. Andrea F. de Winter
Website
Guest Editor
Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands
Interests: health literacy; person-centred care; epidemiology; health promotion; public health; cost-effectiveness; capacity building of healthcare professionals; theories and models; life-course approach
Prof. Dr. Carel Jansen
Website
Guest Editor
Professor Emeritus in Communication and Information Studies at the University of Groningen, Faculty of Arts and research fellow of the Language Centre at Stellenbosch University in South Africa
Interests: health literacy; persuasion; comprehensibility; narratives; fotonovelas

Special Issue Information

Dear Colleagues,

It is well-known that health literacy (HL), defined as the ability to access, understand, appraise and communicate health information, has a positive impact on health and quality of life. To optimize our health literacy interventions, however, we need to further advance our knowledge on how health literacy impacts various health outcomes.   

Comprehensive person-centered prevention approaches might offer the best chance to reduce health literacy-related problems. It seems recommendable to develop and evaluate health literacy interventions with a focus on a combination of strengthening social support systems, the empowerment of people with limited health literacy, enhancing person-centred communication by healthcare professionals, and improving health communication and policies within health services.  

This Special Issue of the International Journal of Environmental Research and Public Health, “Routes to improve health literacy”, offers an opportunity to publish high-quality studies that advance the evidence in health literacy research, and to contribute to better person-centered prevention. We invite submissions that examine how health literacy impacts health outcomes by unraveling the role of factors such as social support, the needs or motivations of persons, client–professional communication, mass media communication, the competencies of healthcare professionals, and communication or organization of health services. We especially welcome submissions that examine the effectiveness of multifaceted or comprehensive health literacy interventions.  

Dr. Andrea F. de Winter
Prof. Dr. Carel Jansen
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 semimonthly 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 2300 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

  • health literacy
  • health communication
  • health promotion
  • intervention
  • epidemiology
  • empowerment
  • health system
  • health professional
  • person-centered communication

Published Papers (7 papers)

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Research

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Open AccessArticle
Health Literacy Associations with Periodontal Disease among Slovak Adults
Int. J. Environ. Res. Public Health 2020, 17(6), 2152; https://doi.org/10.3390/ijerph17062152 - 24 Mar 2020
Abstract
Periodontal disease is inflammation of the gums and without good oral hygiene, it can progress to periodontitis. Oral hygiene might be related to a patient’s health literacy (HL), defined as ability to gain access, understand, and use information to promote and maintain good [...] Read more.
Periodontal disease is inflammation of the gums and without good oral hygiene, it can progress to periodontitis. Oral hygiene might be related to a patient’s health literacy (HL), defined as ability to gain access, understand, and use information to promote and maintain good health. The aim of our study is to examine the associations of HL with indicators of periodontal disease. A cross-sectional study on 1117 adults (36.2% males; mean age = 36.4, SD = 14.2) attending dental hygiene treatment was conducted. Data on demographics, socioeconomic status, and nine domains of HL (Health Literacy Questionnaire, HLQ) were collected by questionnaire, and Community Periodontal Index of Treatment Needs (CPITN) was established by the dental hygienist. Data were analysed using t-tests and logistic regression. Respondents with periodontal disease (N = 152) had statistically significantly lower levels of HL in seven out of nine HLQ domains compared to intact patients (N = 818) (t from 3.03 to 4.75, p < 0.01). Association of higher HL in seven domains with lower chance of diagnosed periodontal disease remain significant even after adjustment for age, gender and educational attainment (adjusted ORs 0.55–0.67, p < 0.05). Our findings confirm that an individual’s lower HL is significantly associated with higher chance of periodontal disease incidence, specifically among Slovak adults attending oral hygiene clinics. HL might be a promising factor in the improvement of oral health in this population, worthy of consideration in intervention and preventive activities. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
Open AccessArticle
The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening
Int. J. Environ. Res. Public Health 2019, 16(23), 4644; https://doi.org/10.3390/ijerph16234644 - 22 Nov 2019
Abstract
Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in [...] Read more.
Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55–75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
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Open AccessArticle
Is Health Literacy of Dialyzed Patients Related to Their Adherence to Dietary and Fluid Intake Recommendations?
Int. J. Environ. Res. Public Health 2019, 16(21), 4295; https://doi.org/10.3390/ijerph16214295 - 05 Nov 2019
Abstract
Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We [...] Read more.
Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63–0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62–0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65–0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
Open AccessArticle
Systematic Development of Materials for Inviting Low Health-Literate Individuals to Participate in Preconception Counseling
Int. J. Environ. Res. Public Health 2019, 16(21), 4223; https://doi.org/10.3390/ijerph16214223 - 31 Oct 2019
Cited by 1
Abstract
In this study we aimed to systematically analyze problems in the recruitment of women with low health literacy for preconception counseling and to adapt and evaluate written invitations for this group. In a problem analysis (stage 1) we used structured interviews (n = [...] Read more.
In this study we aimed to systematically analyze problems in the recruitment of women with low health literacy for preconception counseling and to adapt and evaluate written invitations for this group. In a problem analysis (stage 1) we used structured interviews (n = 72) to assess comprehension of the initial invitations, perception of perinatal risks, attitude and intention to participate in preconception counseling. These outcomes were used to adapt the invitation. The adapted flyer was pretested in interviews (n = 16) (stage 2) and evaluated in structured interviews among a new group of women (n = 67) (stage 3). Differences between women in stages 1 and 3 regarding comprehension, risk perception, attitude and intention to participate in counseling were analyzed by linear regression analysis and chi-square tests. Women in stage 3 (who read the adapted flyer) had a more positive attitude towards participation in preconception counselling and a better understanding of how to apply for a consultation than women in stage 1 (who read the initial invitations). No differences were found in intention to participate in preconception counseling and risk perception. Systematic adaptation of written invitations can improve the recruitment of low health-literate women for preconception counselling. Further research should gain insight into additional strategies to reach and inform this group. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
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Open AccessArticle
Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries: A Multi-centre Pre-post Intervention Study
Int. J. Environ. Res. Public Health 2019, 16(20), 3923; https://doi.org/10.3390/ijerph16203923 - 15 Oct 2019
Cited by 3
Abstract
Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address [...] Read more.
Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address health literacy related problems and support the development of people’s autonomy and self-management abilities after training and 6–12 weeks later, (2) professionals were satisfied with the training, (3) outcomes differed for the three participating European countries. Health professionals (N = 106) participated in a multicentre pre-post intervention study in Italy, the Netherlands and Northern Ireland. The 8-hour training-intervention involved health literacy knowledge, the practice of comprehensible communication skills, shared decision-making, and enhancing self-management. Self-rated health literacy competencies and training satisfaction were assessed at baseline, immediately after training and 6-12 weeks later, and analysed by multi-level analysis. Professionals’ self-rated health literacy competencies significantly improved following training in all three countries; this increase persisted at 6-12 weeks follow-up. The strongest increase regarded professional’s skills to enhance shared-decision making and enabling self-management after training and follow-up respectively. Professionals perceived the training as relevant for practice. Competency increases seemed to be consistent across countries. In three countries, professionals’ self-rated health literacy competencies increased following this comprehensive training. These promising findings should be confirmed in a further full effect study. Implementation of this training in European education and health care may improve person-centred communication by professionals and might help to tackle health literacy related problems and to strengthen people’s abilities in achieving better health outcomes. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
Open AccessArticle
Using Photo Stories to Support Doctor-Patient Communication: Evaluating a Communicative Health Literacy Intervention for Older Adults
Int. J. Environ. Res. Public Health 2019, 16(19), 3726; https://doi.org/10.3390/ijerph16193726 - 03 Oct 2019
Abstract
Older adults often have limited health literacy and experience difficulties in communicating about their health. In view of the need for efficacious interventions, we compared a narrative photo story booklet regarding doctor-patient communication with a non-narrative but otherwise highly similar brochure. The photo [...] Read more.
Older adults often have limited health literacy and experience difficulties in communicating about their health. In view of the need for efficacious interventions, we compared a narrative photo story booklet regarding doctor-patient communication with a non-narrative but otherwise highly similar brochure. The photo story booklet included seven short picture-based stories about themes related to doctor-patient communication. The non-narrative brochure had comparable pictures and layout and dealt with the same themes, but it did not include any stories. We conducted two Randomized Controlled Trials (RCTs) among older adults with varying levels of health literacy: one RCT in Germany (N = 66) and one RCT in the Netherlands (N = 54); the latter one was followed by an in-depth interview study among a subset of the participants (81.5%; n = 44). In the RCTs, we did not find significant differences between the photo story booklet and the non-narrative brochure. In the interview study, a majority of the participants expressed a preference for the photo story booklet, which was perceived as recognizable, relevant, entertaining and engaging. We conclude that photo story booklets are a promising format but that there is room for improving their effectiveness. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
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Review

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Open AccessReview
Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies
Int. J. Environ. Res. Public Health 2019, 16(21), 4300; https://doi.org/10.3390/ijerph16214300 - 05 Nov 2019
Abstract
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with [...] Read more.
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. “Cultural sensitivity” and “eHealth” were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL. Full article
(This article belongs to the Special Issue Routes to Improve Health Literacy during the Life-Course)
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