Search Results (137)

Background: Health literacy is increasingly recognized as an essential determinant of health, readiness, and safety in the military, especially as health systems become more digitalized. However, evidence on general and digital health literacy in the armed forces remains limited. This study examined levels of general health literacy and digital health literacy among Lithuanian soldiers and explored their associations with sociodemographic, service-related, and health characteristics. Methods: A cross-sectional survey was conducted among 603 military personnel serving in the national armed forces. General and digital health literacy were measured with HLS19-Q12 and HLS19-DIGI. Data on sociodemographic and military characteristics, self-rated health, and self-reported long-term illnesses were collected. Descriptive statistics, correlation analyses, and multivariable regression models were used to analyze the data. Results: The sample was predominantly male (81.9%) with a mean age of 39.08 years (SD = 8.89). The mean general health literacy score was 80.1 (SD = 19.17), whereas the mean digital health literacy score was 67.81 (SD = 30.05). Overall, 45.0% of soldiers had excellent general health literacy, and 12.0% had inadequate general health literacy; 42.1% had excellent digital health literacy, and 35% had inadequate digital health literacy. Higher levels of health literacy were positively associated with better self-rated health and social status. No statistically significant associations were found between health literacy and gender, age, education, length of service, type of military service, and self-reported long-term health complaints. Conclusions: Military personnel in this study displayed relatively high general health literacy, yet digital health literacy was lower and more unevenly distributed, indicating a potential vulnerability for health outcomes as access to information, communication, and care increasingly relies on digital platforms. Given the cross-sectional design, causal inferences cannot be drawn. Military health services may build on existing health literacy strengths while considering strategies to address digital health literacy gaps (e.g., targeted training, tailored support, and user-friendly digital solutions, including service design), acknowledging that feasibility and implementation depend on organizational context and resources. Full article

Rural and unincorporated communities (UCs) experience persistent health disparities driven by limited healthcare infrastructure, geographic isolation, and socioeconomic inequities. Health literacy (HL), the ability to obtain, understand, and use health information, is a critical yet underexplored determinant of health outcomes in these settings. This study examined HL and barriers to healthcare and health information access among low-income adults living with chronic conditions in nine rural UCs in Southern California. A descriptive cross-sectional survey was administered in English or Spanish to 222 respondents during community food distribution events. The questionnaire included demographics, self-reported health status, chronic disease history, perceived access to care and health information, trust in information sources and HL assessment using the Newest Vital Sign (NVS). Over four-fifths (82.7%) of respondents demonstrated limited or possibly limited HL. Although Spanish-speaking respondents scored significantly lower than English speakers on the NVS, language was not a significant predictor of HL after adjusting for age, gender, education and Hispanic origin. Lower education and older age were associated with reduced HL. One in four respondents reported barriers to healthcare access, primarily due to distance and appointment availability. Over half of the respondents reported difficulty accessing or understanding health information, regardless of HL or demographic characteristics. Doctors were the most trusted source of health information, while trust in government and religious organizations was lowest. Findings reveal pervasive low HL and broad challenges accessing care and health information across rural UCs, highlighting the structural and educational inequities underlying these disparities. Addressing these gaps requires community-driven, bilingual, and culturally resonant strategies that build trust, enhance communication, and strengthen health system accessibility for residents of unincorporated rural regions. Full article

Background/Objectives: Health literacy (HL) plays a fundamental role in maternal and neonatal outcomes by influencing women’s ability to access, understand, and apply health information during pregnancy. However, evidence regarding the determinants of HL among pregnant women remains limited, particularly within the Spanish context. This study aimed to assess HL levels among pregnant women and to examine their association with personal, socioeconomic, and health-related factors. Methods: A cross-sectional study was conducted between January 2023 and February 2024 across nine primary care centres within the Vigo Health Area (Spain), including 182 pregnant women receiving prenatal care. HL was measured using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Sociodemographic, obstetric, and health-related variables were collected through structured interviews. Descriptive and inferential analyses were performed to explore associations between HL and the selected variables. Results: Limited HL was observed in 35.7% of participants. A significant association was found between HL and family income (p = 0.037), with limited HL being more frequent among women with a monthly family income below €2000. No associations were identified with other sociodemographic or health-related variables. Thirty-nine per cent of participants visited hospital emergency services on two or more occasions, mostly without admission. The main source of information was healthcare professionals, although Internet use was also relevant. Conclusions: The prevalence of limited HL was lower than that reported in other national studies, although inequalities related to family income persisted. These findings highlight the need to incorporate systematic, HL-tailored strategies into prenatal care, based on prior HL assessment, to promote informed decision-making and improve maternal and neonatal outcomes. Full article

The one-parent-one-language (OPOL) approach has traditionally been considered a widely recommended strategy for heritage-language (HL) maintenance in bilingual families. However, alternative strategies, such as both parents consistently speaking the HL, may be equally or more effective. This study examines families’ self-reported language policies and their perceived effectiveness in HL maintenance in Australia, where minority languages often hold lower status than English and receive minimal institutional support beyond the home. Using data from a nationwide survey of 280 families, we analyzed parents’ self-reported language-use patterns and their perceived impact on HL transmission. Most mothers, who more often identified as primary caregivers, reported speaking a HL with their children, while secondary caregivers’ self-reported language use was varied. Families were categorized into four language-use approaches: OPOL, mixed-language use from one or both caregivers, HL-only from both caregivers, and single-caregiver only. Comparisons across these categories revealed that families following the HL-only and OPOL approaches reported significantly greater success in maintaining the HL than the other two groups, which showed no significant differences in self-reported outcomes. Follow-up analyses showed that Mixed-language families who reported high HL use percieved success comparable to that of HL-only and OPOL families. Our findings suggest that language input may be a central, but not exclusive, contributor to HL transmission. Families who reported higher perceived success showed strong commitment to HL maintenance, with caregivers likely reinforcing each other's efforts beyond direct language input. This study contributes to discussions on bilingual parenting and family language policy, providing empirical insights to inform HL maintenance strategies in diverse linguistic settings. Full article

Urological cancers are associated with reduced quality of life and high psychological burden, yet affected patients receive less psychosocial support than other cancer groups. Electronic health literacy (eHL) may facilitate independent access to resources, but its role for psychological outcomes and quality of life in this group is unclear. This study examined associations between eHL, psychological symptoms, and quality of life during transition from inpatient to outpatient care. A prospective, single-centre observational study was conducted. Eligible inpatients (urological cancer, Distress Thermometer ≥5 and/or request for psycho-oncological support) received an initial psycho-oncology consultation and completed surveys during inpatient treatment (T1) and three months later (T2). Measures included socio-demographics, PO-BADO, eHL (eHEALS), distress, depression (PHQ-2), anxiety (GAD-2), and quality of life (EORTC QLQ-C30). Of 108 patients completing T1, 71 completed T2. After controlling for age, eHL was not significantly associated with distress, depression, anxiety, or quality of life. Age did not moderate these relationships. In this sample, eHL showed no significant associations with psychological outcomes or quality of life. However, higher age was linked to lower eHL, suggesting that older patients may face barriers to digital health engagement. Age-related differences in eHL should be considered when designing digital support services for urological cancer patients. Full article

Background: eHealth literacy (eHL) is the ability to seek, find, understand, and apply digital health information. Adolescents often overestimate their eHL skills, potentially leading to poor health decisions and posing a public health concern. Objectives: This study aimed to examine the knowledge, attitudes, and behaviors toward eHL and seeking health information online among a sample of Italian adolescents aged 10–19 to identify the sociodemographic characteristics and other variables that are associated with the outcomes of interest. Methods: A cross-sectional study was conducted using a structured questionnaire, including the eHealth Literacy Scale (eHEALS). Results: A total of 793 Italian adolescents from seven public schools in Naples, southern Italy, participated in the survey. Among the participants, 58.6% had an eHEALS score below 27. A higher eHL was associated with being male, perceiving the Internet as useful for health decisions, the use of electronic devices for seeking health information, consulting institutional/scientific sources, having a mother with lower education, and having parents without underlying chronic conditions. Additionally, a higher eHL, male sex, younger age, and Internet use for seeking health information in the last three months were linked to perceiving the Internet as a helpful tool for health decision making. Conclusions: Overall, Italian adolescents reported suboptimal eHL with sex, attitudes, and parental factors playing significant roles. Targeted educational interventions are needed to enhance eHL in this specific age group. Full article

Background: Health literacy, including its digital and vaccination-specific components, is essential for informed health decision-making in adolescence—a developmental period when health attitudes and behaviors are shaped and may persist into adulthood. Although the importance of these competencies is increasingly recognized, little is known about the relationship between digital health literacy (DHL) and vaccination literacy (VL) among adolescents. The aim of this study was to investigate the associations between DHL and VL among Lithuanian adolescents, and to evaluate the psychometric properties of the Digital Health Literacy Questionnaire (HLS19-DIGI) and the Vaccination Literacy Questionnaire (HLS19-VAC) in this population. Methods: A cross-sectional survey was conducted with 9–12 grades students from Lithuanian gymnasiums using HLS19-DIGI and HLS19-VAC instruments. Analyses included confirmatory factor analyses for validity, McDonald’s omega for reliability, ANOVA and chi-square tests for group comparisons, and linear regression to evaluate DHL—VL associations, adjusting for gender, grade, and frequency of digital resource use. Results: A total of 792 students (42.0% male; mean age 16.4 years) completed the survey. The HLS19-DIGI (CFI = 0.945, TLI = 0.923, RMSEA = 0.081) and HLS19-VAC (CFI = 0.986, TLI = 0.959, RMSEA = 0.089) showed satisfactory structural validity, and both scales had good reliability (0.757 and 0.803). Mean DHL and VL scores were 78.28 (SD = 24.24) and 82.64 (SD = 27.22), respectively. Over half of the participants had excellent DHL (55.7%) and VL (63.4%). DHL was a strong predictor of VL (β = 0.429, p < 0.001). The frequency of digital resource use was not significantly related to VL. Conclusions: Higher DHL is associated with higher VL, suggesting that skills in searching for, appraising, and applying online health information can enhance informed vaccination decision-making. Interventions delivered through trusted channels, such as schools and healthcare providers, should aim to strengthen both literacies, address misinformation, and foster critical evaluation competencies to support vaccine uptake in youth. Full article

Objectives: Hearing aids (HAs) are the most common intervention recommended for hearing loss (HL). Many adults with HL do not seek HA rehabilitation. Several studies have attempted to identify barriers and facilitators to using HAs. Different bureaucratic processes for acquiring HAs may lead to different barriers and facilitators. In addition, studies have not yet explored the factors influencing compliance with a recommendation for an HA consultation. This study focuses on the stage prior to consultation in a context where HAs are heavily subsidized. Methods: 148 patients who had undergone a hearing test during 2022 at Hadassah University Medical Center and received a recommendation to undergo a hearing aid consultation were contacted for a telephone survey. Seventy-two adults, 48 male and 24 female, aged 25–85 years, with HL ranging from slight to profound, responded to a telephone questionnaire. The questionnaire, based on two previously published English questionnaires and translated and adapted into Hebrew, was used to assess the main reasons a person did or did not comply with the recommendation to pursue an HA consultation. Results: HL was more severe in those who sought hearing rehabilitation. The main reasons for seeking hearing rehabilitation are the need and desire to hear better and pressure from others. The foremost reasons for not pursuing hearing rehabilitation are feeling that there is currently no need, esthetics, lack of time, and self-consciousness. No significant gender- or age-based differences were found. Conclusions: There are additional barriers to seeking HAs aside from cost and accessibility. Understanding the reasons for avoidance of hearing rehabilitation may help in developing strategies that encourage people to seek hearing rehabilitation and use HAs when the need exists. Full article

Introduction: Health literacy (HL) is a key determinant of health outcomes, particularly among vulnerable populations such as low-income older adults. Limited HL is associated with poor understanding of medication instructions and lower medication adherence, which can compromise therapeutic success. This study aims to assess the levels of HL and medication adherence among low-income older adults and to analyse the relationship between HL, medication adherence, and other determinants. Methods: A cross-sectional study was conducted among low-income older adults in Portugal’s Beira and Serra Estrela Region. HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-PT), and medication adherence was measured with the Adherence to Treatment Measure (MAT) scale. Descriptive statistics, Spearman correlations, ordinal logistic regression, and linear regression were used to analyse associations between HL, adherence, and sociodemographic and health factors. Results: Of 196 participants, most had problematic or inadequate HL (87.8%). Medication adherence was relatively high (mean = 5.37, SD = 0.54). HL was positively associated with medication adherence (R = 0.260, p < 0.001), education (R = 0.277, p < 0.001), and ability to pay expenses (R = 0.235, p = 0.002) and negatively with age (R = −0.179, p = 0.019), poor health status (R = −0.237, p = 0.002), and difficulty affording medication (R = −0.389, p < 0.001). Completion of the third cycle of primary education predicted higher HL (OR = 1.939, 95% CI: 0.088–3.790, p = 0.040); the ability to pay expenses predicted better adherence (B = 0.101, 95% CI: 0.014–0.187, p = 0.022). Conclusions: Low HL remains a significant barrier among low-income older adults in Portugal, despite generally high medication adherence. Education and financial stability are key determinants to HL and adherence. Interventions should integrate HL promotion with efforts to reduce socioeconomic barriers and support medication management in the vulnerable populations. Full article

Background: Health literacy (HL) is a key determinant of health outcomes and equity. The European Health Literacy Survey 2019 (HLS₁₉) introduced three domain-specific instruments—HLS₁₉-NAV, HLS₁₉-COM-P-Q11, and HLS₁₉-VAC. We present the translation, cultural adaptation, field testing, and descriptive pilot evaluation of their Greek versions (HLS₁₉-NAV-GR, HLS₁₉-COM-GR, HLS₁₉-VAC-GR). Methods: Dual forward/back-translation and expert review (11 health professionals/academics) produced the final versions. A purposive, quota-guided field test (N = 71) approximated population distributions by sex, age, education, and geographical region. Test–retest stability (n = 16; ~12 days) was summarized primarily with intraclass correlation ICC (2,1), with Pearson/Spearman correlations reported secondarily. Internal consistency was assessed using ordinal alpha computed from polychoric (polytomous) and tetrachoric (dichotomous) correlations. We report item- and scale-level descriptive statistics for both the original polytomous (four-category, 1–4) responses and a dichotomous difficulty–ease scheme (1–2 vs. 3–4). Given the non-probability sampling in this pilot, the results are descriptive, not statistically representative. Results: Instruments were well accepted, requiring only minor revisions. Scales demonstrated high short-term stability and good internal consistency; inter-scale correlations were moderate, interpreted as associations among related but distinct constructs. Item distributions skewed toward Easy/Very Easy; several HLS₁₉-VAC-GR items showed a clear ceiling, suggesting the need to consider harder items or a larger item pool in future validation. By scale, scores followed the descending order NAV, COM, and VAC. Distributions and ranking patterns broadly mirrored population-level findings from other countries. Conclusions: The adapted HLS₁₉-NAV/COM/VAC-GR instruments are linguistically and culturally appropriate and prepared for large-scale validation, while items NAV9, COM4, and the VAC ceiling are flagged for further assessment. Full article

Background: Health system literacy is crucial for immigrants to navigate health care systems and access necessary services. Little is known about how well immigrants understand and use the healthcare system in Canada. This study aimed to adapt and validate a health system literacy scale for the Canadian context (HSL-CAN). Methods: A cross-sectional online survey was conducted from March 11 to July 19, 2024, among Chinese individuals aged 30 or older who have lived in Canada for at least 6 months. The HSL-CAN was developed through a literature review, patient and provider consultation, and adaptation of the European Health Literacy Population Survey 2019–2021 for navigational health literacy measurement (HLS₁₉–NAV) and was then translated into simplified and traditional Chinese. Content validity was evaluated via stakeholders’ feedback, and structural validity was evaluated via exploratory and confirmatory analyses (EFA/CFA). Convergent and discriminant validity, as well as known-group validity, were tested using correlations with the HLS₁₉-SF12, ANOVA (or t-test), and effect size. Internal consistency was measured with Cronbach’s alpha coefficient and composite reliability. Results: Initially, HSL-CAN contained 25 items developed using a five-point Likert response scale. Some minor revisions were made according to the stakeholders’ feedback (n = 12). Five redundancy items were removed based on the EFA. CFA supported a one-factor model with good fit indices (CFI = 0.960, TLI = 0.955, SRMR = 0.033, RMSEA = 0.025),${\chi }^2$/df = 1.41). The scale showed a solid internal reliability (Cronbach’s alpha = 0.81; composite reliability = 0.812). The HSL-CAN is highly correlated with the “health care” construct but lowly with the “health prevention and promotion” construct of HLS₁₉–SF12. Known-group validity showed large mean differences by education, income, and non-cancer chronic comorbidities and small to moderate mean differences by gender, age groups, employment status, self-rated health, and assistance needed to see a healthcare provider. Conclusions: The HSL-CAN is the first validated instrument to evaluate health system literacy in the Chinese population in Canada. Given strong validity and reliability, the instrument can be useful for research and practice, although further refinement is recommended before using this scale on the general population in Canada. Full article

Hearing loss (HL) causes numerous challenges for individuals. N,N-diethyl-meta-toluamide (DEET) is a common ingredient in insect repellants and some sunscreens. M-(diethylcarbamoyl) benzoic acid (DCBA) is a DEET metabolite measured in the urine of National Health and Nutrition Examination Survey participants. This study examines potential associations between HL and urinary DCBA in U.S. adults. Speech-frequency hearing loss (SFHL) was defined as an average hearing threshold above 25 dB across four frequencies (0.5, 1, 2, and 4 kHz). In comparison, high-frequency hearing loss (HFHL) was based on the average threshold above 25 dB at three higher frequencies (3, 4, and 6 kHz) in the better hearing ear. Hearing loss severity was categorized as normal (≤25 dB), mild (26–40 dB), and moderate or worse (≥41 dB). Higher DCBA exposure was significantly associated with increased odds of high-frequency hearing loss (HFHL). Participants in the highest exposure quartile had greater odds of HFHL (aOR = 2.34; 95% CI: 1.14–4.81), with a dose–response trend (p < 0.05) confirmed in sensitivity analyses controlling for chronic conditions and inflammation. Multinomial models further showed elevated odds of both slight/mild (aOR = 2.15; 95% CI: 1.05–4.42) and moderate/worse HFHL (aOR = 2.84; 95% CI: 1.10–7.37), supporting the robustness of the association. To our knowledge, this is the first report of HL being associated with a DEET metabolite in a nationally representative cross-sectional sample. Full article

Health literacy is crucial for effectively navigating health systems and promoting equitable health outcomes. Multilingual and culturally dual regions present unique challenges for health communication; however, disparities in health literacy within such contexts remain insufficiently explored. This study constitutes the first population-based assessment of health literacy in Alto Adige/South Tyrol, a bilingual province in northern Italy, utilizing the validated HLS-EU-Q16 instrument. A stratified random sample of 2090 residents aged 18 and older was surveyed in 2024. Weighted analyses ensured population representativeness, and scores were analyzed overall, by domain (health care, disease prevention, health promotion), and by language group (German, Italian, multilingual). Regression models incorporating sociodemographic and health-related covariates were employed to identify predictors of health literacy. Half of the population (50.0%) exhibited problematic or inadequate health literacy, with significant differences observed across language groups. Italian speakers demonstrated the highest scores, whereas German speakers scored lowest overall. These differences remained significant after adjustment for age, education, chronic illness, and professional background. Domain-specific analyses revealed distinct patterns: German-speaking respondents scored particularly low in the health promotion domain, while multilingual individuals achieved the highest scores in the prevention and promotion domains. Education level and language background emerged as the strongest predictors of health literacy, while most other covariates exhibited limited explanatory power. The findings underscore the necessity for language-sensitive and domain-specific interventions, highlighting health literacy as both a personal skill and a structural responsibility. Full article

Background/Objectives: The social importance of health literacy (HL) is widely understood, and its measurement is the subject of various studies. Due to the recent pandemic, several instruments for measuring HL about COVID-19 have been proposed in different countries, including the HLS-COVID-Q22 questionnaire. The diversity of cultures and languages necessitates the cross-cultural adaptation of this instrument. Thus, the present study translates, adapts, and validates the psychometric properties of the HLS-COVID-Q22 questionnaire to provide its cross-cultural adaptation from English to Spanish (Peru). Methods: As part of ensuring that the final questionnaire accommodates the cultural nuances and idiosyncrasies of the target language, the following activities were carried out: (a) a survey of 40 respondents; and (b) a focus group with 10 participants, followed by expert approval. In addition, the validity and reliability of the health instrument have been ascertained through a further pilot test administered to 490 people in the city of Tacna in southern Peru. Results: The resulting questionnaire helps measure HL in Peru, aiding better-informed decision-making for individual health choices. Conclusions: The presence of such a tool is advantageous in case of similar global health emergencies, when the questionnaire can be made readily available to support a promotion of strategies towards better self-care. Moreover, it encourages other Latin American stakeholders to adjust the instrument to their own cultural, language, and socio-economic contexts, thus invigorating the regional and global expansion of the HL study network. Full article

Health literacy improves informal caregivers’ knowledge and ability to provide care. The aim of this study is to analyze the impact of a group-based intervention on the health literacy of informal caregivers of children with special health needs (SHNs). The intervention focuses on movement, hydrotherapy, walking, and relaxation, with three evaluation stages. Participants included 34 informal caregivers of children with SHNs, recruited at a Physical Medicine and Rehabilitation Service. We collected sociodemographic data of the participants and measured their health literacy through the short-form version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Around 70% of the participants were female, with a mean age of 41.06 ± 4.98 years, and nearly 85% were married or in a de facto union. About 26% were unemployed, and more than 65% had completed secondary education or higher. The mean scores of the HLS-EU-Q16 were statistically significantly higher throughout the intervention, with differences over the evaluation stages [F(2,56) = 75.55; p < 0.05]. A structured, dynamic, and group-based intervention plan showed improvements in the health literacy of the participants, with an increase in the percentage of participants with sufficient and excellent levels of health literacy at the end of the intervention. Full article