Health literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study.
ABSTRACT: Background:The increasing number of people living with one or more chronic conditions imposes a growing demand on healthcare providers. One way to handle this challenge is by re-orientating the way care is provided, empower people and increase their ability to manage their condition. This requires, amongst other factors, sufficient level of health literacy (HL) and digital competences among both patients and the healthcare providers, who serve them. The focus of this study is the level of HL, digital literacy (DL), and eHealth literacy (eHL) in nursing students in Denmark.The objective was to examine the level of these three literacies in entry- and graduate-level nursing students and examine sociodemographic characteristics and self-rated health (SRH) associations. Methods:A cross sectional study was conducted among 227 students at entry-level and 139 students at graduate-level from a nursing program. The survey consisted of the health literacy questionnaire (HLQ (nine scales)), the eHealth Literacy Assessment toolkit (eHLA (seven scales)), the eHealth Literacy Questionnaire (eHLQ (seven scales)), questions soliciting sociodemographic data, and a single item assessing the students' SRH. Pearson's chi-square test and the Mann-Whitney test were used to examine the differences in HL, DL, and eHL and between groups, and Kendall's tau-b test to examine correlations between SRH and HL, DL, and eHL. Results:The level of HL, DL and eHL tended to be higher among graduate-level students than in entry-level students and was satisfactory. Age, sex, country of origin, and parents' educational level and occupational background influenced students' HL levels. SRH was higher in students at the graduate level. Amongst entry-level students, SRH was positively associated to seven HLQ, four EHLA and four eHLQ, amongst graduate-level students, SRH was positively associated to seven HLQ and six eHLQ. Conclusions:Educators must be aware of how sociodemographic factors affects students' literacies and increase learning opportunities by mixing students when planning activities. Considering the higher SRH in graduate-level students, HL, DL, and eHL levels indicate that current curricula and study activities are appropriate, but there is still room for improvement.
Project description:OBJECTIVE:To explore ehealth literacy, ability to actively engage with healthcare providers and health system navigation among pregnant immigrant women and their descendants compared with women of Danish origin. DESIGN AND SETTING:A cross-sectional survey at antenatal clinics in 2016, Denmark. PARTICIPANTS:Pregnant women attending antenatal care (n=405). OUTCOME MEASURES:The eHealth Literacy Questionnaire (eHLQ) and two domains from the Health Literacy Questionnaire (HLQ): ability to actively engage with healthcare providers and health system navigation. Range of response options for eHLQ (1-4) and HLQ (1-5). With mixed-effect linear regressions, eHLQ and HLQ among immigrants and their descendants compared with women of Danish origin were assessed. RESULTS:The response rate was 75%. The overall trend was lower ehealth literacy and HLQ domains among immigrants and their descendants compared with women of Danish origin. For ehealth literacy, the results suggest that challenges related more to digital abilities than motivation, trust and access to technology. The mean ability to engage with digital services was 3.20 (SD 0.44) for women of Danish origin. Non-Western descendants (-0.14, 95%?CI -0.31 to 0.02), non-Western (-0.20, 95%?CI -0.34 to -0.06) and Western (-0.22, 95%?CI -0.39 to -0.06) immigrants had lower adjusted means of this outcome. No differences in motivation to engage with digital services were found for descendants (-0.00, 95%?CI -0.17 to 0.17), non-Western (0.03, 95%?CI -0.11 to 0.18) or Western (-0.06, 95%?CI -0.23 to 0.10) immigrants compared with the mean of the reference (2.85, SD 0.45). Lower ability to engage with healthcare providers was found for non-Western born immigrants (-0.15,?CI 95% -0.30 to -0.01) compared with the mean of women with Danish origin (4.15, SD 0.47). CONCLUSION:Generally, descendant and immigrant women had lower levels of ehealth literacy and health literacy than women of Danish origin. These differences are potentially antecedents of adverse birth outcomes and could inform structural efforts to mitigate health inequalities.
Project description:An overwhelming flood of misinformation is accompanying the pandemic of COVID-19. Fake news and conspiracy theories are so prevalent that the World Health Organization started as early as February 2020 to use the term "infodemic". This paper is focused on the assessment of the prevalence of beliefs in conspiracy theories related to COVID-19 in Polish society. The association of support for conspiracy theories with sociodemographic variables, health literacy (HL) and eHealth literacy (eHL) was studied. The analysis reported here was based on the data from an online survey of a representative sample (n = 1002) of the adult population of Polish Internet users. The multivariate linear regression for the COVID-19-related conspiracy belief score (CCBS) and logistic regression models for the support of individual conspiracy theories was developed. The percentage of supporters of particular conspiracy theories in the study sample ranged from 43% to 56%. The CCBS was significantly associated with age, education level, vocational status and both HL and eHL. However, it was lower for persons with higher HL (regression coefficient (B) = -0.04, p < 0.001) but higher for those with higher eHL (B = 0.04, p = 0.038). The most influential predictors of CCBS were age (standardised regression coefficient (?) = -0.21) and education level (? from 0.08 to 0.16 for respondents with lower education levels and those with master's degrees). In conclusion, younger persons rather than older, those with a lower rather than with a higher level of education, employees rather than students and persons with lower rather than higher HL were more likely to believe the conspiracy theories. Surprisingly, contrary to expectations, higher eHL was significantly associated with greater belief in such theories.
Project description:BACKGROUND:Health literacy is a multidimensional concept that is considered a primary public health concern. This concept is often neglected in research, and the evidence regarding health literacy in college students is limited. The aim of this study was two-fold: to determine the needs and limitations of health literacy among college students and to explore the relationships among the nine dimensions of health literacy and sociodemographic factors, including age, gender, nationality, year of study, field of study, smoking status, history of chronic diseases, use of on-campus gym, and the intention to exercise on-campus. METHODS:This study was conducted using a cross-sectional approach. A total of 520 college students participated in this study. The average age was 21.03 years (SD = 2.29), with 47.5% males and 52.5% females. Data were collected using a demographics questionnaire and the Health Literacy Questionnaire (HLQ). In addition to descriptive statistics, multivariate analysis of variance (MANOVA) and follow-up analyses were performed to explore any statistically significant mean differences among levels of health literacy and sociodemographic factors. RESULTS:The levels of health literacy on the nine HLQ scales were lower than the levels reported in the literature. Multivariate analysis showed a significant effect of age, gender, smoking status, year of study, and field of study on the level of health literacy. Follow-up analyses revealed that female students, students from the health-related faculties, and those who do not smoke have higher levels of health literacy compared to their counterparts. A detailed comparison between the levels of the HLQ scales was made based on students' demographic characteristics. The field of study had the most prominent effect on the level of college students' health literacy; mean differences were statistically significant (p < .001), and effect sizes were large (ranging from .66 to 1.35 for the nine scales of the HLQ). CONCLUSION:College students' health literacy is influenced by demographic characteristics. Such variations could amplify some of the existing health disparities. The implications of the findings on health, health promotion, and interprofessional education are discussed.
Project description:BACKGROUND:Health literacy (HL) and patient activation (PA) are necessary foundations to engage patients in self-management intervention. Each concept plays a unique role in improving access to the effective self-management of chronic disease. In this cross-sectional study, we examined the levels and determinants of HL and PA among the multi-morbid COPD patients in Nepal. METHODS:We conducted interviews with a simple random sample of 238 multi-morbid COPD people from July 2018 to January 2019. The questionnaire included sociodemographic profiles, five domains of the Health Literacy Questionnaire (HLQ), 13-item Patient Activation Measure (PAM) and patient's illness perception by Brief Illness Perception Questionnaire (BIPQ). Multivariable logistic regression was used to examine the associations. RESULTS:Most people with COPD had low health levels across each of the five domains of the HLQ. The proportion of people with low literacy level across each of the domains was: (i) feeling understood and supported by healthcare providers (79.0%), (ii) having sufficient information to manage my own health (76.5%), (iii) social support for health (77.3%), (iv) ability to find the good health information (75.2%), and (v) understand the health information well enough to know what to do (74.8%), respectively. The majority of patients also reported low levels of patient activation (level 1: 81.5%; level 2: 11.8%), with only 6.7% (level 3: 5%; level 4: 1.7%) reported higher patient activation level. We found significant associations between poor HL levels in the HLQ domains and having no education, being female or from Indigenous and Dalits communities, and having a monthly family income of less than USD176. Having no education and poor illness perception were significantly associated with poor activation level on PAM scale. CONCLUSION:A high proportion of multi-morbid COPD peoples had low levels of HL and were less activated than what would be required to self-manage COPD. These were in turn associated with socioeconomic factors and poor illness perception. The findings from this study are being used to design a COPD self-management program tailored to the low health literate population.
Project description:(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents' HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.
Project description:BACKGROUND:The Health Literacy Questionnaire (HLQ) is a multidimensional generic questionnaire developed to capture a wide range of health literacy needs. There is a need for validation evidence for the Norwegian version of the HLQ (N-HLQ). OBJECTIVE:The present study tested an initial version of the Norwegian HLQ by exploring its utility and construct validity among a group of nursing students. METHODS:A pre-test survey was performed in participants (N = 18) who were asked to consider every item in the N-HLQ (44 items across nine scales). The N-HLQ was then administered to 368 respondents. Scale consistency was identified and extracted in a series of factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution performed on randomly drawn 50% of the samples obtained by bootstrapping. Correlations between the nine factors obtained in the 13-factor PCA and the scale scores computed by the scale scoring syntaxes provided by the authors of the original HLQ were estimated. KEY RESULTS:The pre-test survey did not result in the need to rephrase items. The internal consistency of the nine HLQ scales was high, ranging from 0.81 to 0.72. The best fit for reproduction of the scales from the original HLQ was found for these dimensions: "1. feeling understood and supported by health care providers," "2. having sufficient information to manage my health," and "3. actively managing my health." For the dimensions "7. navigating in the healthcare system" and "8. ability to find good health information," a rather high degree of overlap was found, as indicated by relatively low differences between mean highest correlations and mean next-highest correlations. CONCLUSIONS:Despite some possible overlap between dimensions 7 and 8, the N-HLQ appeared relatively robust. Thus, this study's results contribute to the evidence validation base for the N-HLQ in Norwegian populations. [HLRP: Health Literacy Research and Practice. 2020;4(4):e190-e199.] PLAIN LANGUAGE SUMMARY: This study tested the Norwegian version of the Health Literacy Questionnaire. The questionnaire (44 items across nine scales) was completed by 368 nursing students. Despite some overlap between scale 7 ("navigating in the health care system") and scale 8 ("ability to find good health information"), the questionnaire appears to serve as a good measurement for health literacy in the Norwegian population.
Project description:BACKGROUND:The increasing digitization of health care services with enhanced access to fast internet connections, along with wide use of smartphones, offers the opportunity to get health advice or treatment remotely. For service providers, it is important to consider how consumers can take full advantage of available services and how this can create an enabling environment. However, it is important to consider the digital context and the attributes of current and future users, such as their readiness (ie, knowledge, skills, and attitudes, including trust and motivation). OBJECTIVE:The objective of this study was to evaluate how the eHealth Literacy Questionnaire (eHLQ) combined with selected dimensions from the Health Education Impact Questionnaire (heiQ) and the Health Literacy Questionnaire (HLQ) can be used together as an instrument to characterize an individual's level of health technology readiness and explore how the generated data can be used to create health technology readiness profiles of potential users of health technologies and digital health services. METHODS:We administered the instrument and sociodemographic questions to a population of 305 patients with a recent cancer diagnosis referred to rehabilitation in a setting that plans to introduce various technologies to assist the individuals. We evaluated properties of the Readiness and Enablement Index for Health Technology (READHY) instrument using confirmatory factor analysis, convergent and discriminant validity analysis, and exploratory factor analysis. To identify different health technology readiness profiles in the population, we further analyzed the data using hierarchical and k-means cluster analysis. RESULTS:The confirmatory factor analysis found a suitable fit for the 13 factors with only 1 cross-loading of 1 item between 2 dimensions. The convergent and discriminant validity analysis revealed many factor correlations, suggesting that, in this population, a more parsimonious model might be achieved. Exploratory factor analysis pointed to 5 to 6 constructs based on aggregates of the existing dimensions. The results were not satisfactory, so we performed an 8-factor confirmatory factor analysis, resulting in a good fit with only 1 item cross-loading between 2 dimensions. Cluster analysis showed that data from the READHY instrument can be clustered to create meaningful health technology readiness profiles of users. CONCLUSIONS:The 13 dimensions from heiQ, HLQ, and eHLQ can be used in combination to describe a user's health technology readiness level and degree of enablement. Further studies in other populations are needed to understand whether the associations between dimensions are consistent and the number of dimensions can be reduced.
Project description:OBJECTIVES:Poor health literacy (HL) is associated with poorer health outcomes in diabetes but little is known about its effects on foot disease. This study was aimed to determine the associations between HL and diabetic foot disease. DESIGN:This is a cross-sectional analysis of baseline data from a prospective study of foot disease. SETTING:Attendees of the Royal Hobart Hospital's Diabetes outpatient clinics. PARTICIPANTS:222 people with type 1 or type 2 diabetes aged >40 years and without a history of foot disease, psychotic disorders or dementia. MEASURES:Outcomes were peripheral neuropathy, peripheral arterial disease and foot deformity according to published guidelines. The exposure, HL, was measured using the short form Test of Functional Health Literacy in Adults (S-TOFHLA) and the Health Literacy Questionnaire (HLQ). Covariates included demographic characteristics, medical history, psychological measures and foot care behaviour. RESULTS:Of 222 participants, 204 had adequate HL. (Mean (SD) S-TOFHLA scores were 31.9 (6.7)), mean(SD) HLQ scores were 134.4 (18.4)). In univariable but not multivariable analyses, higher S-TOFHLA scores were associated with lower overall risk for foot disease (OR 0.96, 95% CI 0.93 to 0.99) and loss of protective sensation (OR 0.95, 95% CI 0.91 to 0.995). CONCLUSIONS:These data provide little support for clinically important impacts of HL on risk factors for diabetic foot disease. However, in the absence of longitudinal data, such effects cannot be ruled out. Longitudinal studies measuring incident foot disease are needed to properly judge the potential for interventions improving HL to reduce the incidence of diabetic foot disease.
Project description: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.
Project description:Health literacy (HL) has become an important public health issue and is receiving growing attention. However, the HL levels of military college students in China have never been analyzed. This study aimed to investigate the HL and related associate factors in military college students in Chongqing, China. Data was obtained with the "Chinese Citizen Health Literacy Questionnaire (2012 edition)" from 3183 military college students aged 16-28 years at Chongqing in December 2015. A total score of ?80 points determined adequate HL, and HL level was defined as the proportion of students who had adequate HL out of the total number of participants. Multiple logistic regression analysis with a stepwise forward likelihood ratio (LR) method was used to determine the effects of sociodemographic characteristics, health-related behaviors, and family-related factors on HL level. The mean score of HL was 68.56, and the HL level of military college students was 21.05%; the overall knowledge rate was 71.33%. The independent factors that were associated with HL level were years in college, educational system, time playing online games, annual household income and father's education level. Senior (odds ratio [OR] = 1.229, 95% confidence interval [CI] 1.018?1.484), undergraduate (OR = 1.509, 95% CI 1.151?1.978), time played games more than 5 hours each week (OR = 0.638, 95% CI 0.486?0.837), annual household incomes more than 50,000 yuan (OR = 1.231, 95% CI 1.027?1.476) and father's education level (high school: OR = 2.327, 95% CI 1.186?4.565; university: OR = 2.450, 95% CI 1.244?4.825), were independently associated with higher HL level. HL levels of military college students in Chongqing need to be improved across the board. Our data suggests that special emphasis should be placed on students in junior and those in the specialist educational system. School departments may also benefit from incorporating health literacy into their curricula and helping students manage the time they spend playing online games.