The evolving concept of health literacy

The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots – in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical “risk”, or a personal “asset”. In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health.The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.     

Collaborative Processes of Developing A Health Literacy Toolkit: A Case from Fukushima after the Nuclear Accident

Following the Fukushima nuclear accident in 2011, the central government provided health and radiation-related information that was incomplete, difficult to understand and contradictory, leading to widespread distrust in the community. Thus, from 2013 to 2014, we developed and implemented a series of health literacy training workshops for local public health nurses, often the first health care professionals with whom members of the community interact. The results from our program evaluation revealed that the task of paraphrasing professional terms and skills related to relaying numeric information to the community were difficult for the nurses to acquire. In 2016, to further support the communication efforts of public health nurses, we developed a pocket-size “health literacy toolkit” that contained a glossary explaining radiation-related terms in plain language and an index to measure the accessibility of both text and numerical information, so that nurses could calibrate and appreciate the literacy demand of information. This case study documents an interprofessional collaborative effort for the development of the toolkit, and highlights the iterative process of building health literacy skills in health care professionals.     

宁夏回族自治区农村居民健康素养水平及其影响因素研究

摘 要 目的 了解宁夏回族自治区实施县域公立医院综合医改试点后农村居民健康素养水平及其影响因素。方法 在宁夏回族自治区选取2个试点县和2个非试点县,在各县随机抽取两个乡镇进行居民入户调查;运用二元logistic回归分析影响农村居民健康素养水平的因素。结果 宁夏农村居民健康素养水平为7.00%,三个方面健康素养水平由高到低分别为基本知识和理念(19.10%)、生活方式与行为(15.96%)和基本技能(15.68%);所在县、年龄、婚姻状况、文化程度、总体健康状况、健康体检和签约家庭医生是影响农村居民健康素养水平的重要因素。结论 农村居民具备健康素养的人数比较少;应进一步加强对农村重点人群的健康教育和健康促进工作;深化县域公立医院综合医改有利于提高居民健康素养。     

青浦区2020年居民健康素养监测结果分析

目的 了解上海市青浦区2020年居民健康素养水平.方法 采用分层整群随机抽样的方法,抽取青浦区三个街道(镇)9个村居的463名社区居民开展调查.结果 2020年青浦区居民的健康素养水平为38.77％.健康素养三维度方面,基本健康知识和理念、健康生活方式和行为以及健康技能的素养水平分别为53.6％、41.0％和43.2％...     

合肥市蜀山区居民健康素养调查

目的了解蜀山区居民健康素养现状,为提高社区居民健康素养水平工作的开展提供参考依据。方法采取随机抽样的方法,抽取某社区15～69周岁居民150人,采用卫生部统一制定的健康素养调查问卷进行调查。结果调查对象具备健康素养的比例为11.3%,具备基本知识和理念、健康生活方式与行为、基本健康技能的比例分别为14.7%、12.0%和55.3%;从事医疗工作,文化程度越高者,其健康素养越高(P0.05)。结论蜀山区居民健康素养水平较低,应进一步加强健康教育工作,提高居民健康水平。     

北京市顺义区农村居民健康素养知识知晓情况调查

目的了解北京市顺义区农村居民健康素养水平,分析影响居民健康素养的各种因素,为制定健康教育策略和措施提供科学依据。方法采用分层随机抽样方法 ,在顺义农村地区抽取两个村,每村随机抽取15～69岁常住人口进行健康素养问卷调查,样本总量共670人。结果健康理念和基本知识、健康生活方式与行为、健康技能三方面健康素养知晓率分别为74.68%、69.82%、63.97%,均呈现45岁以下年龄组高于45岁以上年龄组的特点。同时受教育程度越高,健康素养知识知晓率越高。结论顺义区农村居民健康素养知识知晓水平总体不高,未达到居民健康知识知晓率80%的指标,应针对不同年龄、不同文化程度人群特点,采用个性化的健康教育策略和措施,提高居民的健康素养水平。     

无锡市健康素养监测干预效果分析

目的:为做好中国公民健康素养的宣传普及工作,探索社区健康素养监测干预方式。方法:以健康知识讲座、行为指导等方式,对无锡市15～69岁的社区常住居民进行3个月左右的健康干预,并对社区居民健康素养的知识与技能进行本底调查和干预评估。结果:居民的健康观念持有率提高了5.19%;总体健康知识知晓率提高了9.27%;健康行为与技能形成率提高了14.01%。结论:与日常生活密切相关的重大疾病防治及食品卫生知识,更易引起群众的关注,干预后知晓率有较大提高;简单易学的健康行为、技能短期干预效果好于知识与态度。     

本溪市两县居民健康素养情况调查分析

目的了解本溪市两县居民健康素养水平及其影响因素,为开展精准健康教育,制订医疗卫生服务政策和措施提供科学依据。方法采用分层多阶段整群抽样方法,随机抽取辽宁省本溪市两个自治县(本溪县和桓仁县)的15～69岁常住人口909人进行问卷调查。结果本溪县和桓仁县的15～69岁居民健康素养水平为22.0%。随着居民文化程度和家庭年收入的增高,居民健康素养水平也逐渐增高,中老年居民健康素养水平低于年轻居民,医务人员的健康素养水平最高;患有慢性病的居民健康素养水平低于无慢性病的居民。结论本溪两县居民健康素养水平略低于本溪市总体健康素养水平,其中健康生活方式与行为、健康技能素养水平以及传染病防治素养水平较低。应针对居民的不同特征,有针对性的开展健康教育与健康促进工作,提高居民健康素养水平。     

南京市雨花台区居民健康素养干预效果评价

目的了解南京市雨花台区居民健康素养基本情况,评价开展健康教育与健康促进活动对提高居民健康素养的效果,为进一步推进"健康素养促进活动"提供依据。方法通过开展综合性的健康促进创建活动、健康干预活动如主题巡讲、发放健康素养传播材料等措施,对雨花台区的15～69岁的常住居民进行了为期3个月的健康干预,并对干预结果做出评价。结果居民健康素养的持有率从18.1%上升到76.9%,其中基本知识与理念持有率提高了50.1%,健康生活方式与行为提高53.1%、健康技能提高53.4%,其差异均有统计学意义(P0.01)。结论综合干预对提高居民健康素养效果显著,干预方法有待改进;与日常生活有关的知识,更能引起居民的关注。     

2009年上海市青浦区健康素养监测结果分析

目的了解上海市青浦区社区、企业和公共场所健康素养状况,为政府决策和制定健康素养干预措施提供依据。方法在青蒲区社区、企业和公共场所监测点随机抽取部分人员作为调查对象,进行健康素养知识监测。采用多阶段分层、整群抽样的抽样方法,用SPSS 16.0进行数据分析,均数的比较采用t检验。结果 830名调查对象的健康素养相关知识理念(18.01±4.01分),行为(7.96±1.85分)和技能(6.53±2.44分)的总体平均正确率为63.74%;对不同场所、性别、年龄和文化水平调查对象的健康素养知识均分情况进行比较,发现调查对象不同性别之间的健康素养知识均分无统计学差异(P>0.05)。各场所中不同年龄组、文化程度之间比较,调查对象的健康素养知识均分有统计学差异(P<0.01)。基本健康素养方面,社区与企业、社区与公共场所从业人员之间的健康素养均分差异均有统计学差异(P<0.01),而企业与公共场所从业人员的健康素养均分无统计学差异(P>0.05)。结论应针对不同场所从业人员采取不同的干预手段,提高场所从业人员的健康素养水平,从而促进整个地区健康素养水平的提高。     

吉林省城乡居民健康素养现状调查

目的评价吉林省居民的健康素养水平,为相关部门制定决策提供科学依据。方法采用多阶段分层整群随机抽样方法抽取吉林省城乡居民9913人进行问卷调查。问卷采用原卫生部设计的{2009年中国公民健康素养调查问卷》,由经过培训的调查员采用面对面方式进行调查。结果吉林省居民健康素养具备率为22．9％。其中,基本知识和理念素养、健康生活方式与行为素养、基本技能素养的具备率分别为37．1％、10．3％和46．8％。科学健康观、安全与急救素养、传染病预防素养、基本医疗素养、慢性病预防素养具备率分别为23．2％、59．9％、30．0％、14．6％和21．0％。城市与农村居民、不同文化程度、不同年龄人群健康素养水平存在统计学差异。结论应采取针对性的干预措施,提高整体人群的健康素养水平。     

Critical health literacy: a review and critical analysis

Though there has been a considerable expansion of interest in the health literacy concept worldwide, there has also been criticism that this concept has been poorly defined, that it stretches the idea of "literacy" to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion. This paper takes as a starting point the expanded model of health literacy advanced by Nutbeam (2000) and addresses these concerns by interrogating the concept of "critical health literacy" in order to draw conclusions about its utility for advancing the health of individuals and communities. The constituent domains of critical health literacy are identified; namely information appraisal, understanding the social determinants of health, and collective action, and as far as possible each are clearly delineated, with links to related concepts made explicit. The paper concludes that an appreciation of work undertaken in a range of different disciplines, such as media studies, medical sociology, and evidence-based medicine can enhance our understanding of the critical health literacy construct and help us understand its usefulness as a social asset which helps individuals towards a critical engagement with health information. There is some evidence that aspects of critical health literacy have indeed been found to be a resource for better health outcomes, but more research is needed in this area, both to develop quantitative and qualitative approaches to evaluating health literacy skills, and to offer convincing evidence that investment in programmes designed to enhance critical health literacy are worthwhile.     

"Let's Talk Back": a program to empower laundry workers.

Laundry workers have traditionally been offered little input into the ergonomic and health and safety aspects of their jobs. The "Let's Talk Back" program was developed in response to worker demands, in order to empower them to effectively address some of these concerns. The program, endorsed by the union and administered by a hospital ergonomist, provided formal educational sessions, physical demand analyses, and a forum in which to communicate concerns and suggestions for improvements. Language and/or literacy barriers required innovative educational approaches. Management's reluctance to allow the program to interfere with production schedules hindered the efficiency of the program, but probably contributed to the sense of empowerment in the workforce. Through active participation in ergonomic assessments as well as the educational program, workers were able to demonstrate to management that changes were needed.     

Instructional design of a clinical photography course for undergraduate dental students

Medical and health educators in South Africa are facing many problems. These are caused by the diverse communication characteristics and socioeconomic, as well as educational, differences of its communities. Visual literacy is often ignored when audiovisual media are used in medical and health education. Consequently, communication and education fail because some target groups, e.g. illiterate patients from rural areas, are unable to interpret visual messages correctly. This study determined to what extent illiterate female patients were able to interpret instructional illustrations on breast feeding. Findings indicate that visual literacy is a key factor in effective medical and health education. There was a distinct variation in the visual literacy skills of this particular target group. The implication is that extreme care must be taken when visual materials are designed for health education in South Africa.     

某战区部队官兵健康素养现状调查分析

目的了解某战区部队官兵健康素养现状,为制定适宜战区官兵的健康传播策略提供依据。方法采用分层整群随机抽样的方法,对某战区部分官兵1865人进行健康素养调查,用χ2检验进行分析。结果调查对象具备健康素养比例为14.30%,其中具备基本知识和理念、健康生活方式与行为和基本技能素养的比例分别为13.87%、30.23%和50.92%。不同特征中老兵总体健康素养（17.84%）和知识与理念（17.93%）、生活方式与行为（39.27%）具备比例高于新兵;中专及以上文化程度官兵总体健康素养（18.05%）和知识与理念方面（17.21%）高于高中及以下官兵;由城镇入伍的官兵在总体健康素养（17.54%）和知识与理念（17.35%）、健康技能方面（53.41%）高于由农村入伍官兵。结论某战区部队官兵具备健康素养的总体水平不高,部队开展的健康教育活动起到了一定的作用。今后要定期开展健康素养调查分析,及时掌握健康素养水平,评估健康教育效果,制定适宜战区官兵的健康传播策略。     

“健康江西”背景下健康素养影响因素研究

目的了解江西省居民健康素养水平及其影响因素,为政府和卫生行政部门制订针对性措施提供科学依据。方法采用多阶段抽样方法,抽取15县(市、区)、45个街道(乡镇)、90个村(居)委会的1500名居民进行问卷调查。结果多因素logistic回归结果显示,健康素养整体水平的影响因素为性别、年龄、文化程度、自身慢病情况和职业类型;健康理念和基本知识的影响因素为性别、年龄、文化程度、自身慢病情况、职业类型和是否购买商业医疗保险;健康生活方式和行为的影响因素为年龄、文化程度、职业类型和是否购买商业医疗保险;基本健康技能的影响因素为年龄、文化程度和是否购买商业医疗保险。结论今后的健康教育工作需要改变传统思维,通过提高部分健康素养水平来带动整体的提升,应更加关注重点人群的行为干预,强化家庭的预防作用,借鉴商业医疗保险的有效经验和模式,创新宣传方式并落到实处。     

武警某部官兵健康素养干预效果研究

目的 评价武警官兵健康素养干预效果,为武警部队开展健康素养教育提供依据.方法 采用整群抽样方法抽取某部官兵621人,对其进行1年的健康教育干预,干预前后分别进行健康素养问卷调查.结果 武警官兵干预后整体健康素养水平为21.2％,高于干预前14.8％,差异有统计学意义（P＜0.05）.健康生活方式素养水平为34.8％,高于干预前20.3％,差异有统计学意义（P＜0.05）.技能行为素养水平为35.8％,高于干预前24.2％.差异有统计学意义（P＜0.05）.结论 继续教育可以提高健康素养水平,提高官兵整体健康素养水平需要有针对性的健康教育.     

Skills and attributes of directors of educational programmes

OBJECTIVES: The purpose of this study was to obtain a list of desirable skills and attributes of prospective educational programme directors as judged by potential employers of future directors. DESIGN: An international mail survey was conducted worldwide, using a one-page, open-ended questionnaire. SETTING: University of Illinois at Chicago, USA. SUBJECTS: Deans, department heads and chief executive officers from the various health professions. RESULTS: A total of 139 respondents completed the questionnaire (22. 3% response rate). Responses were remarkably similar across health professions. The nine leading skills were: oral communication skills, interpersonal skills, competent practitioner, educational goal-definition skills, educational design skills, problem-solving and decision-making skills, team worker and building skills, written communication skills and fiscal manager and budgeting skills. The three leading personal attributes were: visionary, flexible and open-minded and trustworthy and value-driven individual. CONCLUSIONS: The complete list of skills and attributes can be used by employers or administrators to build checklist items when hiring or reviewing programme directors or to plan and evaluate training programmes. The importance of leadership compared to managerial responsibilities is discussed as well as the need to train future educational programme directors.     

Electronic Communication Channel Use and Health Information Source Preferences Among Latinos in Northern Manhattan

Understanding key health concepts is crucial to participation in Precision Medicine initiatives. In order to assess methods to develop and disseminate a curriculum to educate community members in Northern Manhattan about Precision Medicine, clients from a local community-based organization were interviewed during 2014–2015. Health literacy, acculturation, use of Internet, email, and text messaging, and health information sources were assessed. Associations between age and outcomes were evaluated; multivariable analysis used to examine the relationship between participant characteristics and sources of health information. Of 497 interviewed, 29.4?% had inadequate health literacy and 53.6?% had access to the Internet, 43.9?% to email, and 45.3?% to text messaging. Having adequate health literacy was associated with seeking information from a healthcare professional (OR 2.59, 95?% CI 1.54–4.35) and from the Internet (OR 3.15, 95?% CI 1.97–5.04); having?≤?grade school education (OR 2.61, 95?% CI 1.32–5.17) also preferred information from their provider; persons >45 years (OR 0.29, 95?% CI 0.18–0.47) were less likely to use the Internet for health information and preferred printed media (OR 1.64, 95?% CI 1.07–2.50). Overall, electronic communication channel use was low and varied significantly by age with those ≤45 years more likely to utilize electronic channels. Preferred sources of health information also varied by age as well as by health literacy and educational level. This study demonstrates that to effectively communicate key Precision Medicine concepts, curriculum development for Latino community members of Northern Manhattan will require attention to health literacy, language preference and acculturation and incorporate more traditional communication channels for older community members.     

贵州省某苗族村寨参与式健康教育干预研究

目的探索参与式健康教育方法在贵州农村少数民族地区的可行性和有效性,为今后开展相关工作提供经验借鉴。方法分别以凯里市所属两个苗族村寨为干预和对照点,在干预村开展为期6个月的参与式健康教育干预活动,干预前后用问卷进行健康素养调查,比较两组干预前后健康素养得分变化情况。结果基线调查健康素养3个维度的知晓率分别为,干预组36.1%、35.0%,27.1%,对照组23.5%、23.7%,19.7%;干预后两组各维度的知晓率均有提高(P﹤0.05);控制混杂因子影响后,干预组健康素养得分的提高率比对照组高13.2%。其中,教育程度高的人健康素养提高程度比教育程度低的人明显。结论参与式健康教育对培养和提高公众健康素养的效果显著高于传统的健康教育或传播手段的效果,值得推广。