Colorectal Cancer Screening: Low Health Literacy and Limited English Proficiency Among Asians and Whites in California

The authors examined the relationship between low health literacy (LHL), limited English proficiency (LEP), and meeting current U.S. Preventive Service Task Force colorectal cancer (CRC) screening guidelines for Asians and Whites in California. For 1,478 Asian and 14,410 White respondents 50–75 years of age in the 2007 California Health Interview Survey, the authors examined meeting CRC screening guidelines using multivariable logistic models by LEP and LHL separately and in combination. Analyses were run with the full sample, then separately for Whites and Asians controlling for demographics and insurance. For those with LEP, patient-provider language concordance and CRC screening was examined. Overall, respondents with LEP and LHL were the least likely to meet CRC screening guidelines (36%) followed by LEP-only (45%), LHL-only (51%), and those with neither LHL nor LEP (59%), a hierarchy that remained significant in multivariable models. For Whites, LHL-only was associated with screening, whereas LEP-only and LEP and LHL were significant for Asians. Having a language concordant provider was not significantly associated with CRC screening among those with LEP. Health literacy is associated with CRC screening, but English proficiency is also critical to consider. Asians with both LEP and LHL appear particularly vulnerable to cancer screening disparities.     

Recommendations for Advancing Health Literacy Measurement

Health literacy has become a national priority in the United States. Although less is known about the rate, outcomes, and costs associated with health literacy globally relative to the United States, the subject has received increasing attention internationally as well. Definitions, conceptual models, and health literacy measures have proliferated in recent years, and consensus does not exist regarding which of these to use. This article offers the following 5 recommendations for setting a research agenda to advance the science of health literacy measurement: (a) develop a comprehensive unified conceptual framework, (b) leverage the measurement knowledge the field has gained thus far, (c) empirically test frameworks and measures using robust research methods, (d) use a tiered approach to measuring health literacy, and (e) advocate for ongoing research and dissemination. These recommendations seek to ensure clarity, rigor, and transparency as part of a systematic approach to health literacy measurement. Once these steps are taken, the field of health literacy can move forward more effectively.     

Health Literacy and Health-Related Quality of Life Among a Population-Based Sample of Cancer Patients

Health-related quality of life is an important outcome in cancer care. A few studies indicate that health literacy influences cancer patients’ health-related quality of life, but additional investigation is needed. The authors examined the relation between health literacy and health-related quality of life among cancer patients. A cross-sectional survey was conducted with cancer patients in Wisconsin during 2006–2007. Data on sociodemographics, clinical characteristics, health-related quality of life, and health literacy were obtained from the state's cancer registry and a mailed questionnaire. Regression analyses were used to characterize the association between health-related quality of life and health literacy. The study sample included 1,841 adults, newly diagnosed with lung, breast, colorectal, or prostate cancer in 2004 (response rate = 68%). Health-related quality of life was measured with the Functional Assessment of Cancer Therapy-General. Adjusting for confounders, higher health literacy was associated with greater health-related quality of life (p < .0001). Controlling for covariates, we found significant differences between those in the highest and lowest health literacy categories (p < .0001) and in the physical (p < .0001), functional (p < .0001), emotional (p < .0001), and social (p = .0007) well-being subscales. These associations exceeded the minimally important difference threshold for overall health-related quality of life and functional well-being. Health literacy is positively and independently associated with health-related quality of life among cancer patients. These findings support adoption of health literacy best practices by cancer care systems.     

Screening Questions to Predict Limited Health Literacy: A Cross-Sectional Study of Patients With Diabetes Mellitus

PURPOSE Limited health literacy is increasingly recognized as a barrier to receiving adequate health care. Identifying patients at risk of poor health outcomes secondary to limited health literacy is currently the responsibility of clinicians. Our objective was to identify which screening questions and demographics independently predict limited health literacy and could thus help clinicians individualize their patient education.     

健康素养评估与监测研究进展

通过健康素养评估与监测,可以掌握居民健康素养水平及其动态变化,同时也可衡量健康教育和健康促进工作效果。通过介绍健康素养的概念,分析探索国内外健康素养评估与监测现状及其存在的不足。     

Limited Health Literacy and Decline in Executive Function in Older Adults

Limited health literacy is associated with worse executive function, but the association between limited health literacy and decline in executive function has not been established because of a lack of longitudinal studies. The authors aimed to examine this association by studying a prospective cohort in the setting of a randomized controlled trial to promote walking in older adults. Participants were community-dwelling older adults (65 years of age or older) who scored 2 or more on the Mini-Cog, without depression (score of less than 15 on the 9-item Patient Health Questionnaire), and who completed baseline and 12-month evaluations (n = 226). Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Executive function measured at baseline and 12 months using the Trail Making Test (TMT), Controlled Oral Word Association Test, and Category Fluency. The associations between health literacy and 12-month decline in each test of executive function were modeled using multivariate linear regression. Health literacy was found to be limited in 37% of participants. Limited health literacy was associated with reduced performance on all 3 executive function tests. In fully adjusted models, limited health literacy was associated with greater 12-month decline in performance on the TMT than higher health literacy (p = .01). In conclusion, older adults with limited health literacy are at risk for more rapid decline in scores on the TMT, a measure of executive function.     

Understanding Health Literacy Measurement Through Eye Tracking

This study used eye-tracking technology to explore how individuals with different levels of health literacy visualize health-related information. The authors recruited 25 university administrative staff (more likely to have adequate health literacy skills) and 25 adults enrolled in an adult literacy program (more likely to have limited health literacy skills). The authors administered the Newest Vital Sign (NVS) health literacy assessment to each participant. The assessment involves having individuals answer questions about a nutrition label while viewing the label. The authors used computerized eye-tracking technology to measure the amount of time each participant spent fixing their view at nutrition label information that was relevant to the questions being asked and the amount of time they spent viewing nonrelevant information. Results showed that lower NVS scores were significantly associated with more time spent on information not relevant for answering the NVS items. This finding suggests that efforts to improve health literacy measurement should include the ability to differentiate not just between individuals who have difficulty interpreting and using health information, but also between those who have difficulty finding relevant information. In addition, this finding suggests that health education material should minimize the inclusion of nonrelevant information.     

《慢性病病人健康素养调查量表》的维度结构分析

[目的]通过对《慢性病病人健康素养调查量表》的因子分析,探索其维度结构. [方法]按照多阶段分层随机抽样的原则在上海市抽取4个区共计1013人,将所有的研究对象随机分为两组:516人组的数据用于探索量表的结构,497人组的数据用于验证所得的结果.采用EpiData 3.1建立数据库,采用SPSS 18.0和LISERAL 8.7对所得数据进行探索性因子分析和验证性因子分析. [结果]探索性因子分析最终提取4个公因子,解释了66.274％的方差变异.根据探索性因子分析的结果分别构建三因子模型、四因子模型和五因子模型并进行验证性因子分析,其中四因子模型的误差均方根(RMSEA)=0.080、拟合优度指数(GFI)=0.85、本特勒-波内特规范指数(NFI)=0.94、增量拟合指数(IFI)=0.95、比较拟合指数(CFI)=0.95、x2/v=3.93,最符合推荐值,因此接受四因子模型. [结论]《慢性病病人健康素养调查量表》应包括24个条目,这24个条目分别归属于信息获取能力、交流互动能力、改善健康意愿、经济支持意愿4个维度.     

Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health.     

乳腺癌患者的心理分析与健康教育

对165例乳腺癌患者可能出现的心理问题、健康教育情况进行回顾性分析。结果显示乳腺癌患者的预后和康复与心理情绪稳定、正确掌握健康知识、建立良好健康的生活方式等因素有关联。说明研究乳腺癌患者的心理特点、进行心理分析、针对患者存在的心理问题进行健康知识宣教对早期手术、化疗的患者可起到良好的治疗效果。     

Health Literacy Associations Between Hispanic Elderly Patients and Their Caregivers

Knowing health literacy levels of older patients and their caregivers is important because caregivers assist patients in the administration of medications, manage daily health care tasks, and help make health services utilization decisions. The authors examined the association of health literacy levels between older Hispanic patients and their caregivers among 174 patient-caregiver dyads enrolled from 3 community clinics and 28 senior centers in San Antonio, Texas. Health literacy was measured using English and Spanish versions of the Short-Test of Functional Health Literacy Assessment and categorized as “low” or “adequate.” The largest dyad category (41%) consisted of a caregiver with adequate health literacy and patient with low health literacy. Among the dyads with the same health literacy levels, 28% had adequate health literacy and 24% had low health literacy. It is notable that 7% of dyads consisted of a caregiver with low health literacy and a patient with adequate health literacy. Low health literacy is a concern not only for older Hispanic patients but also for their caregivers. To provide optimal care, clinicians must ensure that information is given to both patients and their caregivers in clear effective ways as it may significantly affect patient health outcomes.     

Developing a Typology of African Americans With Limited Literacy Based on Preventive Health Practice Orientation: Implications for Colorectal Cancer Screening Strategies

Preventive health messages are often tailored to reach broad sociodemographic groups. However, within groups, there may be considerable variation in perceptions of preventive health practices, such as colorectal cancer screening. Segmentation analysis provides a tool for crafting messages that are tailored more closely to the mental models of targeted individuals or subgroups. This study used cluster analysis, a psychosocial marketing segmentation technique, to develop a typology of colorectal cancer screening orientation among 102 African American clinic patients between the ages of 50 and 74 years with limited literacy. Patients were from a general internal medicine clinic in a large urban teaching hospital, a subpopulation known to have high rates of colorectal cancer and low rates of screening. Preventive screening orientation variables included the patients' responses to questions involving personal attitudes and preferences toward preventive screening and general prevention practices. A k-means cluster analysis yielded three clusters of patients on the basis of their screening orientation: ready screeners (50.0%), cautious screeners (30.4%), and fearful avoiders (19.6%). The resulting typology clearly defines important subgroups on the basis of their preventive health practice perceptions. The authors propose that the development of a validated typology of patients on the basis of their preventive health perceptions could be applicable to a variety of health concerns. Such a typology would serve to standardize how populations are characterized and would provide a more accurate view of their preventive health-related attitudes, values, concerns, preferences, and behaviors. Used with standardized assessment tools, it would provide an empirical basis for tailoring health messages and improving medical communication.     

健康素质与健康素养

依靠广泛的社会参与、多部门的合作和支持,从卫生、文化、社会各方面提高对健康促进的重视程度,最终达到提高国民健康素养,进而提高全民族健康素质的目标。1健康素质1·1健康素质的定义素质的定义迄今仍属于一个颇具争议的理论问题,研究者从语义学、哲学、社会学、心理学、教育     

Limited Literacy and Poor Health: The Role of Social Mobility in Germany and the United States

The Organization for Economic Cooperation and Development (OECD) implemented the Program for the International Assessment of Adult Competencies (PIAAC) to provide policymakers with nationally representative profiles of knowledge, skills, and competencies. Results among participating countries indicate that the United States and Germany stand out as having the strongest relationship between literacy skills and self-reported health. Our analysis addresses factors that could mediate the particularly strong link between low literacy and poor health in these two countries and possible remedies for the problem. In particular, PIACC results also reveal that the United States and Germany share the most entrenched multigenerational literacy problem among the countries in the PIAAC survey. In spite of the many social differences that currently distinguish Germany and the United States, these countries share the lowest level of social mobility for education. Promoting social mobility by making higher education more accessible for those whose parents did not have the chance to access it might thus not only promote literacy and social capital, but indirectly also promote public health. Given the PIACC findings, the concept of social mobility and opportunities to dissolve the educational stratification merit more attention in public health research.     

Development and Validation of the Comprehensive Health Activities Scale: A New Approach to Health Literacy Measurement

Current health literacy measures have been criticized for solely measuring reading and numeracy skills when a broader set of skills is necessary for making informed health decisions, especially when information is often conveyed verbally and through multimedia video. The authors devised 9 health tasks and a corresponding 190-item assessment to more comprehensively measure health literacy skills. A sample of 826 participants between the ages of 55 and 74 years who were recruited from an academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois, completed the assessment. Items were reduced using hierarchical factor analysis and item response theory resulting in the 45-item Comprehensive Health Activities Scale. All 45 items loaded on 1 general latent trait, and the resulting scale demonstrated high reliability and strong construct validity using measures of health literacy and global cognitive functioning. The predictive validity of the Comprehensive Health Activities Scale using self-reported general, physical, and mental health status was comparable to or better than widely used measures of health literacy, depending on the outcome. Despite comprehensively measuring health literacy skills, items in the Comprehensive Health Activities Scale supported 1 primary construct. With similar psychometric properties, current measures may be adequate, depending on the purpose of the assessment.     

健康教育在鼻咽癌放射疗法患者中的应用

医院健康教育不仅是密切医患关系 ,促进精神文明建设的重要桥梁和纽带 ,同时 ,也是一种对心身疾病重要和有效易行的治疗和护理手段。 1 997年 1 0月福建省肿瘤医院开始对3 61例鼻咽癌放射疗法患者采用有计划、有组织、有系统和有评价的健康教育活动 ,取得较好的效果 ,今报告如下。临床资料3 61例患者中 ,男 2 67例 ,女 94例。年龄1 1～ 77岁 ,平均年龄 44岁。病理 :低分化癌3 1 9例 ,未分化癌 42例。首次放射疗法 2 40例 ,再次放射疗法 1 2 1例 ,放射治疗采用 6ｍｖＸ射线或并用电子束 ,总量为 70～ 80Ｇｙ。治愈2 3 8例 ,好转 1 2 2例 ,自…