Utilizing computerized entertainment education in the development of decision aids for lower literate and naïve computer users

Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and na?ve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.     

Connecting the MDGs and NCDs with Digital Health

Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.     

Good Googling: A Consumer Health Literacy Program Empowering Parents to Find Quality Health Information Online

Only 12% of Americans possess adequate health literacy skills. Among the populations cited with the lowest health literacy are those who experience chronic health conditions. A pilot health information literacy program was designed for parents of children with complex medical needs to help improve low health literacy in this population. The program targeted finding and determining trustworthy information online and was evaluated using a pre-post survey design. After the program parents’ confidence improved significantly in finding, interpreting, and judging quality online health information. These skills play an important role in promoting family-centered care and decreasing the burden on health care consumers.     

Factors Influencing Nutrition Education for Patients with Low Literacy Skills

Although there has been increasing attention to cancer prevention among low-income and minority populations, only a few nutrition interventions have addressed the special needs of people with low literacy skills. To determine the best provider and the most effective format for a nutrition intervention targeting patients with low literacy skills, we conducted interviews with literacy experts and health care providers and focus groups with members of adult basic education classes. Thirty-five literacy experts and health-center–based physicians, nurses, and nutritionists in Boston, Mass, were interviewed. In addition, 50 volunteer clients from 4 Boston-based adult basic education programs participated in 6 focus groups. Results suggested that health care providers consider nutrition to be a fundamental health education topic, but that its successful inculcation in patients with limited literacy skills is hindered mostly by insufficient provider time. Almost all providers agreed that patients need to be referred to nutritionists for nutrition education. Although most providers and patients acknowledged that patients perceive physicians to be the authorities on health, patients with low literacy skills turned first to family members and friends for health information. These results suggest that effective nutrition interventions must build on patients’ social networks; appear in a visually based, interactive format; and be culturally appropriate. J Am Diet Assoc. 1998; 98:559–564.     

闵行区4家制造企业职工健康素养状况调查

摘要：[目的]了解上海市闵行区4家制造企业职工健康素养水平现状、影响因素和健康教育需求,为制定职业人群健康素养的干预策略提供依据。[方法]采用简单随机抽样方法对4家大型设备制造企业640名职工进行健康素养问卷调查。运用矿检验和趋势检验分析健康素养与相关因素的关系。[结果]企业职工总体健康素养具备率为33．1％,各维度具备率相差较大。男性、低文化程度者、低收入者和工人的健康素养较低,其中文化程度是主要的影响因素,过去的健康教育（以发放健康宣传材料和举办讲座为主）对提高总体健康素养有一定的促进作用,不同的健康教育方式对健康素养的不同维度产生影响,职工健康教育需求形式和内容丰富。[结论]职业人群总体健康素养具备情况较农村居民好,但各维度具备率相差较大,需结合健康教育需求,考虑低文化程度者的适应性,选择合适的干预方式和干预内容。     

Will patients agree to have their literacy skills assessed in clinical practice?

If health providers are aware of their patients' literacy skills, they can more appropriately tailor their communication with patients. Few providers, however, assess patient's literacy skills for fear of offending patients, but no research has ever determined if patients object to such assessments. Our objectives were to determine the percentage of patients seen for routine health care that would agree to undergo literacy assessment and if satisfaction of patients differs in practices that perform literacy assessments versus practices that do not. We randomized 20 private and public medical practices to an intervention group that implemented literacy assessments with the Newest Vital Sign and a control group that did not. For intervention practices, we noted the percentage of patients agreeing to undergo the assessment. For both intervention and control practices, we assessed patient satisfaction. Of 289 patients asked to undergo literacy assessment in the intervention practices, 284 (98.3%) agreed to do so, including 125 (46.1%) with low or possibly low literacy skills. There was no difference in satisfaction between the intervention group and the control group. We conclude that patients are willing to undergo literacy assessments during routine office visits and performing such assessments does not decrease patient satisfaction.     

Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites

Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites is a practical and well-written resource for public health and health communication professionals and web designers. This guide builds on the principles of web usability and adds to existing best practices by providing research-based strategies for writing and designing health websites especially for users with limited literacy and health literacy skills. This guide synthesizes years of lessons learned from Office of Disease Prevention and Health Promotion's original research with hundreds of web users, experience with revising the healthfinder.gov, as well as strategies supported by the Research-Based Web Design and Usability Guidelines (Usability.gov). In the United States, roughly one third of adults have limited literacy skills, yet far more (as many as 90%) have limited health literacy skills, meaning they have trouble understanding complex health information. This how-to guide is timely and developed with the aim of creating easy-to-use health websites to reach as many web users as possible, especially those with limited literacy and health literacy skills.     

Health literacy as an empowerment tool for low-income mothers

Health literacy commonly refers to the extent to which one can access and accurately interpret healthcare information. Statistics reveal that limited health literacy is prevalent among those of lower socioeconomic status. When working with low-income mothers, it is recommended in this article that healthcare professionals operationalize a broader conceptualization of health literacy than assessment of reading levels and translating knowledge of risk factors for illness and disease. Nutbeam's continuum of functional, interactive, and critical health literacy directs healthcare professionals to expand their health education mandate to encompass equipping low-income mothers with the necessary knowledge and skills to gain control over their lives and optimize the healthy development of their children. Tenets from social cognitive theory, principles from interdependence theory, and strategies from Freire's empowerment education model are integral to successful progression along Nutbeam's health literacy continuum.     

2008-2015年上海市15~69岁居民健康素养变化趋势及相关因素研究

目的 了解上海市居民健康素养的现状,为制定卫生政策和干预策略提供依据。方法 采取多阶段随机抽样方法,2008-2015年对上海市15~69岁常住居民进行抽样调查。结果 上海市15~69岁居民健康素养水平逐年上升,2015年为21.94%,较2008年提升了14.97%。在健康素养的3个方面中,基本知识和理念、健康基本技能历年均较健康生活方式与行为素养水平高;健康素养的6类问题中,除了传染病防治素养和健康信息素养,其余素养水平均有明显提升。各类人群的健康素养水平在过去8年间均有不同程度的提升,但农村居民、文化程度较低的人群健康素养水平历年均相对较低且增长相对缓慢。结论 健康素养干预成效显著,需要进一步强化薄弱人群的健康素养。     

Self-rated literacy level does not explain educational differences in health and disease

Background

Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health.

Methods

Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals’ self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health.

Results

People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%.

Conclusion

Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.     

Health Literacy Practices and Educational Competencies for Health Professionals: A Consensus Study

Health care professionals often lack adequate knowledge about health literacy and the skills needed to address low health literacy among patients and their caregivers. Many promising practices for mitigating the effects of low health literacy are not used consistently. Improving health literacy training for health care professionals has received increasing emphasis in recent years. The development and evaluation of curricula for health professionals has been limited by the lack of agreed-upon educational competencies in this area. This study aimed to identify a set of health literacy educational competencies and target behaviors, or practices, relevant to the training of all health care professionals. The authors conducted a thorough literature review to identify a comprehensive list of potential health literacy competencies and practices, which they categorized into 1 or more educational domains (i.e., knowledge, skills, attitudes) or a practice domain. The authors stated each item in operationalized language following Bloom's Taxonomy. The authors then used a modified Delphi method to identify consensus among a group of 23 health professions education experts representing 11 fields in the health professions. Participants rated their level of agreement as to whether a competency or practice was both appropriate and important for all health professions students. A predetermined threshold of 70% agreement was used to define consensus. After 4 rounds of ratings and modifications, consensus agreement was reached on 62 out of 64 potential educational competencies (24 knowledge items, 27 skill items, and 11 attitude items), and 32 out of 33 potential practices. This study is the first known attempt to develop consensus on a list of health literacy practices and to translate recommended health literacy practices into an agreed-upon set of measurable educational competencies for health professionals. Further work is needed to prioritize the competencies and practices in terms of relative importance.     

2018年四川省绵竹市居民健康素养现状及影响因素分析

目的了解绵竹市居民健康素养现状,为制定科学合理的健康促进措施和干预策略提供依据。方法以多阶段分层整群随机抽样方法,在绵竹市居民中抽取1623名15~69岁调查对象进行问卷调查,采用Logistics回归法分析影响绵竹市居民健康素养水平的主要因素。结果绵竹市1623名调查对象健康素养水平为14.1%;基本知识和理念素养水平为41.7%,健康生活方式行为素养水平为14.6%,基本技能素养水平为16.0%,呈现出基本知识水平高于基本技能、基本技能高于健康生活方式行为的特点;6类健康问题素养水平由高到低分别为安全与急救33.5%、科学健康观30.3%、慢性病防治16.5%、传染病防治10.2%、健康信息10.0%、基本医疗8.1%。二元Logistic回归分析显示,年龄越大,健康素养水平越低;随着文化水平增高,健康素养水平逐步增高;在职业方面,医务人员健康素养水平最高。结论年龄、文化程度、职业是绵竹市居民健康素养水平的主要影响因素,今后应对老年人、低文化水平、农民等重点人群采取针对性干预措施,创新宣传模式,加强慢性病和传染病防治知识的宣传和技能传播。     

Just-in-time evidence-based e-mail "reminders" in home health care: impact on nurse practices

OBJECTIVE: To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban, nonprofit home care agency. STUDY DESIGN: The study employed a randomized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient. The basic intervention was a one-time e-mail reminder highlighting six HF-specific clinical recommendations. The augmented intervention consisted of the initial e-mail reminder supplemented by provider prompts, patient education material, and clinical nurse specialist outreach. DATA COLLECTION: At each home health visit provided by a study nurse to an eligible HF patient during the 45-day follow-up period, a structured chart abstraction tool was used to collect information on whether the nurse provided the care practices highlighted in the e-mail reminder. PRINCIPAL FINDINGS: Both the basic and the augmented interventions greatly increased the practice of evidence-based care, according to patient records, in the areas of patient assessment and instructions about HF disease management. While not all results were statistically significant at conventional levels, intervention effects were positive in virtually all cases and effect magnitudes frequently were large. CONCLUSIONS: The results of this randomized trial strongly support the efficacy of just-in-time evidence-based reminders as a means of changing clinical practice among home health nurses who are geographically dispersed and spend much of their time in the field.     

Health Literacy and Its Association With the Use of Information Sources and With Barriers to Information Seeking in Clinic-Based Pregnant Women

We investigated health literacy and its association with the use of information sources and with barriers to information seeking in clinic-based pregnant women. The Short Test of Functional Health Literacy in Adults (STOFHLA) was used to measure health literacy in 143 English-speaking low-income pregnant women. About 15% of the participants demonstrated low health literacy. Participants with low health literacy were less likely to use the Internet and more likely to have self-efficacy barriers than participants with high health literacy. Interventions to promote information-seeking skills and Internet access are indicated for women with low health literacy.     

2012年甘肃省居民健康素养状况及影响因素分析

目的了解甘肃省居民健康素养现状,分析影响居民健康素养的因素,为政府部门制定健康促进相关政策提供科学依据。方法采用多阶段分层整群抽样的方法,抽取15~69岁常住人口2946名,采用入户调查方式进行数据收集。结果甘肃省居民健康素养具备率为11.99%;基本知识和理念、健康生活方式与行为和健康技能的具备率分别为25.05%、16.13%和10.22%。Logistic回归分析显示,文化程度和职业是居民健康素养的独立影响因素。文化程度越高,健康素养具备率越高（OR=1.582）;医务人员的健康素养具备率明显高于其他职业人群（OR=3.598）。结论甘肃省居民健康素养具备率与2009年相比有一定的提高,3个方面素养的具备率符合＂知信行＂模式;文化程度和职业是健康素养的独立影响因素。应根据行为干预理论和不同人群的特征,开展居民健康素养干预工作,以提高省内全人群的健康素养水平。     

吉林幼儿园教师健康素养相关知识技能干预效果评价

了解吉林省幼师健康素养现状及干预效果,为积极开展相关干预工作提供依据.方法 便利整群抽取吉林省10个地区16所幼儿园的622名幼师,以地区为单位随机分为干预组和对照组,围绕洗手刷牙、气道异物阻塞处理(海姆立克急救法)、外伤处理及拨打求救电话的健康素养相关知识与技能开展培训和资料收集.结果 干预前,干预组洗手刷牙、海姆立克急救法、外伤处理及拨打求救电话的健康素养具备率分别为42.3%,29.2%,26.3%,63.5%,对照组分别为39.0%,32.6%,22.6%,64.8%,2组间差异均无统计学意义(x2值分别为0.986,2.001,0.745,1.203,P值均>0.05);干预组在干预后洗手刷牙、海姆立克急救法、外伤处理及拨打求救电话的健康素养相关知识与技能均高于对照组,差异均有统计学意义(P值均<0.05).结论 健康素养相关知识技能教育培训可有效提高幼师健康素养水平及自信心.政府及相关教育机构应定期、全面系统且有针对性的开展培训.     

Health Literacy among Medically Underserved: The Role of Demographic Factors,Social Influence,and Religious Beliefs

The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50–75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.     

Development of an adaptive multimedia program to collect patient health data

BACKGROUND: Direct entry of personal health survey information into a computer by patients could streamline clinical data collection, improve completeness and accuracy of health information available to providers, and provide data for tailoring health education messages. Few computerized programs, however, have been developed to adapt the interface to diverse literacy levels, language, computer skills, and health literacy levels of the broad spectrum of patient populations. METHODS: To develop such a program, we conducted cognitive response interviews with a diverse sample of 21 adult participants from two North Carolina health clinics. Participants were placed into one of three interview categories: (1) low reading skill level, low computer skills; (2) high reading skill level, low computer skills; and (3) high reading skill level, high computer skills. The "think-aloud" technique was employed to elicit feedback on a series of computer interface screens and health risk assessment questions. RESULTS: Interface-related findings showed that preference for touchscreen versus keyboard data entry was not strongly related to computer skill level but was related to question type. Respondents with limited education indicated that they would not click on a "help" or hyperlink option to get more information and that frequent reminders of directions on the screen were needed. Content-related findings showed numerous misperceptions regarding meanings of common health questions and terminology (e.g., seat belt use and intravenous drugs). CONCLUSIONS: These findings have implications for health literacy and may have an impact on the accuracy of information obtained. Study results will be incorporated into the development and testing of an innovative, adaptive multimedia program.     

2019年上海市某社区外来服务业从业人员健康素养水平及影响因素分析

目的:了解上海市外来服务业从业人员健康素养水平及影响因素,为健康促进干预工作提供依据。方法:采用《中国公民健康素养》调查问卷,以530名办理健康证的外来服务业从业人员作为调查对象。结果:2019年上海市外来服务业从业人员健康素养具备率为15.1%。基本知识和理念、健康生活方式和行为和健康技能素养具备率分别为19.8%、7.3%和42.7%;科学健康观、传染病防治、慢性病防治、安全与急救、基本医疗和健康信息素养具备率依次为56.6%、15.9%、14.1%、56.8%、16.3%和28.9%;多因素logistic回归分析显示,文化程度是影响健康素养的主要因素,OR=2.202,95%CI(1.533,3.164)。结论:上海市外来服务业从业人员健康素养水平较低,文化程度较低的外来服务业从业人员是健康促进的重点干预对象。     

Health literacy and adolescents: a framework and agenda for future research

Health literacy is an important issue in public health today, especially as patients are taking a greater role in obtaining information about their health. Health literacy is commonly defined as 'the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions'. While there is a large body of literature concerning health literacy and adults, few studies have focused on adolescents. Adolescents may have less interaction with the health care system and lower health care costs than adults, but they are increasingly involved with their health care, especially those with chronic illness. They are frequent users of mass media and other technology to access health information and are a target group for many health-related educational interventions. Adolescents are also at a crucial stage of development, learning skills they will carry with them into adulthood. The goal of this paper is to provide a summary of issues justifying the importance of studying health literacy as it relates to adolescents and to provide a framework and suggestions for future research.