A communication inequalities approach to disparities in fruit and vegetable consumption: Findings from a national survey with U.S. adults

ObjectivesThis study assessed whether socioeconomic disparities in fruit and vegetable consumption and its differences by social capital are accounted for by exposure to media information about fruits and vegetables and reflective integration of that information.MethodsOnline survey data were collected in July 2014 from 572 U.S. adults from a nationally representative online panel. Path analysis was employed to test our models.ResultsEducation and social capital were positively associated with media exposure, which was in turn positively related to reflective integration and finally led to fruit and vegetable consumption. Education and income were positively associated with social capital.ConclusionDifferences in fruit and vegetable consumption across social groups are at least partly explained by exposure to information about fruits and vegetables from the media, and by reflective integration of that information.Practice ImplicationsHealthcare professionals and health educators should create health messages delivered via the media that are easy to understand with an appropriate level of health literacy. Also, health interventions that aim to build social capital may promote health media use and its reasoning processes, thereby reducing communication inequalities by SES as well as disparities in fruit and vegetable consumption.     

Health literacy,multimorbidity, and patient-perceived treatment burden in individuals with cardiovascular disease. A Danish population-based study

ObjectiveThe aim was to investigate the association between: 1) multimorbidity and high treatment burden 2) health literacy and high treatment burden, and 3) the interaction between multimorbidity and health literacy in relation to high treatment burden.MethodsWe included respondents with cardiovascular disease who participated in a Danish population-based survey from 2017 (N = 2,111). Logistic regression analyses were used to study associations.ResultsThe study showed that multimorbid individuals with cardiovascular disease were more likely to experience a high treatment burden than individuals with cardiovascular disease only (2+ additional conditions OR 4.16 [2.80–6.18]). Also, individuals with difficulties in understanding health information were more likely to report a high treatment burden than individuals who found it easy to understand information about health (OR 9.97 [6.23–15.95]). Finally, individuals with multimorbidity and difficulties in understanding health information had markedly higher odds of experiencing a high treatment burden.ConclusionIf individuals find it difficult to understand health information, there is a risk they might feel overwhelmed by the treatment.Practice implicationsHealthcare professionals should be aware of health literacy challenges in planning medical treatment particularly for patients with both low health literacy levels and multimorbidity.     

Information seeking behavior and perceived health literacy of family caregivers of persons living with a chronic condition. The case of spinal cord injury in Switzerland

ObjectiveTo examine the information seeking behavior and health literacy of caregivers of individuals living with spinal cord injury in Switzerland and their impact on the caregiving experience.MethodsNationwide survey of family caregivers of people with spinal cord injury (N = 717). Caregivers aged 18+ who assisted with activities of daily living were included. Self-reported information seeking behavior, including topics, preferred sources, and health literacy were assessed and analyzed.ResultsHealth professionals were the most trusted source of information. Among information-seekers, higher health literacy levels were shown to be associated with lower subjective caregiver burden and, in turn, with higher caregivers’ satisfaction with own health.ConclusionCaregivers use information on different topics and coming from different sources. In order for information to improve the caregiving experience, however, caregivers need health literacy skills to make sense of it.Practice implicationsBuilding health literacy is a promising approach to support caregivers in their activities, reduce their subjective burden, and even to improve their health. Interventions should consider involving health professionals, as the most trusted source of information, and address both health-related and more practical issues.     

Professional Use of Social Media by Pharmacists: A Qualitative Study

BackgroundSocial media is frequently used by consumers and health care professionals; however, our knowledge about its use in a professional capacity by pharmacists is limited.ObjectiveOur aim was to investigate the professional use of social media by pharmacists.MethodsIn-depth semistructured interviews were conducted with practicing pharmacists (N=31) from nine countries. Interviews were recorded, transcribed verbatim, and thematically analyzed.ResultsWikipedia, YouTube, and Facebook were the main social media platforms used. Professional use of social media included networking with peers, discussion of health and professional topics, accessing and sharing health and professional information, job searching, and professional promotion. Wikipedia was the participants’ first choice when seeking information about unfamiliar topics, or topics that were difficult to search for. Very few pharmacy-related contributions to Wikipedia were reported. YouTube, a video-sharing platform, was used for self-education. University lectures, “how-to” footage, and professionally made videos were commonly watched. No professional contribution was made to YouTube. Facebook, a general social networking site, was used for professional networking, promotion of achievements, and job advertisements. It also afforded engagement in professional discussions and information sharing among peers.ConclusionsParticipants used social media in a professional capacity, specifically for accessing and sharing health and professional information among peers. Pharmacists, as medicines experts, should take a leading role in contributing to health information dissemination in these user-friendly virtual environments, to reach not only other health care professionals but also health consumers.     

“It’s Got to Be on This Page”: Age and Cognitive Style in a Study of Online Health Information Seeking

BackgroundThe extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy.ObjectiveThis study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy.MethodsThe Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing.ResultsCognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved.ConclusionsThe increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making.     

An unsupervised machine learning model for discovering latent infectious diseases using social media data

IntroductionThe authors of this work propose an unsupervised machine learning model that has the ability to identify real-world latent infectious diseases by mining social media data. In this study, a latent infectious disease is defined as a communicable disease that has not yet been formalized by national public health institutes and explicitly communicated to the general public. Most existing approaches to modeling infectious-disease-related knowledge discovery through social media networks are top-down approaches that are based on already known information, such as the names of diseases and their symptoms. In existing top-down approaches, necessary but unknown information, such as disease names and symptoms, is mostly unidentified in social media data until national public health institutes have formalized that disease. Most of the formalizing processes for latent infectious diseases are time consuming. Therefore, this study presents a bottom-up approach for latent infectious disease discovery in a given location without prior information, such as disease names and related symptoms.MethodsSocial media messages with user and temporal information are extracted during the data preprocessing stage. An unsupervised sentiment analysis model is then presented. Users’ expressions about symptoms, body parts, and pain locations are also identified from social media data. Then, symptom weighting vectors for each individual and time period are created, based on their sentiment and social media expressions. Finally, latent-infectious-disease-related information is retrieved from individuals’ symptom weighting vectors.Datasets and resultsTwitter data from August 2012 to May 2013 are used to validate this study. Real electronic medical records for 104 individuals, who were diagnosed with influenza in the same period, are used to serve as ground truth validation. The results are promising, with the highest precision, recall, and F₁ score values of 0.773, 0.680, and 0.724, respectively.ConclusionThis work uses individuals’ social media messages to identify latent infectious diseases, without prior information, quicker than when the disease(s) is formalized by national public health institutes. In particular, the unsupervised machine learning model using user, textual, and temporal information in social media data, along with sentiment analysis, identifies latent infectious diseases in a given location.     

The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study

Background

Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections.

Objective

The aim of this study was to explore health researchers’ and clinicians’ current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence.

Methods

This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey.

Results

A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information.

Conclusions

A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice.     

Mind the Gap: Social Media Engagement by Public Health Researchers

Background

The traditional vertical system of sharing information from sources of scientific authority passed down to the public through local health authorities and clinicians risks being made obsolete by emerging technologies that facilitate rapid horizontal information sharing. The rise of Public Health 2.0 requires professional acknowledgment that a new and substantive forum of public discourse about public health exists on social media, such as forums, blogs, Facebook, and Twitter.

Objective

Some public health professionals have used social media in innovative ways: to surveil populations, gauge public opinion, disseminate health information, and promote mutually beneficial interactions between public health professionals and the lay public. Although innovation is on the rise, most in the public health establishment remain skeptical of this rapidly evolving landscape or are unclear about how it could be used. We sought to evaluate the extent to which public health professionals are engaged in these spaces.

Methods

We conducted a survey of professorial- and scientist-track faculty at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. We asked all available faculty via email to complete a 30-question survey about respondent characteristics, beliefs about social media, and usage of specific technologies, including blogs, Facebook, Twitter, and YouTube.

Results

A total of 181 (19.8%) of 912 professor- and scientist-track faculty provided usable responses. The majority of respondents rarely used major social media platforms. Of these 181 respondents, 97 (53.6%) had used YouTube, 84 (46.4%) had used Facebook, 55 (30.4%) had read blogs, and 12 (6.6%) had used Twitter in the prior month. More recent degree completion was the best predictor of higher usage of social media. In all, 122 (67.4%) agreed that social media is important for disseminating information, whereas only 55 (30.4%) agreed that social media is useful for their research. In all, 43 (23.8%) said social media was helpful for professional career advancement, whereas 72 (39.8%) said it was not. Only 43 (23.8%) faculty said they would employ a full- or part-time social media consultant, and 30 (16.6%) currently employed one.

Conclusions

Despite near-universal appreciation of the potential for social media to serve as a component of public health strategy, a small minority are actually engaged in this space professionally, whereas most are either disinterested or actively opposed to professional engagement. Social media is seen by most as more useful for spreading information than obtaining it. As public discourse on a number of critical health topics continues to be influenced and sometimes shaped by discussions online from Twitter to Facebook, it would seem that greater discourse is needed about when and how public health professionals should engage in these media, and also how personal, institutional, and professional barriers to greater use of social media may be overcome.     

eHealth Literacy and Web 2.0 Health Information Seeking Behaviors Among Baby Boomers and Older Adults

BackgroundBaby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information.ObjectiveThe intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults.MethodsA random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information.ResultsAlmost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t _217.60=−2.98, P=.003. Younger age (b=−0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R ² =.17, R ²adj =.14, F_9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information.ConclusionsBeing younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.     

Patients’ challenges,competencies, and perceived support in dealing with information needs – A qualitative analysis in patients with breast and gynecological cancer

ObjectivesThis study aimed to investigate challenges, competencies, and support in breast and gynecological cancer patients when dealing with information needs and how health literacy as an interplay of these factors might be improved.MethodsSemi-structured interviews were conducted with patients in acute care (n = 19), undergoing rehabilitation (n = 20) or attending self-help groups (n = 16). Interviews were analyzed using content analysis.ResultsChallenges: gain information according to own needs, internet as information source, information evaluation and decisions, doctor-patient communication, situationally limited information processing, difficult access to information. Competencies: self-regulation of information needs, media and social competencies, communication skills in the doctor-patient conversation, internet competencies, self-directed decisions according to own needs, interest/self-efficacy, previous knowledge, trust in the doctor. Support: by professionals (e.g., patient-centered communication), relatives (e.g., support during consultations), peers (e.g., exchange), facilities (e.g., clinics).ConclusionsOur findings provide insight into challenges and competencies relevant to patients’ health literacy and the influence of support. The individuality of the interplay highlights the relevance of an active patient role and patient-centered care.Practice implicationsPatients’ health literacy should be improved in (psycho)oncological work by both reducing challenges (e.g., by communication skills training, involving relatives) and promoting competencies (e.g., by needs- and competence-oriented information offers).     

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study

BackgroundApproximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers.ObjectiveThe aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice.MethodsThe study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings.ResultsData were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice.ConclusionsSocial media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice.     

The psychosocial impact of Klinefelter syndrome and factors influencing quality of life

PurposeThere is considerable information regarding the medical and cognitive aspects of Klinefelter syndrome yet little research regarding its psychosocial impact. This study investigates the personal impact of Klinefelter syndrome and the influence of age at diagnosis, clinical, social, and demographic factors on adult quality of life outcomes.MethodsMen from across Australia, diagnosed with KS at different ages, were recruited through multiple sources. Participants completed a questionnaire assessing subjective well-being, body image, self-esteem, mental health, social support, and general health.ResultsEighty-seven individuals self-completed the questionnaire. All outcomes were much poorer for the study population than for the general male population. Individuals diagnosed later in life reported many of the same symptoms as those diagnosed at younger ages. Employment status, social support, and phenotypic features were the strongest predictors of psychosocial outcomes. Age at diagnosis was not as influential because it did not correlate with phenotypic severity score.ConclusionThis is the first quantitative study to show Klinefelter syndrome has a significant personal impact. Men diagnosed with Klinefelter syndrome later in life reported similar difficulties as those at younger ages, suggesting that they would benefit from early detection and intervention. Understanding factors influencing this can assist in providing adequate services to individuals with Klinefelter syndrome, their partners, families, and the health professionals caring for them.     

A systematic review of the association between health literacy and pain self-management

ObjectiveTo synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes.MethodsThis systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies.ResultsTwenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education.ConclusionsLimited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation.Practice ImplicationsUsing brief functional literacy scales in the clinical environment can be more practical. Identifying patients’ literacy levels helps clinicians personalize education, which then promotes patients’ knowledge of pain, medication regimen adherence, and pain control.     

How can we improve information for people affected by cancer? A national survey exploring gaps in current information provision,and challenges with accessing cancer information online

ObjectiveDespite improved recognition regarding the importance and association between provision of high quality information for people affected by cancer and improved outcomes and experiences; gaps and unmet needs are still reported. As oncology health information provision increasingly moves online, understanding how service users experience and manage misinformation is important. Determining patient and carer preferences regarding cancer provision is needed to address outstanding gaps.MethodsThis study utilised a purpose-built national cross-sectional survey distributed via social media to assess perspectives regarding cancer information in Australia. Quantitative and qualitative (open text) items assessed respondents’ perspectives regarding current inforation preferences and gaps, and experiences with accessing information online.ResultsA total of 491 people affected by cancer completed the survey. Respondents highlighted a preference for information that better addresses the diversity of cancer experience, and is more timely and responsive to personal situation and care context. Despite increasing attention to health literacy standards, complex medical jargon and terminology remains prevalent. Many respondents have concerns about misinformation, and seek improved mechanisms or skills to assist with determining the trustworthiness and relevance of information found online.ConclusionsSurvey responses identified current gaps in information provision for people affected by cancer. Personalised information in formats which are more flexible, accessible, and responsive to user needs are required.Practice ImplicationsEducation and resources to target and improve digital health literacy and combat health misinformation are needed. Novel solutions co-designed by people affected by cancer will ensure that information is provided in a manner that is relevant, timely, and personalised.     

Understanding Online Health Groups for Depression: Social Network and Linguistic Perspectives

BackgroundMental health problems have become increasingly prevalent in the past decade. With the advance of Web 2.0 technologies, social media present a novel platform for Web users to form online health groups. Members of online health groups discuss health-related issues and mutually help one another by anonymously revealing their mental conditions, sharing personal experiences, exchanging health information, and providing suggestions and support. The conversations in online health groups contain valuable information to facilitate the understanding of their mutual help behaviors and their mental health problems.ObjectiveWe aimed to characterize the conversations in a major online health group for major depressive disorder (MDD) patients in a popular Chinese social media platform. In particular, we intended to explain how Web users discuss depression-related issues from the perspective of the social networks and linguistic patterns revealed by the members’ conversations.MethodsSocial network analysis and linguistic analysis were employed to characterize the social structure and linguistic patterns, respectively. Furthermore, we integrated both perspectives to exploit the hidden relations between them.ResultsWe found an intensive use of self-focus words and negative affect words. In general, group members used a higher proportion of negative affect words than positive affect words. The social network of the MDD group for depression possessed small-world and scale-free properties, with a much higher reciprocity ratio and clustering coefficient value as compared to the networks of other social media platforms and classic network models. We observed a number of interesting relationships, either strong correlations or convergent trends, between the topological properties and linguistic properties of the MDD group members.Conclusions(1) The MDD group members have the characteristics of self-preoccupation and negative thought content, according to Beck’s cognitive theory of depression; (2) the social structure of the MDD group is much stickier than those of other social media groups, indicating the tendency of mutual communications and efficient spread of information in the MDD group; and (3) the linguistic patterns of MDD members are associated with their topological positions in the social network.     

Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study

BackgroundInsomnia is a common psychological complaint. Cognitive behavioural therapy for insomnia (CBT-I), although effective, is little used because of lack of trained providers. Computerised CBT-I (CCBT-I) may be a solution to this shortfall in access.AimTo explore patient and health professional perspectives and the role of social networking, to develop a novel CCBT-I programme to increase access to this form of intervention.MethodSemi-structured interviews and focus groups with a purposive sample of health professionals and adults with insomnia.ResultsA total of 23 health professionals and 28 patients were interviewed. Features designed to engender trust and improve functionality were perceived to improve uptake and adherence to CCBT-I. Trust lay in programme accreditation; for professionals, trust derived from evidence of effectiveness; for patients, trust depended on the doctor–patient relationship, professional support, the quality of online peer support, and perceptions of risk. Patients wanted mobile applications; access in short periods; self-assessment; interactive, personalised information on sleep; and moderated contact with other users. Patients and practitioners differed over whether useful information could be distinguished from less useful or potentially incorrect information.ConclusionImproving uptake and adherence to online programmes for insomnia requires design features focusing on trust and functionality. Enabling greater patient control and interaction with other users and professionals may stimulate positive experiences of online therapy. CCBT-I would enable greater access to treatment but is limited by lack of online access or poor computer literacy.     

Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children

ObjectiveTo investigate the relationship between parents’ health literacy and decision-making regarding child vaccinations.MethodsA cross-sectional survey was conducted among 731 parents of children aged 3–4 years. Functional, communicative, and critical health literacy (HL), knowledge, beliefs, reliability of the vaccine’s information resources, and vaccine's attitudes were measured. Attitudes included three types: pro-vaccine attitudes, anti-vaccine attitudes, and attitudes regarding mandatory vaccination. Path analysis was conducted to explore direct and indirect associations of compliance with childhood vaccinations and HL.ResultsCommunicative HL has a significant negative direct association with compliance with vaccinations (ß = − 0.06, p < 0.05). High functional and critical HL have significant negative indirect associations with vaccinations through parents’ attitudes regarding vaccines. Higher levels of perception of reliability of informal information resources are associated with non-compliance.ConclusionsThe results indicate that parents with high functional, communicative, and critical HL are more at risk of not vaccinating their children. The results are contrary to expectations in which people with high HL adopt more positive health behaviors.Practical implicationsPublic health professionals may need more sophisticated communication methods to transfer messages regarding vaccines to parents in order to prevent decline in vaccine coverage rates, taking into account levels of trust and health literacy.     

Health literacy as a predictor of emergency department visits and self-rated health among Chinese immigrants: findings from an Australian survey

ObjectivesOur objectives were to examine health literacy among first-generation Chinese immigrants living in Australia, identifying health literacy domains associated with emergency department (ED) visits and self-rated health (SRH).MethodsChinese immigrants (n = 362, mean age = 59) were recruited from communities across New South Wales and surveyed for health literacy, ED visits in the past 12 months, and SRH using the Health Literacy Questionnaire (simplified Chinese version).ResultsMore than 70% of participants experienced health literacy difficulties. Health literacy was significantly lower among the following participants: older, migration at older age, recent immigrants, and those without university level education or proficient English.ED visits were independently associated with the health literacy domains lacking ‘social support for health’ (OR: 1.80; p = .031) and ‘ability to appraise health information’ (OR: 2.22; p = .005). Poor SRH was associated with the health literacy domains ‘insufficient health information’ (OR: 1.81; p = .025), ‘inactively managing health’ (OR: 1.72; p = .048), and ‘lacking ability to appraise health information’ (OR: 1.70; p = .048).ConclusionsInadequate health literacy was identified in the majority of first-generation Chinese immigrants and it had significantly association with higher prevalence of ED use and poorer SRH.Practice implicationsEarly screening and support for health literacy is critical in Chinese immigrants.     

Health literacy in the eHealth era: A systematic review of the literature

ObjectivesThis study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era.MethodsTo identify the relevant literature published since 2010, we performed four rounds of selection—database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications.ResultsThe themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior.ConclusionBarriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy.Practice implicationsEfforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs.