养老机构老年人健康素养与身体健康和心理健康状况的关系

目的了解养老机构老年人健康素养与身体健康、心理健康状况的关系,为进一步提高老年人身体健康和心理健康状况提供科学依据。方法于2011年9月至2012年6月,采用整群抽样法对新疆乌鲁木齐市、昌吉市、石河子市、克拉玛依市44所养老机构1396名老年人进行调查,将其中符合纳入标准的1452名老年人作为研究对象,发放健康素养量表、健康状况问卷及一般状况量表。结果单因素分析结果显示,养老机构老年人身体健康在性别、教育水平、家庭收入、婚姻状况方面差异均有统计学意义（P〈0．01,P〈0．05）;心理健康在教育水平、家庭收入、婚姻状况、曾经从事职业方面差异均有统计学意义（P〈0．01）。进一步分析表明,教育水平低、家庭收入少及丧偶老年人身体健康、心理健康状况较差。养老机构老年人健康素养总分数为（71．74±28．35）分,4个维度分别为健康知识（32．49±16．88）分、健康信念（22．80±7．41）分、健康行为（9．60±3．91）分、健康技能（6．22±5．09）分,均处于较低水平。多元线性回归分析表明,养老机构老年人身体健康的独立影响因素有健康行为、教育水平、婚姻状况、曾经从事职业（P〈0．05）,心理健康的独立影响因素有健康行为、曾经从事职业、家庭人口数、健康技能、教育水平、婚姻状况（P〈0．05）。结论健康素养是影响老年人身体、心理健康状况的重要因素,提高老年人健康素养是促进老年人自我健康管理和健康状况的重要途径。     

辽宁省丹东市城乡居民健康素养水平调查分析

目的了解辽宁省丹东市城市与农村居民健康素养的具备情况,为进一步提高居民健康素养整体水平提供参考和建议。方法采用多阶段分层整群抽样的方法,抽取本地区城市和农村居民共1000人,采取国家统一设计的《2010年中国公民健康素养调查问卷》进行问卷调查。结果城市居民具备健康素养的比例（13.43%）高于农村居民（9.04%）,差异有统计学意义（P〈0.05）;城市居民在基本知识和理念（23.65%）和基本技能（24.65%）两个方面均高于农村居民,差异有统计学意义（P〈0.05）;城市居民对科学健康观（39.88%）、传染病预防（23.45%）、慢性病预防（11.02%）和安全与急救（36.67%）4类健康素养具备率高于农村居民,差异有统计学意义（P〈0.05）。结论丹东市城乡居民健康素养具备情况存在不平衡现象,城市要高于农村,提示应加大农村健康教育力度,大力提高农村居民健康素养水平。     

内蒙古自治区居民健康素养现状及影响因素分析

目的了解内蒙古自治区居民健康素养水平及影响因素,为政府和卫生计生行政部门制定相关政策提供科学依据。方法采用分层多阶段整群随机抽样方法,抽取10个盟市3600名15-69岁城乡常住人口。用中国健康教育中心编制的《全国居民健康素养监测调查问卷》进行问卷调查,利用多元逐步回归分析进行评价并分析影响因素。结果内蒙古居民健康素养水平为6.8%,平均得分为（56.50±16.60）分。其中调查对象对基本知识和理念素养中的法规政策、健康的理解和环境与职业的素养水平较高,分别为79.4%、73.5%和55.1%。对基本知识和理念素养中的生理卫生常识、基本知识中的安全与急救和慢性病防治的素养水平较低,分别为3.0%、0.9%和0.5%。多因素分析结果显示,年龄、民族、文化程度和是否患有慢性病是健康素养得分影响因素,其中文化程度是主要影响因素（β=3.849,95%CI：3.252-4.218）。结论开展有针对性的健康促进与健康教育活动,从而促进内蒙古地区居民形成健康生活方式与行为。     

高校学生电子媒介健康素养量表的编制及评价

目的编制适合高校学生的电子媒介健康素养量表,并评价该量表的信度和效度。方法通过将eHealth Literacy Scale（eHEALS）翻译为中文,结合文献、定性访谈、预测试进行修订。使用修订后的量表对1163名高校学生的电子媒介健康素养进行评估。结果高校学生电子媒介健康素养量表由20个条目组成,分为3个纬度：健康信息获取能力和健康信息评价能力和健康信息实践能力。量表各个维度的Cronbach＇s α系数在0.836-0.895之间,量表的所有条目的Cronbach＇s α 系数为0.915,说明量表具有较好的内部一致性。量表的因子分析载荷系数在0.451～0.829之间,3个维度与其对应的条目的相关系数有统计学意义（P〈0.05）。1163名学生所得的总分为（68.03-4-13.04）分,各条目平均（3.40±0.08）分。结论高校学生电子媒介健康素养量表有较好的的结构效度、内容效度和内部一致性,可作为评估高校学生电子媒介健康素养的工具。     

Asthma outcomes are poor among older adults with low health literacy

Objective: To examine the association of health literacy (HL) with asthma outcomes among older asthmatics. Methods: The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1?s (FEV₁) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life. HL was assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Multivariate logistic regression models controlled for age, sex, race, income, general health and years with asthma. Results: Among 433 individuals, 36% had low HL, 55% were over age 65, 38% were Hispanic and 22% were black. Poor asthma control was reported by 40% and 32% had FEV₁ <70% of predicted; 9% had a hospital stay, 23% had an ED and 38% had poor quality of life. In multivariable analysis, individuals with low HL were more likely to have FEV₁ <70% predicted (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.39–3.94, p?=?0.001), hospitalizations (OR 2.53, 95% CI 1.17–5.49, p?=?0.02) and ED visits for asthma (OR 1.81, 95% CI 1.05–3.10, p?=?0.03). There were no differences in self-reported asthma control and quality of life. Conclusions: Low HL is associated with poor asthma control by objective measure, and greater likelihood of ED visits and hospitalization. HL is a modifiable target for interventions to improve asthma outcomes in the elderly.     

Socio-economic correlates of functional health literacy among patients of primary health care in Kosovo

Objectives

Functional health literacy (FHL) has been related to individual characteristics, ill-health and disease knowledge. However, the information about FHL in Kosovo is very limited and thus the aim of this study was to assess the demographic and socio-economic correlates of FHL among users of primary health care in Kosovo, a postconflict country in the Western Balkans.

Study design

Cross-sectional study.

Methods

A cross-sectional study was conducted in Kosovo between November 2012–February 2013, including a representative sample of 1035 consecutive primary care users aged ≥18 years (60% females; overall mean age: 44.3 ± 16.9 years; overall response rate: 86%). Test of Functional Health Literacy in Adults (TOFHLA) was used to assess FHL. General linear model and logistic regression were used to assess the association of TOFHLA score with demographic and socio-economic characteristics.

Results

Overall, four out of five participants exhibited inadequate or marginal FHL in this Kosovo sample. FHL score was independently and inversely related to age, but positively associated with educational attainment and being in a situation other than unemployed.

Conclusions

Limited or marginal FHL was very common among primary care users in Kosovo and considerably higher than in the neighbouring Serbia. The low health literacy levels in Kosovo may provide an additional barrier towards achievement of health care goals. There is a need to design and implement suitable and effective educational and health system interventions in the Kosovo context.     

Improving organizational capacity to address health literacy in public health: a rapid realist review

Objectives

Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services.

Study design

A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group.

Methods

Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited.

Results

Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing electronic materials, community organizations and school-based programs. Contextual factors for success include positive leadership models, interorganizational relationships, and a culture committed to experimentation and learning. Potential mechanisms activated by strategies and contextual factors include increased visibility and recognition of health literacy efforts, enthusiasm and momentum for health literacy activities, reduced cognitive dissonance between vision and action, a sense of ownership for health literacy data, and creation of a common language and understanding.

Conclusions

Government initiated interventions and policies are powerful strategies by which organizational capacity to improve health literacy may be affected. Using the foundations created by the government policy environment, organizations may improve the impact of health literacy interventions through supported distributed leadership.