Showing papers in "Journal of Health Communication in 2013"
TL;DR: Improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.
Abstract: Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.
519 citations
TL;DR: Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions and provided further support for the differential benefits of tailored web-based interventions over nontailed approaches.
Abstract: Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N =20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d =.139 (95% CI = .111, .166, p <.001, k =40) and at follow-up, d =.158 (95% CI = .124, .192, p <.001, k =21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participa...
500 citations
TL;DR: Examination of the influence of the social networking site Facebook and face-to-face support networks on depression among college students indicated empirical support for the Relational Health Communication Competence Model, with interpersonal motives predicting increased face- to-face and computer-mediated competence and lower depression scores.
Abstract: This study examined the influence of the social networking site Facebook and face-to-face support networks on depression among (N = 361) college students. The authors used the Relational Health Communication Competence Model as a framework for examining the influence of communication competence on social support network satisfaction and depression. Moreover, they examined the influence of interpersonal and social integrative motives as exogenous variables. On the basis of previous work, the authors propose and test a theoretical model using structural equation modeling. The results indicated empirical support for the model, with interpersonal motives predicting increased face-to-face and computer-mediated competence, increased social support satisfaction with face-to-face and Facebook support, and lower depression scores. The implications of the findings for theory, key limitations, and directions for future research are discussed.
202 citations
TL;DR: An ongoing lack of use or underreporting of the use of theory in social marketing campaigns is highlighted and the call to action for applying and reporting theory to guide and evaluate interventions is reinforced.
Abstract: The existing literature suggests that theories and models can serve as valuable frameworks for the design and evaluation of health interventions. However, evidence on the use of theories and models in social marketing interventions is sparse. The purpose of this systematic review is to identify to what extent papers about social marketing health interventions report using theory, which theories are most commonly used, and how theory was used. A systematic search was conducted for articles that reported social marketing interventions for the prevention or management of cancer, diabetes, heart disease, HIV, STDs, and tobacco use, and behaviors related to reproductive health, physical activity, nutrition, and smoking cessation. Articles were published in English, after 1990, reported an evaluation, and met the 6 social marketing benchmarks criteria (behavior change, consumer research, segmentation and targeting, exchange, competition and marketing mix). Twenty-four articles, describing 17 interventions, met the inclusion criteria. Of these 17 interventions, 8 reported using theory and 7 stated how it was used. The transtheoretical model/stages of change was used more often than other theories. Findings highlight an ongoing lack of use or underreporting of the use of theory in social marketing campaigns and reinforce the call to action for applying and reporting theory to guide and evaluate interventions.
180 citations
TL;DR: The results demonstrate that nurses incorrectly identify patients with low health literacy and overestimates outnumber underestimates 6 to 1, and reinforce previous evidence that health care providers overestimate a patient's health literacy.
Abstract: Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates.
142 citations
TL;DR: 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.
Abstract: 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.
134 citations
TL;DR: In these insured subjects receiving care in integrated health care delivery systems, those with low health literacy were less likely to be up to date on screening for colorectal cancer, but the difference was not statistically significant.
Abstract: Using a multidimensional assessment of health literacy (the Cancer Message Literacy Test-Listening, the Cancer Message Literacy Test-Reading, and the Lipkus Numeracy Scale), the authors assessed a stratified random sample of 1013 insured adults (40-70 years of age) The authors explored whether low health literacy across all 3 domains (n =111) was associated with sets of variables likely to affect engagement in cancer prevention and screening activities: (a) attitudes and behaviors relating to health care encounters and providers, (b) attitudes toward cancer and health, (c) knowledge of cancer screening tests, and (d) attitudes toward health related media and actual media use Adults with low health literacy were more likely to report avoiding doctor's visits, to have more fatalistic attitudes toward cancer, to be less accurate in identifying the purpose of cancer screening tests, and more likely to avoid information about diseases they did not have Compared with other participants, those with lower health literacy were more likely to say that they would seek information about cancer prevention or screening from a health care professional and less likely to turn to the Internet first for such information Those with lower health literacy reported reading on fewer days and using the computer on fewer days than did other participants The authors assessed the association of low health literacy with colorectal cancer screening in an age-appropriate subgroup for which colorectal cancer screening is recommended In these insured subjects receiving care in integrated health care delivery systems, those with low health literacy were less likely to be up to date on screening for colorectal cancer, but the difference was not statistically significant
121 citations
TL;DR: Overweight/obese individuals were significantly more likely than were nonoverweight individuals to be portrayed as headless, with an unflattering emphasis on isolated body parts, from an unflattered rear view of their excess weight, eating unhealthy foods, engaging in sedentary behavior, and dressed in inappropriately fitting clothing.
Abstract: The news media has substantial influence on public perceptions of social and health issues This study conducted a video content analysis to examine portrayals of obese persons in online news reports about obesity The authors downloaded online news videos about obesity (N = 371) from 5 major news websites and systematically coded visual portrayals of obese and nonobese adults and youth in these videos The authors found that 65% of overweight/obese adults and 77% of overweight/obese youth were portrayed in a negative, stigmatizing manner across multiple obesity-related topics covered in online news videos In particular, overweight/obese individuals were significantly more likely than were nonoverweight individuals to be portrayed as headless, with an unflattering emphasis on isolated body parts, from an unflattering rear view of their excess weight, eating unhealthy foods, engaging in sedentary behavior, and dressed in inappropriately fitting clothing Nonoverweight individuals were significantly more likely to be portrayed positively In conclusion, obese children and adults are frequently stigmatized in online news videos about obesity These findings have important implications for public perceptions of obesity and obese persons and may reinforce negative societal weight bias
120 citations
TL;DR: A new conceptual model is introduced that deconstructs the tasks associated with taking prescription drugs; including the knowledge, skills and behaviors necessary for patients to correctly take medications and sustain use over time in ambulatory care.
Abstract: Medication adherence has received a great deal of attention over the past several decades; however, its definition and measurement remain elusive. The authors propose a new definition of medication self-management that is guided by evidence from the field of health literacy. Specifically, a new conceptual model is introduced that deconstructs the tasks associated with taking prescription drugs; including the knowledge, skills and behaviors necessary for patients to correctly take medications and sustain use over time in ambulatory care. This model is then used to review and criticize current adherence measures as well as to offer guidance to future interventions promoting medication self-management, especially among patients with low literacy skills.
109 citations
TL;DR: It is suggested that health organizations need a more strategic approach to managing positive organizational self-presentations in order to create an optimal level of exposure on social networking sites.
Abstract: This study explored health-related organizations' use of Twitter in delivering health literacy messages. A content analysis of 571 tweets from health-related organizations revealed that the organizations' tweets were often quoted or retweeted by other Twitter users. Nonprofit organizations and community groups had more tweets about health literacy than did other types of health-related organizations examined, including health business corporations, educational institutions, and government agencies. Tweets on health literacy topics focused predominantly on using simple language rather than complicated language. The results suggest that health organizations need a more strategic approach to managing positive organizational self-presentations in order to create an optimal level of exposure on social networking sites.
105 citations
TL;DR: The authors offer several explanations for why information seeking predicts healthy lifestyle behaviors: information obtained motivates these behaviors; information sought teaches specific techniques; and the act of information seeking may reinforce a psychological commitment to dieting, eating fruits and vegetables, and exercising.
Abstract: The amount of cancer-related information available to the general population continues to grow; yet, its effects are unclear. This study extends previous cross-sectional research establishing that cancer information seeking across a variety of sources is extensive and positively associated with engaging in health-related behaviors. The authors studied how active information seeking about cancer prevention influenced three healthy lifestyle behaviors using a 2-round nationally representative sample of adults ages 40–70 years (n = 1,795), using propensity scoring to control for potential confounders including baseline behavior. The adjusted odds of dieting at follow-up were 1.51 (95% CI: 1.05, 2.19) times higher for those who reported baseline seeking from media and interpersonal sources relative to nonseekers. Baseline seekers ate 0.59 (95% CI: 0.28, 0.91) more fruits and vegetable servings per day and exercised 0.36 (95% CI: 0.12, 0.60) more days per week at 1-year follow-up compared with nonseekers. The ...
TL;DR: It is found that medical residents used clear communication techniques infrequently and tended to overestimate the clarity with which they communicate.
Abstract: Low health literacy negatively affects processes and outcomes of care. Physicians do not routinely use communication techniques recommended for use with low health literate patients. This study was conducted to compare the self-reported and actual use of clear verbal communication among medical residents and to identify characteristics associated with clear communication. Residents self-assessed their communication behaviors and then completed a low health literacy standardized patient encounter. Answers on the self-assessment were compared with behaviors observed in the standardized patient encounter. Residents (N = 82) reported frequent use of techniques recommended for clear verbal communication, including plain language (88%) and teach-back (48%). However, during the standardized patient encounter, they used an average of 2 jargon terms per minute, and only 22% used teach-back. No resident characteristics consistently predicted better communication. In conclusion, the study found that medical resident...
TL;DR: The hypothesis that, among people high in worry, attempts to increase risk perception could be counterproductive is suggested; the importance of distinguishing worry from risk perception is suggested, and future research is necessary to determine the causal nature of these associations.
Abstract: Worry and risk perceptions are generally found to be independently associated with health-promoting behaviors, although it is unknown whether they interact in ways that potentially dampen the effect of either construct on behavior. In this hypothesis-generating study, cancer-related worry and risk perception, and their interaction, were used to predict odds of meeting 5-a-day fruit and vegetable consumption guidelines and engaging in any exercise using data from a nationally representative sample (N = 10,230). Risk perception was not associated with either behavior; worry was associated only with exercise (OR = 1.77, 95% CI: 1.16, 2.70, p < .01). More important, their interaction was associated with these behaviors in a counterintuitive manner; among those higher in worry, higher levels of risk perception were associated with lower vegetable consumption (OR = 0.79, 95% CI: 0.62, 1.00, p < .05) and exercise (OR = 0.77, 95% CI: 0.63, 0.95, p = .01). These results suggest the hypothesis that, among people hi...
TL;DR: Predictors of perceived H1N1 contraction risk and vaccination intentions among Canadian adults responding to an online questionnaire were determined and vaccination intent was related to the perception that the threat was not particularly great, mistrust of the media to provide accurate information regarding H1n1, and whether individuals endorsed problem-focused versus avoidant coping strategies.
Abstract: Swine flu (H1N1) reached pandemic proportions in 2009, yet ambivalence was met concerning intentions to be vaccinated The present investigation determined predictors of perceived H1N1 contraction risk and vaccination intentions among Canadian adults (N = 1,027) responding to an online questionnaire The relatively low rate of vaccination intent (3012%, and 3499% being unsure of their intent) was related to a sense of invulnerability regarding illness contraction and symptom severity Most individuals were skeptical that H1N1 would be widespread, believing that less than 10% of the population would contract H1N1 Yet, they also indicated that their attitudes would change once a single person they knew contracted the illness Also, worry regarding H1N1 was related to self-contraction risk and odds of individuals seeking vaccination Moreover, vaccination intent was related to the perception that the threat was not particularly great, mistrust of the media to provide accurate information regarding H1N1, a
TL;DR: The results indicate that a virtual advisor delivering culturally and linguistically adapted physical activity advice led to meaningful 4-month increases in walking relative to control among underserved older adults.
Abstract: Electronically delivered health promotion programs that are aimed primarily at educated, health-literate individuals have proliferated, raising concerns that such trends could exacerbate health disparities in the United States and elsewhere. The efficacy of a culturally and linguistically adapted virtual advisor that provides tailored physical activity advice and support was tested in low-income older adults. Forty inactive adults (92.5% Latino) 55 years of age and older were randomized to a 4-month virtual advisor walking intervention or a waitlist control. Four-month increases in reported minutes of walking/week were greater in the virtual advisor arm (mean increase = 253.5 ± 248.7 minutes/week) relative to the control (mean increase = 26.8 ± 67.0 minutes/week; p = .0008). Walking increases in the virtual advisor arm were substantiated via objectively measured daily steps (slope analysis p = .002). All but one intervention participant continued some interaction with the virtual advisor in the 20-week po...
TL;DR: Analysis of the effects of scanning on cancer screening behaviors and prevention behaviors provides substantial support for a claim that routine exposure to health content from nonmedical sources affects specific health behaviors.
Abstract: Research on health information exposure focuses primarily on deliberate information-seeking behavior and its effects on health. By contrast, this study explores the complementary and perhaps more influential role of health information acquired through exposure to routinely used sources, called scanning. The authors hypothesized that scanning from nonmedical sources, both mediated and interpersonal, affects cancer screening and prevention decisions. The authors used a nationally representative longitudinal survey of 2,489 adults 40 to 70 years of age to analyze the effects of scanning on 3 cancer screening behaviors (mammography, prostate-specific antigen [PSA], and colonoscopy) and 3 prevention behaviors (exercising, eating fruits and vegetables, and dieting to lose weight). After adjustment for baseline behaviors and covariates, scanning at baseline predicted weekly exercise days 1 year later as well as daily fruit and vegetable servings 1 year later for those whose consumption of fruits and vegetables was already higher at baseline. Also, among those reporting timely screening mammogram behavior at baseline, scanning predicted repeat mammography. Scanning was marginally predictive of PSA uptake among those not reporting a PSA at baseline. Although there were strong cross-sectional associations, scanning did not predict dieting or colonoscopy uptake in longitudinal analyses. These analyses provide substantial support for a claim that routine exposure to health content from nonmedical sources affects specific health behaviors.
TL;DR: This is the first study of women's knowledge about fertility, aging, and their health literacy, and several demographic factors correlated with knowledge; health literacy and numeracy were both important predictive variables.
Abstract: Female fertility declines dramatically with age, and childbearing at older maternal ages has significant medical consequences for mother and infant that are well-known to health professionals. Despite this, the average maternal age in the United States continues to rise. Many factors likely contribute to this secular trend; to date, no research has examined whether American women are aware of the complications of deferring conception and how this correlates with health literacy. The purpose of this study was to evaluate women's knowledge of the implications of delaying pregnancy. A structured, in-person interview was administered to 300 women between 20 and 50 years of age attending 1 of 2 gynecologic clinics at a single institution. Demographic information, medical history, and gynecologic history were obtained; and participants answered questions about the implications of aging for fertility and pregnancy outcome. Health literacy and numeracy were assessed. Participants demonstrated knowledge deficits about the implications of aging on fertility and pregnancy, and many were unfamiliar with success rates of infertility treatments. Several demographic factors correlated with knowledge; health literacy and numeracy were both important predictive variables. To the authors' knowledge, this is the first study of women's knowledge about fertility, aging, and their health literacy. Awareness of the importance of health literacy and numeracy should inform future educational efforts about fertility.
TL;DR: The authors show that the cognitive mediation model can be applied to health contexts, in which motivations were positively associated with news attention, elaboration, and interpersonal communication, and that the motivations have significant indirect effects on behavioral intentions.
Abstract: This study uses the cognitive mediation model as the theoretical framework to examine the influence of motivations, communication, and news elaboration on public knowledge of the H1N1 pandemic and the intention to take precautionary behaviors in Singapore. Using a nationally representative random digit dialing telephone survey of 1,055 adult Singaporeans, the authors' results show that the cognitive mediation model can be applied to health contexts, in which motivations (surveillance gratification, guidance, and need for cognition) were positively associated with news attention, elaboration, and interpersonal communication. News attention, elaboration, and interpersonal communication in turn positively influence public knowledge about the H1N1 influenza. In addition, results show that the motivations have significant indirect effects on behavioral intentions, as partially mediated by communication (media attention and interpersonal communication), elaboration, and knowledge. The authors conclude that the cognitive mediation model can be extended to behavioral outcomes, above and beyond knowledge. Implications for theory and practice for health communication were discussed.
TL;DR: A substantial evidence base on risk communication is found, but limited research on other trust building communications is found: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources are identified.
Abstract: Population-level compliance with health protective behavioral advice to prevent and control communicable disease is essential to optimal effectiveness. Multiple factors affect perceptions of trustworthiness, and trust in advice providers is a significant predeterminant of compliance. While competency in assessment and management of communicable disease risks is critical, communications competency may be equally important. Organizational reputation, quality of stakeholder relationships and risk information provision strategies are trust moderating factors, whose impact is strongly influenced by the content, timing and coordination of communications. This article synthesizes the findings of 2 literature reviews on trust moderating communications and communicable disease prevention and control. We find a substantial evidence base on risk communication, but limited research on other trust building communications. We note that awareness of good practice historically has been limited although interest and the availability of supporting resources is growing. Good practice and policy elements are identified: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources. Priority areas for future research include process and cost-effectiveness evaluation and the development of frameworks that integrate communication and biomedical disease control and prevention functions, conceptually and at scale.
TL;DR: African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes, and race qualified by an age and race interaction is found.
Abstract: Studies reveal high levels of inadequate health literacy and numeracy in African Americans and older veterans. The authors aimed to investigate the distribution of health literacy, numeracy, and graph literacy in these populations. They conducted a cross-sectional survey of veterans receiving outpatient care and measured health literacy, numeracy, graph literacy, shared decision making, and trust in physicians. In addition, the authors compared subgroups of veterans using analyses of covariance. Participants were 502 veterans (22-82 years). Low, marginal, and adequate health literacy were found in, respectively, 29%, 26%, and 45% of the veterans. The authors found a significant main effect of race qualified by an age and race interaction. Inadequate health literacy was more common in African Americans than in Whites. Younger African Americans had lower health literacy (p <.001), graph literacy (p <.001), and numeracy (p <.001) than did Whites, even after the authors adjusted for covariates. Older and younger participants did not differ in health literacy, objective numeracy, or graph literacy after adjustment. The authors found no health literacy or age-related differences regarding preferences for shared decision making. African Americans expressed dissatisfaction with their current role in decision making (p =.03). Older participants trusted their physicians more than younger participants (p =.01). In conclusion, African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes.
TL;DR: Focus groups explored public perceptions of health causation, attributions of responsibility, and potential solutions in a large U.S. Northeastern state and suggested research paths and possible communication strategies for scholars and advocates.
Abstract: Success in addressing health disparities and their social determinants will require understanding public perceptions of health causation, attributions of responsibility, and potential solutions. To explore these perceptions, the authors conducted 12 focus groups (6 with liberals, 6 conservatives; N = 93 participants) in a large U.S. Northeastern state. Participants communicated highly nuanced views about health causation and disparities, identifying layers of responsibility for health. However, individual behaviors and personal responsibility dominated the discussion and served as a counterargument to the significance of social determinants. Participants also showed limited awareness of the range of policies that could be adopted to address health disparities. As policy initiatives benefit from public support in gaining political traction, the authors suggest research paths and possible communication strategies for scholars and advocates.
TL;DR: Nurse practitioners' knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework and the intention to Use Health Literacy Strategies Behavioral Intention Questionnaire found to be strong.
Abstract: Nurse practitioners' (NPs) knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework. NPs who work in outpatient settings were recruited at a national NP conference. Participants were administered 3 self-report instruments: Health Literacy Knowledge and Experience Survey, Parts I and II; and the Health Literacy Strategies Behavioral Intention Questionnaire. Overall knowledge of health literacy and health literacy strategies was found to be low. Screening patients for low health literacy and evaluating patient education materials were found to be areas of knowledge deficit. Most NP participants used written patient education materials with alternate formats for patient education, such as audiotapes, videotapes, or computer software rarely used. Statistically significant differences were found in mean experience scores between NP level of educational preparation and NP practice settings. The intention to use health literacy strategies in practice was found to be strong. The findings of this investigation offer implications for enhancing NP curriculum and for continuing education opportunities. Increasing NPs' knowledge of health literacy and facilitating the use of health literacy strategies has the potential to change clinical practice and support improved patient outcomes.
TL;DR: Blacks, but not Hispanics, were significantly less likely to seek online information than were Whites, and disparities in the way that women from different backgrounds use the Internet for health-related information could be associated with overall health awareness.
Abstract: To examine the influence of race/ethnicity on seeking health information from the Internet among women aged 16-24 years, the authors conducted a self-administered survey on 3,181 women regarding their Internet use and obtaining information on reproductive health (menstruation, contraception, pregnancy, sexually transmitted infections) and general health from the Internet. The authors performed multivariate logistic regression to examine the association between race/ethnicity and online health-related information seeking after adjusting for covariates. Racial/ethnic disparities were noted in overall Internet use and its use to locate health information. Overall, more White (92.7%) and Black (92.9%) women used the Internet than did Hispanics (67.5%). More White women (79.2%) used it to find health information than did Blacks and Hispanics (70.3% and 74.3%, respectively). Compared with White women, Blacks and Hispanics were less likely to seek information on contraception [(OR 0.73, 95% CI 0.58-0.91) and (OR 0.75, 95% CI 0.61-0.92)] and more likely to seek information on pregnancy tests [(OR 1.67, 95% CI 1.28-2.18) and (OR 1.40, 95% CI 1.09-1.81] and sexually transmitted infections [(OR 1.39, 95% CI 1.11-1.73) and (OR 1.25, 95% CI 1.01-1.54)], respectively. With regard to general health issues-such as how to quit smoking, how to lose weight, alcohol/drug use, mood disorders, and skin disorders-Blacks, but not Hispanics, were significantly less likely to seek online information than were Whites. Disparities in the way that women from different backgrounds use the Internet for health-related information could be associated with overall health awareness.
TL;DR: 5 recommendations are offered for setting a research agenda to advance the science of health literacy measurement: develop a comprehensive unified conceptual framework, leverage the measurement knowledge the field has gained thus far, empirically test frameworks and measures using robust research methods, and use a tiered approach to measuring health literacy.
Abstract: 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.
TL;DR: Health literacy is associated with CRC screening, but English proficiency is also critical to consider, and Asians with both LEP and LHL appear particularly vulnerable to cancer screening disparities.
Abstract: 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.
TL;DR: It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs than those who experienced poor health and those who had more concerns about the quality of their searched information.
Abstract: Increasing numbers of people have turned to the Internet for health information. Little has been done beyond speculation to empirically investigate patients' discussion of online health information with health care professionals (HCPs) and patients' perception of HCPs' reactions to such discussion. The author analyzed data from the 2007 Health Information National Trends Survey (HINTS) to identify the characteristics of patients (a) who search for health information on the Internet, (b) who discuss the information found on the Internet with HCPs, and (c) who positively assess HCPs' reaction to the online information. Findings show that men were more likely than were women to have a conversation on online information with HCPs. It is unfortunate that patients who had trouble understanding or trusting online health information were no more likely to ask questions to or seek guidance from HCPs. Reactions of HCPs to online information were perceived as particularly negative by certain groups of patients, such as those who experienced poor health and those who had more concerns about the quality of their searched information. Results are discussed for their implications for patient empowerment and patient-HCP relationships.
TL;DR: The authors found that top breakfast cereal manufacturers maintain child-oriented websites, using strategies unique to the Internet to capture and maintain children's attention, including branded engagement techniques such as advergames, videos, site registration, and viral marketing.
Abstract: The Institute of Medicine has warned of the harm of food marketing to children from television to new media channels such as the Internet. The authors identified and analyzed the techniques used to engage children on websites from cereal companies--the third largest food marketer to children. The authors found that top breakfast cereal manufacturers maintain child-oriented websites, using strategies unique to the Internet to capture and maintain children's attention. These include branded engagement techniques such as advergames, videos, site registration, and viral marketing, including inviting friends to join the site. The authors found 3 progressive levels of telepresence on child-targeted cereal websites: sites with more than 1 engaging feature, multiple techniques present on individual pages, and the construction of a virtual world. Using Internet traffic data, the authors confirm that these techniques work: cereal marketers reach children online with lengthier and more sophisticated engagements than are possible with traditional, passive media such as television advertisements or product packaging. Despite the cereal manufacturer's self-regulatory pledge to improve their marketing to children, their marketing practices exploit children's susceptibility to advertising by almost exclusively promoting high-sugar cereals using deeply engaging techniques.
TL;DR: A rapid review of the evidence concerning effective strategies for improving health literacy in Europe found substantial gaps in the evidence regarding the most effective population-level health literacy interventions, particularly with regard to communicable diseases.
Abstract: The promotion of health literacy is critical to active and informed participation in health promotion, disease prevention, and health care. This article reports on a rapid review of the evidence concerning effective strategies for improving health literacy. This review was undertaken as part of a series of evidence reviews commissioned by the European Centre for Disease Prevention and Control through the Translating Health Communications Project. The authors searched a range of electronic databases and identified six evidence reviews published between 2000 and 2011. A narrative synthesis of the findings was then conducted. The majority of the published research originated in the United States, and the studies reviewed mainly focused on functional health literacy interventions that occurred in clinical settings. Considerable gaps in the evidence exist regarding the most effective population-level health literacy interventions, particularly with regard to communicable diseases. There is a paucity of intervention studies conducted on this topic in Europe. Implications of the findings for improving population health literacy on the prevention and control of communicable diseases in Europe are considered.
TL;DR: 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.
Abstract: 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.
TL;DR: The authors offer 3 major findings: the 3 primary components in the Integrative Model of Behavioral Prediction predicted the intention to perform hand washing and sanitizing, with self-efficacy being the strongest predictor and unrealistic optimists had significantly lower intentions to performHand hygiene practices compared with realists or unrealistic pessimists.
Abstract: This study aims to determine the utility of constructs from the Integrative Model of Behavioral Prediction in predicting behaviors associated with flu prevention in a college campus. Building on previous studies that document substantial optimistic bias among college students, this study explores possible roles for optimistic bias in the Integrative Model of Behavioral Prediction. The authors conducted an online survey among a stratified random sample (N = 429) of undergraduate students in a university that experienced a large H1N1 influenza outbreak in the fall of 2009. The authors offer 3 major findings: (a) the 3 primary components in the Integrative Model of Behavioral Prediction predicted the intention to perform hand washing and sanitizing, with self-efficacy being the strongest predictor; (b) unrealistic optimists had significantly lower intentions to perform hand hygiene practices compared with realists or unrealistic pessimists; and (c) comparative optimism was a significant moderator of the rela...