Derivation, Evaluation, and Validation of Illustrations of Key Counselling Points for a Pediatric Eczema Action Plan

Background: Current eczema action plans (EAP) are based on written instructions without illustrations. Incorporating validated illustrations into EAPs can significantly improve comprehension and usability. Objective: To produce and validate a set of illustrations for key counselling points of a pediatric EAP. Methods: Illustrations were developed using key graphic elements and refined by subject experts. Illustrations were evaluated during one-on-one structured interviews with parents/caregivers of children ages 9 and younger, as well as with children ages 10 to 17 years between September 2015 and June 2016. The concepts of transparency, translucency, and short-term recall were assessed for validation. Results: Of 245 participants, 81.3% were parents and/or caregivers of children 0 to 9 years old, and 18.7% were children between 10 and 17 years old. A total of 15 illustrations and 2 storyboards were evaluated; 9 illustrations and 2 storyboards were redesigned to reach the preset validation targets. Overall, 13 illustrations and 2 storyboards were validated. Conclusion: A set of illustrations for use in an EAP was prospectively designed and validated, achieving acceptable transparency, translucency, and recall, with input from patients and a multidisciplinary medical team. The incorporation of validated illustrations into eczema action plans benefits patients with limited health literacy. Future studies should evaluate if illustrations improve understanding of eczema management and translate into improved clinical outcomes.

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Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach

Journal of Medical Internet Research ◽

10.2196/26434 ◽

2021 ◽

Vol 23 (9) ◽

pp. e26434

Author(s):

Hani Salim ◽

Ping Yein Lee ◽

Sazlina Sharif-Ghazali ◽

Ai Theng Cheong ◽

Jasmine Wong ◽

...

Keyword(s):

Health Literacy ◽

Action Plan ◽

Real Life ◽

Mobile App ◽

Self Management ◽

Primary Care Center ◽

Long Term Conditions ◽

Web Based ◽

Limited Health Literacy ◽

Limited Health

Background Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

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Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach (Preprint)

10.2196/preprints.26434 ◽

2020 ◽

Author(s):

Hani Salim ◽

Ping Yein Lee ◽

Sazlina Sharif-Ghazali ◽

Ai Theng Cheong ◽

Jasmine Wong ◽

...

Keyword(s):

Health Literacy ◽

Action Plan ◽

Real Life ◽

Mobile App ◽

Self Management ◽

Primary Care Center ◽

Long Term Conditions ◽

Web Based ◽

Limited Health Literacy ◽

Limited Health

BACKGROUND Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). OBJECTIVE The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. METHODS We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. RESULTS The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. CONCLUSIONS This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

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Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-11194-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

H. Salim ◽

S. Shariff Ghazali ◽

P. Y. Lee ◽

A. T. Cheong ◽

N. H. Harrun ◽

...

Keyword(s):

Health Literacy ◽

Action Plan ◽

Cross Sectional Study ◽

Self Management ◽

Cross Sectional ◽

Limited Health Literacy ◽

Healthcare Settings ◽

History Of ◽

Limited Health ◽

Asthma Action Plan

Abstract Background Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings. Method A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy. Results The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001). Conclusion In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.

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Malaysian Health Literacy: Scorecard Performance from a National Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115813 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5813

Author(s):

Norrafizah Jaafar ◽

Komathi Perialathan ◽

Manimaran Krishnan ◽

Nurashma Juatan ◽

Masitah Ahmad ◽

...

Keyword(s):

Health Literacy ◽

Nationwide Survey ◽

Population Based ◽

Average Score ◽

Future Health ◽

Limited Health Literacy ◽

Health Literacy Level ◽

Prevention And Health Promotion ◽

Literacy Level ◽

Limited Health

Health literacy is an indicator of a society’s ability to make better health judgements for themselves and the people around them. This study investigated the prevalence of health literacy among Malaysian adults and provided an overall picture of the society’s current health literacy status, which has not been previously assessed. The study also highlighted socio-demographic markers of communities with limited health literacy that may warrant future intervention. A population-based self-administered survey using the Health Literacy Survey Malaysian Questionnaire18 (HLS-M-Q18) instrument was conducted as part of the National Health Morbidity Survey 2019 in Malaysia. The nationwide survey utilized a two-staged stratified random sampling method. A sample of 9478 individuals aged 18 and above, drawn from the living quarter list, participated in the study. The health literacy score was divided into three levels; limited, sufficient, and excellent. Findings showed a majority of the Malaysian population had a sufficient health literacy level in all three domains—healthcare, diseases prevention and health promotion (49.1%, 44.2%, and 47.5%, respectively)—albeit leaning towards the lower end of the category with an average score of 35.5. The limited health literacy groups were prevalent among respondents with older age (68%), lower education level (64.8%), and lower household income (49.5%). The overall health literacy status for Malaysia was categorized at a lower sufficiency level. Future health literacy improvements should focus on communities with a limited health literacy level to improve the overall score.

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Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study

BMC Nephrology ◽

10.1186/s12882-021-02464-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Annabel Boyer ◽

Yannick Begin ◽

Julie Dupont ◽

Mathieu Rousseau-Gagnon ◽

Nicolas Fernandez ◽

...

Keyword(s):

Health Literacy ◽

Observational Study ◽

Health Information ◽

Healthcare Providers ◽

Significant Proportion ◽

Good Health ◽

Sufficient Information ◽

Home Dialysis ◽

Limited Health Literacy ◽

Limited Health

Abstract Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

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31.C. Workshop: Development and implementation of action plans on health literacy

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1396 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Public Health ◽

Health Care ◽

Health Literacy ◽

Health Information ◽

Digital Health ◽

Action Plan ◽

Knowledge Society ◽

Implementation Strategies ◽

Social Consequences ◽

Action Plans

Abstract Health literacy (HL) has become an important topic in many countries. As HL - meaning the ability to access, understand, appraise and apply health information (Sørensen et al. 2012) - is important to make sound health decisions, to promote health and to take an active part in managing health and illness in everyday life and navigating the health care system. In the modern digital knowledge society, HL is also indispensable for orienting oneself in the abundance of mostly digital health information, including incorrect and false information, for locating reliable information and for assessing the trustworthiness and quality of information. However, available studies show that HL is insufficient in many countries. Low HL has - as many studies show - negative social consequences ranging from unhealthy behaviour, higher risk for diseases, less self-care and deficits in coping with illness and chronicity, to over- and misuse (extensive use) of health care. The promotion of HL is therefore an important public health task. An increasing number of population studies and policy documents currently underline this. The WHO has therefore included HL into many of its strategies, like the declarations of Shanghai (2016) and Astana (2018), and has published several publications focusing on HL, like the Solid Facts (2013), the 57th Health Evidence Network Report (2018) or the Roadmap for Implementing Health Literacy Activities (2019). In many countries, strategies and national action plans to improve HL have been developed in response to the political call for action, e.g. in Scotland, Germany and recently also in Portugal. Other countries and regions are currently working on the development of a HL action plan, e.g. Belgium and the WHO European Region action plan on HL. The development and especially the implementation strategies of action plans in different countries and the experiences gained will be discussed comparatively in the workshop. Following an introduction (10'), two countries, which already have action plans will introduce their implementation strategy in one presentation each: Germany and Portugal (30'). This will be followed by two presentations of countries/regions in which action plans are currently being developed: Belgium and WHO Europe (30'). Afterwards the participants will have the opportunity to ask questions and discuss on the different strategies (20'). The workshop will help other initiatives to successfully develop and implement policy plans and strategies in different fields of public health. Key messages Strategies and national action plans to improve HL have been developed in different countries/regions. It is important to reflect on the chosen development and implementation strategies and to discuss their effects, successes and barriers.

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Instructions for masking the taste of medication for children

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163516669383 ◽

2016 ◽

Vol 150 (1) ◽

pp. 52-59 ◽

Cited By ~ 4

Author(s):

Régis Vaillancourt ◽

Yen Truong ◽

Shazya Karmali ◽

Amanda Kraft ◽

Selina Manji ◽

...

Keyword(s):

High School ◽

Health Literacy ◽

School Health ◽

Clinical Impact ◽

Pediatric Hospital ◽

Structured Interviews ◽

Short Term ◽

Low Health Literacy ◽

Health Literacy Level ◽

Literacy Level

Background: Medications that taste unpleasant can be a struggle to administer to children, most often resulting in low adherence rates. Pictograms can be useful tools to improve adherence by conveying information to patients in a way that they will understand. Methods: One-on-one structured interviews were conducted with parents/guardians and with children between the ages of 9 and 17 years at a pediatric hospital. The questionnaire evaluated the comprehension of 12 pictogram sets that described how to mask the taste of medications for children. Pictograms understood by >85% of participants were considered validated. Short-term recall was assessed by asking participants to recall the meaning of each pictogram set. Results: There were 51 participants in the study—26 (51%) were children aged 9 to 17 years and 25 (49%) were parents or guardians. Most children (54%) had health literacy levels of grade 10 or higher. Most parents and guardians (92%) had at least a high school health literacy level. Six of the 12 pictogram sets (50%) were validated. Eleven of 12 pictogram sets (92%) had a median translucency score greater than 5. All 12 pictogram sets (100%) were correctly identified at short-term recall and were therefore validated. Conclusion: The addition of validated illustrations to pharmaceutical labels can be useful to instruct on how to mask the taste of medication in certain populations. Further studies are needed to assess the clinical impact of providing illustrated information to populations with low health literacy.

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Can Screening Items Identify Surgery Patients at Risk of Limited Health Literacy?

Journal of Surgical Research ◽

10.1016/j.jss.2007.01.029 ◽

2007 ◽

Vol 140 (2) ◽

pp. 208-213 ◽

Cited By ~ 75

Author(s):

Lorraine S. Wallace ◽

David C. Cassada ◽

Edwin S. Rogers ◽

Michael B. Freeman ◽

Oscar H. Grandas ◽

...

Keyword(s):

At Risk ◽

Health Literacy ◽

Limited Health Literacy ◽

Patients At Risk ◽

Limited Health

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AB0300 LUPUS DISEASE ACTIVITY CORRELATES WITH QUALITY OF LIFE BUT NOT WITH HEALTH LITERACY STATUS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.581 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1176.2-1176

Author(s):

E. Eraslan ◽

R. Bilici Salman ◽

H. Satiş ◽

A. Avanoglu Guler ◽

H. Karadeniz ◽

...

Keyword(s):

Quality Of Life ◽

Health Literacy ◽

Disease Activity ◽

Lupus Erythematosus ◽

Patient Reported Outcome ◽

The Body ◽

Limited Health Literacy ◽

Patient Reported ◽

Limited Health

Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology that can affect any organ of the body. SLE is associated with adverse effects on both health and non-health-related quality of life (HRQOL and non-HRQOL). Lupus PRO is a patient reported outcome measure that has been validated in many languages. It has 44 items that cover both HRQOL and non-HRQOL (1). Health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Multiple studies indicate that people with limited health literacy have worse health status and higher rates of hospitalization (2).Objectives:We aimed to evaluate the relationship between the LLDAS (Lupus Low Disease Activity State) criteria and the Lupus PRO test, as well as the health literacy status of lupus patients.Methods:83 SLE patients (94% women) were included in the study. We performed Lupus PRO and the European Health Literacy Survey tests during the routine follow-up visits of lupus patients to our rheumatology outpatient clinic and admissions to rheumatology inpatient clinic. Available clinical data on medical records were obtained, physician global assessments (PGA) were recorded by the attending physician.Results:LLDAS criteria strongly and inversely correlated with the total score, as well as the mood subunit of the Lupus PRO. Similarly, it also significantly inversely correlated with the body appearence and goals subunits. Health literacy status of the patients did not correlate with their LLDAS scores, ie their disease activities.Conclusion:Our results suggest that lupus disease activity, assessed by LLDAS criteria, significantly correlates with measures of quality of life, spesicifically Lupus PRO test, but not with health literacy status. Further studies are needed to evaluate if health literacy is related with damage, hospitalization or mortality associated with lupus.References:[1]Jolly M, Pickard AS, Block JA, Kumar RB, Mikolaitis RA, Wilke CT, et al., editors. Disease-specific patient reported outcome tools for systemic lupus erythematosus. Seminars in arthritis and rheumatism; 2012: Elsevier.[2]Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. Journal of general internal medicine. 2005;20(2):175-84.Disclosure of Interests:None declared

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Health Literacy—How do we Improve the Conversation at the Heart of Healthcare When We Know so Many People are Struggling with It?

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00117 ◽

2019 ◽

Vol 39 (1) ◽

pp. 13-18

Author(s):

Blythe Robertson ◽

Annamarie Horne ◽

Eleri Williams

Keyword(s):

Health Literacy ◽

Action Plan ◽

Action Plans ◽

Key Points ◽

Scottish Government

The Scottish Government published “Making it Easy – A Health Literacy Action Plan for Scotland” in 2014, and in 2017 the next steps were set out in “Making it Easier – A Health Literacy Action Plan for Scotland 2017–2025.” This article discusses what health literacy is, outlining the key points from these national action plans. The importance of understanding and addressing health literacy in relation to renal services, and dialysis in particular, is highlighted by use of an example of a Scottish renal unit's practice to outline the principles being used in a service.

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