Back to the Basics

Health literacy is a critical foundation that needs to be considered prior to the development and deployment of consumer e-health technologies. The authors indicate the problems associated with the lack of effective health literacy strategies in current consumer e-health interventions and then present a patient-centered, disease-specific, task-relevant, and contextualized health literacy approach. The goal of such an approach is to help patients better understand their illnesses make sense of their health data, make informed decisions, and more effectively manage their health conditions. The authors make five recommendations concerning health literacy in order to make e-health interventions effective. They also describe next-generation health literacy interventions that take advantage of emerging technologies such as speech recognition, natural language processing, artificial intelligence, automatic translation, and augmented reality. Finally, the authors point out a research and development direction towards an intelligent, integrated, and connected consumer e-health solution.

Stroke Literacy Video for Patients and Families: Symptoms, Risk Factors, and Prevention (Preprint)

BACKGROUND Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy, an understanding of stroke symptoms, risk factors, and treatment, likely contributes to vascular risk factor control and in turn stroke recurrence risk. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce stroke recurrence. However, failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. OBJECTIVE To develop a video-based educational intervention to improve stroke literacy in hospitalized acute stroke patients. METHODS The 6-step iterative process of Intervention Mapping (IM) was used to develop a video-based educational intervention and related implementation and evaluation plans. RESULTS A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. CONCLUSIONS An IM approach guided the development of a video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support wide-spread access and participation in video-based health literacy interventions for the stroke population. Studies are needed to assess the impact of video-based educational interventions paired with stroke systems of care optimization to promote stroke recurrence risk reduction. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1371/journal.pone.0171952

Links of Perceived Pornography Realism with Sexual Aggression via Sexual Scripts, Sexual Behavior, and Acceptance of Sexual Coercion: A Study with German University Students

Exposure to pornographic material has been linked to sexual aggression perpetration and victimization in a large body of research. Based on social learning theory and 3A theory of script learning, this study contributes to this research by testing the hypothesis that the more realistic pornography is perceived to be by young adults, the more likely they are to experience and engage in sexual aggression. Two underlying pathways were proposed: one path via scripts and patterns of sexual behavior regarding consensual sexual interactions that contain established risk factors for sexual aggression victimization and perpetration, and a second path via the acceptance of sexual coercion. In a cross-sectional study, 1181 university students in Germany (762 female; 419 male) completed measures of pornography use and perception, risky sexual scripts and sexual behavior, and acceptance of sexual coercion. As predicted, pornography realism was a positive predictor of risky sexual scripts, risky sexual behavior, and acceptance of sexual coercion. Indirect links with sexual aggression victimization and perpetration were found via both pathways. No gender differences in the associations were found. The implications for media literacy interventions addressing the realism of pornography are discussed.

Does Digital Literacy Empower Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review

Background: The vast majority (90%) of the world's adolescents aged 10–19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in LMICs.Methods: We conducted a systematic review of studies following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. The collected data include the design of the study, type of digital literacy intervention, target audience, intervention received, intervention reach, data analysis, and study outcomes. The review is registered with PROSPERO (CRD42020216756).Results: Thirty-five studies met the eligibility for inclusion and of those, 11 were experimental studies (randomized controlled trial = 6; quasi-experimental = 2; before-after with no control = 3), 11 were cross-sectional/descriptive studies, seven studies used a mixed-method approach, and six were qualitative studies on digital literacy interventions to empower young girls in LMICs. The majority of digital literacy interventions were designed and implemented to improve sexual and reproductive health rights and decision-making of adolescent girls in LMICs (n = 33). Only three papers reported the use of digital media for health-related information and decision making, while only one reported on educational and social empowerment.Discussion: Our findings suggest that digital literacy interventions such as mobile phones, mobile health tools, media exposure, access to the internet, internet-based educational strategies, social media exposure are effective to empower adolescent girls to access health services and information and also enhance the access to educational resources. However, we found inconclusive evidence on the effectiveness of digital literacy to enhance girls' access to financial services and economic empowerment. More rigorous studies with long-term follow-ups to assess the effectiveness of such interventions to empower adolescent girls in LMICs are urgently needed.

Reading and Literacy Interventions for Improving Reading and Motivation in Adolescence: A Narrative Review

Reading interventions measuring motivational outcomes in adolescence vary in terms of their theoretical frameworks, methodological approaches and findings. However, a review of these is not currently available. Drawing on narrative review principles, this article synthesises academic and grey literature to outline the breadth and scope of interventions which have measured changes in adolescents’ reading motivation and reflects upon those interventions identified. Key characteristics from the existing literature include a strong focus on struggling readers and skills-based goals. Outcomes of reading interventions measuring motivational effects among adolescents are mixed, and often not explicitly grounded in theory. There is also a notable absence of research taking account of the opinions and experiences of adolescents. There is need for much deeper exploration of “what works” for motivating adolescents to read; this should be based in established theory and centre the experiences of adolescents themselves.

Contribution of Risk Perception and Communication in Aviation Safety Events

Although effective risk management during operations relies on risk perception and risk communication, the aviation industry has not systematically considered the contribution of these two constructs to safety events. This study analyzed a representative sample of safety investigation reports (1) to identify the degree to which risk perception and communication and their factors have been influential overall and across various flight operation stages of investigated events, and (2) to examine whether their contribution has changed with time. The analysis of 140 reports showed environmental factors affected risk communication and perception most frequently, whereas emotional and physiological factors were found in the sample with very low frequencies. Also, risk communication and perception and their factors did not appear with the same frequency across the various flight stages, and a few variations were observed over time. The aviation industry could consider the results of this study to steer its efforts toward mitigating the adverse effects of factors related to ineffective risk perception and communication. This could include the inclusion of respective factors in safety reporting schemes, investigation methods and analyses and, possibly, a tailored approach to the various flight stages and targeted risk literacy interventions.

Advised or Paid Way to get it right. The contribution of fact-checking tips and monetary incentives to spotting scientific disinformation

Disinformation about science can impose enormous economic and public health burdens. Several types of interventions have been proposed to prevent the proliferation of false information online, where most of the spreading takes place. A recently proposed strategy to help online users recognise false content is to follow the techniques of professional fact checkers, such as looking for information on other websites (lateral reading) and looking beyond the first results suggested by search engines (click restraint). In two preregistered online experiments (N = 5387), we simulated a social-media environment and set-out two interventions, one in the form of a pop-up meant to advise participants to follow such techniques, the other based on monetary incentive. In Experiment 1, we compared these interventions to a control condition. In Experiment 2 another condition was added to test the joint impact of the pop-up and the monetary incentive. We measured participants' ability to identify whether presented information was scientifically valid or invalid. Results revealed that while monetary incentives were overall more effective in increasing accuracy, the pop-up contributed when the post originated from an unknown source (and participants could rely less on prior information). Additional analysis on participants’ search style based on both self-report responses and objectively measured behaviour revealed that the pop-up increased the use of fact-checking strategies, and that these in turn increased accuracy. Study 2 also clarified that the pop-up and the incentive did not interfere with each other, but rather acted complementarily, suggesting that attention and literacy interventions can be designed in synergy.

Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island

Background: Low socio-economic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socio-economic setting. Methods: This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N=907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c=5.5-5.6% and FCBG=1.00-1.09 g/L]. Medical, socio-cultural, and socio-economic characteristics were collected via a face-to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey. Results: Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N=417), 77.7% (95% CI=73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI=9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with non-use of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI=1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI=1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI=1.46-6.57). Conclusion: Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socio-economic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.

A Systematic Review of Interventions for Multilingual Preschoolers With Speech and Language Difficulties

Purpose There is a shortage of information on evidence-based interventions for supporting young multilingual children. The purpose of this review was to identify interventions that have been evaluated with preschool-age multilingual children with a speech and/or language disorder or who are at risk of poor speech, language, literacy, and/or educational outcomes. Method This review considered speech, language, and early literacy interventions evaluated with preschool-age multilingual children with a speech and/or language disorder or who have been identified as being at risk of language difficulties (PROSPERO ID: 165892). The following electronic databases were searched: EBSCO (CINAHL Plus, ERIC, PsycINFO, Medline, Education) and Linguistics, Language, and Behavior Abstracts. Data were extracted describing article, participant, methodological, and intervention variables, and effect sizes. The Council for Exceptional Children's (CEC) standards for evidence-based practice were used to examine the quality of studies. Results Fifty-six relevant studies were identified in 52 articles and these studies described 4,551 participants who had speech sound disorder (six articles), developmental language disorder (11 articles), or were considered to be at risk (36 articles). The interventions targeted speech production (seven studies), language (45 studies), and early literacy (11 studies) skills. Most studies reported positive effects. Only 15 studies met all quality indicators specified by the CEC (2014) and these described 18 interventions targeting language and literacy skills. The only intervention with sufficient evidence to be considered an evidence-based practice was Nuestros Niños [Our Children] for children's early literacy and phonological awareness skills. Conclusions A number of high-quality studies exist that describe speech, language and/or literacy interventions for preschool-age multilingual children with a speech and/or language disorder, or who have been identified as being at risk of language difficulties. However, there remains limited evidence for specific interventions as to their ability to inform evidence-based practices. Supplemental Material https://doi.org/10.23641/asha.16632649