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Screening for low literacy among adult caregivers of pediatric patients.

BACKGROUND AND OBJECTIVES: The association between functional illiteracy and poor health has led to pediatric literacy promotion programs in the primary care setting. These interventions do not address linked parental literacy needs. An obstacle to referring adults to literacy services is the lack of an instrument that can efficiently identify individuals who could benefit from such programs. We sought to identify screening items sufficiently simple to use in clinical practice. METHODS: This cross-sectional study examined 98 adult primary caregivers of preschool children seen in an inner-city primary care setting. Literacy level and 17 variables predicted to be associated with low literacy were assessed. RESULTS: Three items were independently associated with a 6th grade reading level: (1) less than 12th grade completion, (2) not living with the child's other parent, and (3) not reading for pleasure. Receiver operating characteristic (ROC) curve analysis indicates that, used together, these variables have discriminant capacity, with an area under the ROC curve of.76. CONCLUSIONS: Three items for use in a simple screening instrument for parental low literacy were identified. Used together, they had favorable characteristics but must be further tested for generalizability.

Adult↗

Inadequate functional health literacy in Spanish as a barrier to cervical cancer screening among immigrant Latinas in New York City.

INTRODUCTION: The objective of this study was to examine the association between inadequate functional health literacy in Spanish among low-income Latinas aged 40 and older and cervical cancer screening knowledge and behavior. METHODS: Spanish-speaking Latinas aged 40-78 of various nationalities (n = 205) participated in a study that included a survey on cervical cancer knowledge and behavior administered in Spanish and the Spanish version of the Test of Functional Health Literacy in Adults. RESULTS: Compared to those with adequate and marginal health literacy, women with inadequate functional health literacy in Spanish were significantly less likely to have ever had a Papanicolaou (Pap) test (odds ratio, 0.12; 95% confidence interval [CI], 0.04-0.37) or in the last three years (odds ratio, 0.35; 95% CI, 0.18-0.68) and were significantly more likely to have had their last Pap test at a local public hospital (odds ratio, 2.43; 95% CI, 1.18-4.97). Even when controlling for other factors, women with inadequate health literacy were 16.7 times less likely (adjusted odds ratio, 0.06; 95% CI, 0.01-0.55) to have ever had a Pap test. CONCLUSION: Almost half of the population we studied will have difficulty interpreting written medical materials, even in Spanish. When developing efforts to reach women who have not been screened, programs and service providers need to be aware that the women most in need of information about screening may be more likely to be unable to read any written materials provided to them, regardless of the language or level of simplicity of the materials. Programs and strategies need to be implemented to increase screening prevalence and to minimize the identified gaps in regular screening for Latinas who have low health literacy.

Adult↗

Library outreach: overcoming health literacy challenges.

OBJECTIVE: This paper examines the powerful influences of consumer health literacy on access to and use of relevant health information. METHOD: The paper describes how widespread problems with health literacy significantly limit effective dissemination of relevant health information in society, especially to many vulnerable populations where health literacy challenges are especially pervasive. RESULTS: The paper examines strengths and weaknesses of different programs for addressing health literacy problems, including educational programs, message design programs, and strategic communication training and intervention programs. IMPLICATIONS: The paper evaluates strategies that can be implemented throughout the modern health care system to address problems of health literacy by improving health information access, processing, and understanding. It concludes by examining several strategies that libraries can adopt to overcome many health literacy challenges.

Community-Institutional Relations↗

Functional health literacy of patients with rheumatoid arthritis attending a community-based rheumatology practice.

OBJECTIVE: To determine the health literacy of patients with rheumatoid arthritis (RA) attending community-based rheumatology practice. METHODS: Eighty patients were administered the Test of Functional Health Literacy in Adults (TOFHLA), a 50-item reading comprehension and 17-item numerical ability test (score 0-100); the Rapid Estimate of Adult Literacy in Medicine (REALM), which asks participants to read aloud 66 words of varying difficulty (score 0-66); and the Test of Reading Comprehension (TORCH), which asks participants to read a short text and then fill in the gaps of another version by using one or more of their own words (score 1-9). RESULTS: The study group included 60 women (75%), mean age (SD) 60.29 (15.02) years, median duration of RA 8 years (range 0.3-39). Nineteen of 80 (24%) had completed or= 11 years. TOFHLA and REALM scores ranged from 39-100 and 41-66 respectively. Scores for 8 patients (10%) indicated they would have difficulty reading and interpreting health texts and struggle with most currently available patient education materials. Of those who attempted the TORCH, 8/65 (12%) scored low or below average and 23/65 (35%) scored average compared with students completing 9th grade. All 3 literacy tests were significantly correlated with education level, but use of educational level alone as a measure of literacy would have misclassified more than 10% as health literate/illiterate. CONCLUSION: A significant number of patients with RA have limited health literacy and may not understand even simple written instructions or prescription labels.

Adult↗

Assessing AI literacy and attitudes among medical students: implications for integration into healthcare practice.

PURPOSE: This study aims to assess AI literacy and attitudes among medical students and explore their implications for integrating AI into healthcare practice. DESIGN/METHODOLOGY/APPROACH: A quantitative research design was employed to comprehensively evaluate AI literacy and attitudes among 374 Lusaka Apex Medical University medical students. Data were collected from April 3, 2024, to April 30, 2024, using a closed-ended questionnaire. The questionnaire covered various aspects of AI literacy, perceived benefits of AI in healthcare, strategies for staying informed about AI, relevant AI applications for future practice, concerns related to AI algorithm training and AI-based chatbots in healthcare. FINDINGS: The study revealed varying levels of AI literacy among medical students with a basic understanding of AI principles. Perceptions regarding AI's role in healthcare varied, with recognition of key benefits such as improved diagnosis accuracy and enhanced treatment planning. Students relied predominantly on online resources to stay informed about AI. Concerns included bias reinforcement, data privacy and over-reliance on technology. ORIGINALITY/VALUE: This study contributes original insights into medical students' AI literacy and attitudes, highlighting the need for targeted educational interventions and ethical considerations in AI integration within medical education and practice.

Students, Medical↗

Experiments in digital literacy.

Having digital literacy requires more than just the ability to use software or to operate a digital device; it includes a large variety of complex skills such as cognitive, motoric, sociological, and emotional that users need to have in order to use digital environments effectively. A conceptual model that was recently described by the authors suggests that digital literacy comprises five major digital skills: photo-visual skills ("reading" instructions from graphical displays), reproduction skills (utilizing digital reproduction to create new, meaningful materials from preexisting ones), branching skills (constructing knowledge from non-linear, hypertextual navigation), information skills (evaluating the quality and validity of information), and socio-emotional skills (understanding the "rules" that prevail in cyberspace and applying this understanding in online cyberspace communication). The present paper presents results from a performance-based pioneer study that investigated the application of the above digital literacy skills conceptual model among different groups of scholars. Results clearly indicate that the younger participants performed better than the older ones, with photo-visual and branching literacy tasks, whereas the older participants were found to be more literate in reproduction and information literacy tasks. Research results shed light on the cognitive skills that users utilize in performing with digital environments, and provide educators and software developers with helpful guidelines for designing better user-centered digital environments.

Adolescent↗

Online health information and low-literacy African Americans.

African Americans with low incomes and low literacy levels disproportionately suffer poor health outcomes from many preventable diseases. Low functional literacy and low health literacy impede millions of Americans from successfully accessing health information. These problems are compounded for African Americans by cultural insensitivity in health materials. The Internet could become a useful tool for providing accessible health information to low-literacy and low-income African Americans. Optimal health Web sites should include text written at low reading levels and appropriate cultural references. More research is needed to determine how African Americans with low literacy skills access, evaluate, prioritize, and value health information on the Internet.

Black or African American↗

Implementation and evaluation of a low-literacy diabetes education computer multimedia application.

OBJECTIVE: To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population. RESEARCH DESIGN AND METHODS: Five public clinics in Chicago, Illinois, participated in the study with computer kiosks installed in waiting room areas. Two hundred forty-four subjects with diabetes were randomized to receive either supplemental computer multimedia use (intervention) or standard of care only (control). The intervention includes audio/video sequences to communicate information, provide psychological support, and promote diabetes self-management skills without extensive text or complex navigation. HbA(1c) (A1C), BMI, blood pressure, diabetes knowledge, self-efficacy, self-reported medical care, and perceived susceptibility of complications were evaluated at baseline and 1 year. Computer usage patterns and implementation barriers were also examined. RESULTS: Complete 1-year data were available for 183 subjects (75%). Overall, there were no significant differences in change in A1C, weight, blood pressure, knowledge, self-efficacy, or self-reported medical care between intervention and control groups. However, there was an increase in perceived susceptibility to diabetes complications in the intervention group. This effect was greatest among subjects with lower health literacy. Within the intervention group, time spent on the computer was greater for subjects with higher health literacy. CONCLUSIONS: Access to multimedia lessons resulted in an increase in perceived susceptibility to diabetes complications, particularly in subjects with lower health literacy. Despite measures to improve informational access for individuals with lower health literacy, there was relatively less use of the computer among these participants.

Blood Pressure↗

Information literacy in an undergraduate nursing curriculum: development, implementation, and evaluation.

With the increasing complexity of nursing practice and health care delivery, developing information literacy in students for lifelong learning is a vital element of nursing education. The San Francisco State University School of Nursing has developed, implemented, and evaluated an integrated program of information literacy in its undergraduate curriculum. The curriculum strand includes a variety of instructional strategies woven through all semesters of the nursing program. To evaluate the information literacy program, an exploratory descriptive approach was taken using two different cohorts of students. Baseline testing prior to implementation of the information literacy program and posttesting after implementation of the program revealed selected positive occurrences in students' use of bibliographic databases and journal literature. However, students did not perceive they were more successful in accessing information, and faculty assessment of students' ability to evaluate information did not change from 1992 to 1996. These and other evaluation findings have implications for the development of an information literacy curriculum and its integration with other facets of student learning.

Computer Literacy↗

In pursuit of computer literacy in health management education.

Computer literacy skills are essential tools students must possess to do well in computer-related and quantitative courses, and to be effective health managers. Many health management education programs are faced with the challenge of finding an ideal framework for teaching computer literacy courses. Recently, Austin and Malec (1990) proposed an instructional method for teaching computer literacy. This method was used for three consecutive semesters to teach the computer literacy course offered at Sangamon State University. A case analysis technique was utilized to assess of the effectiveness of this method. A pre-test and post-test design was used in the study. Post-test scores were found to be significantly higher than pre-test scores. Improvements in students' attitudes toward computers were noticed in the areas pertaining to how they view their competency levels. Overall, the data for this study suggest that this instructional method is effective for teaching computer literacy to adult students who have had limited exposure to computers.

Attitude to Computers↗

Decree No. 87-010 creating a National Literacy Council, 21 January 1987.

This Decree creates a National Literacy Council under the Mauritania Secretariat of State charged with the battle against illiteracy. The Objectives of the Council are 1) to propose the large outlines of literacy and education programs, as well as the elements of an implementation strategy; 2) to give its advice on any problem that is submitted to it by the Secretariat of State; 3) to mobilize and coordinate national, material, human, and technical forces to be placed at the service of literacy; and 4) to evaluate the progress accomplished in the field of literacy. Decree No. 87-027 of 25 February 1987 creates a special account to record the receipts and expenses in the battle against illiteracy (Journal Officiel de la Republique Islamique de Mauritanie, Nos. 690-691, 29 July 1987, pp. 328-329). Decree No. 87-028 of 25 February 1987 sets up regional literacy coordinators to carry out duties related to fighting illiteracy (Journal Officiel de la Republique Islamique de Mauritanie, Nos. 684-685, 29 April 1987, pp. 209-210).

Africa↗

Evaluation of a tool to categorize patients by reading literacy and computer skill to facilitate the computer-administered patient interview.

Past efforts to collect clinical information directly from patients using computers have had limited utility because these efforts required users to be literate and facile with the computerized information collecting system. In this paper we describe the creation and use of a computer-based tool designed to assess a user's reading literacy and computer skill for the purpose of adapting the human-computer interface to fit the identified skill levels of the user. The tool is constructed from a regression model based on 4 questions that we identified in a laboratory study to be highly predictive of reading literacy and 2 questions predictive of computer skill. When used in 2 diverse clinical practices the tool categorized low literacy users so that they received appropriate support to enter data through the computer, enabling them to perform as well as high literacy users. Confirmation of the performance of the tool with a validated reading assessment instrument showed a statistically significant difference (p=0.0025) between the two levels of reading literacy defined by the tool. Our assessment tool can be administered through a computer in less than two minutes without requiring any special training or expertise making it useful for rapidly determining users' aptitudes.

Computer Literacy↗

Use of a low-literacy patient education tool to enhance pneumococcal vaccination rates. A randomized controlled trial.

CONTEXT: Pneumococcal immunization rates for elderly and high-risk patients are only one third to one half the target rate of 60% established by the US Public Health Service. Limited or marginal literacy, which affects nearly 100 million Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE: To determine whether the use of a simple, low-literacy educational tool enhances patient-physician dialogue about pneumococcal vaccination and increases rates of immunization. DESIGN: A randomized controlled trial conducted between May and June of 1998. SETTING: Ambulatory care clinic of a 900-bed public teaching hospital serving a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS: Of 433 patients who presented for routine primary care, had vaccine indications (age > or =65 years or chronic disease), and had not been previously vaccinated, 221 were randomly assigned to the intervention group and 212 to the control group. Of the total patient population (mean age, 63 years), 280 (64.7%) had less than a high school education, 401 (92.6%) were African American, and 300 (69.3%) were female. INTERVENTION: One-page, low-literacy (below fifth-grade level) educational handout encouraging patients to "ask your doctor about the pneumonia shot" vs a control group (1 -page, low-literacy educational handout conveying information about nutrition). MAIN OUTCOME MEASURES: Vaccination rates (documented by chart audit) of patients who received pneumococcal vaccination and rates of patients who self-reported having discussed vaccination with their physicians. RESULTS: Patients in the intervention group were 4 times more likely to have discussed the pneumococcal vaccine with their physicians than patients in the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97 [95% confidence interval [CI], 2.71-5.83]), and were more than 5 times as likely to have received the pneumococcal vaccine than the control group (44/221 [19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate analysis controlling for race, sex, education, insurance status, age, level of physician training, health status, and vaccine indication, only assignment to the intervention group was statistically significantly related to the probability of being immunized or discussing the issue with their physicians (P<.001 for both trends). CONCLUSIONS: A simple, low-literacy educational tool increased pneumococcal vaccination rates and patient-physician discussions about the vaccine in an elderly, low-literate, indigent, minority population.

Aged↗

Findings from the International Adult Literacy Survey on the incidence and correlates of learning disabilities in New Zealand: is something rotten in the state of New Zealand?.

New Zealand data from the International Adult Literacy Survey were analysed to examine the incidence and correlates of self-reported specific reading learning disability (SRLD). The results showed that 7.7% of New Zealand adults reported having had a learning disability. The ratio of males to females with SRLD was 3:2. Between 40% and 50% of New Zealand adults performed below the minimum level of proficiency required for meeting the complex demands of everyday life in knowledge-based societies. For adults with SRLD, around 80% performed below the minimum level, and the literacy proficiency of adults with SRLD in younger age bands appears to have declined since the early 1960s. Almost 100% of adults with SRLD in the 16-20 years age range performed below the minimum level for document and quantitative literacy and 92% for prose literacy. Compared to non-SRLD adults, those with SRLD were found to leave school earlier, engage more often in manual occupations, are more frequently unemployed, and rely on more state assistance to bring their income levels closer to the levels enjoyed by non-SRLD adults. The results are discussed in terms of SRLD not being officially recognised or provided for in New Zealand, the lack of appropriate remedial provisions for children who experience difficulties with reading, and the effects of a strong whole language orientated approach to literacy instruction in schools that has been in place since 1963.

Adolescent↗

The talking touchscreen: a new approach to outcomes assessment in low literacy.

PURPOSE: Cancer patients who are deficient in literacy skills are particularly vulnerable to experiencing different outcomes due to disparities in care or barriers to care. Outcomes measurement in low literacy patients may provide new insight into problems previously undetected due to the challenges of completing paper-and-pencil forms. DESCRIPTION OF STUDY: A multimedia program was developed to provide a quality of life assessment platform that would be acceptable to patients with varying literacy skills and computer experience. One item at a time is presented on the computer touchscreen, accompanied by a recorded reading of the question. Various colors, fonts and graphic images are used to enhance visibility, and a small picture icon appears near each text element allowing patients to replay the sound as many times as they wish. Evaluation questions are presented to assess patient burden and preferences. RESULTS: An ethnically diverse group of 126 cancer patients with a range of literacy skills and computer experience reported that the 'talking touchscreen' (TT) was easy to use, and commented on the usefulness of the multimedia approach. CLINICAL IMPLICATIONS: The TT is a practical, user-friendly data acquisition method that provides greater opportunities to measure self-reported outcomes in patients with a range of literacy skills.

Adult↗

Literacy skills and communication methods of low-income older persons.

The objectives of this study were to (a) characterize the literacy skills of low-income, community-dwelling, older adults, (b) determine how they obtain information, and (c) determine whether they have difficulty understanding written information provided by clinicians. We studied 177 subjects (mean age 72.2, range 60-94). None had cognitive or visual impairments that precluded assessing literacy. Reading skills were tested, sociodemographic data were recorded, and information was collected on whether subjects have trouble understanding information given to them by health providers. Data analysis determined if literacy was associated with how subjects obtain and understand medical information. The subjects' mean reading skills were at grade level 5, below those of the general US population. One-fourth of subjects reported difficulty understanding written information from clinicians; this was more frequent among poor readers (P = 0.0002). Ninety-seven percent of subjects, regardless of literacy, reported that television was their primary source of information. Health information for low-income seniors should be transmitted through literacy-appropriate communication methods.

Age Factors↗

Lexical restructuring in the absence of literacy.

Vocabulary growth was suggested to prompt the implementation of increasingly finer-grained lexical representations of spoken words in children (e.g., [Metsala, J. L., & Walley, A. C. (1998). Spoken vocabulary growth and the segmental restructuring of lexical representations: precursors to phonemic awareness and early reading ability. In J. L. Metsala & L. C. Ehri (Eds.), Word recognition in beginning literacy (pp. 89-120). Hillsdale, NJ: Erlbaum.]). Although literacy was not explicitly mentioned in this lexical restructuring hypothesis, the process of learning to read and spell might also have a significant impact on the specification of lexical representations (e.g., [Carroll, J. M., & Snowling, M. J. (2001). The effects of global similarity between stimuli on children's judgments of rime and alliteration. Applied Psycholinguistics, 22, 327-342.]; [Goswami, U. (2000). Phonological representations, reading development and dyslexia: Towards a cross-linguistic theoretical framework. Dyslexia, 6, 133-151.]). This is what we checked in the present study. We manipulated word frequency and neighborhood density in a gating task (Experiment 1) and a word-identification-in-noise task (Experiment 2) presented to Portuguese literate and illiterate adults. Ex-illiterates were also tested in Experiment 2 in order to disentangle the effects of vocabulary size and literacy. There was an interaction between word frequency and neighborhood density, which was similar in the three groups. These did not differ even for the words that are supposed to undergo lexical restructuring the latest (low frequency words from sparse neighborhoods). Thus, segmental lexical representations seem to develop independently of literacy. While segmental restructuring is not affected by literacy, it constrains the development of phoneme awareness as shown by the fact that, in Experiment 3, neighborhood density modulated the phoneme deletion performance of both illiterates and ex-illiterates.

Adolescent↗

Nurse-delivered antiretroviral treatment adherence intervention for people with low literacy skills and living with HIV/AIDS.

People living with HIV/AIDS who have lower health literacy show poorer treatment adherence and more adverse health outcomes. The authors undertook the development and pilot testing of a brief HIV treatment adherence improvement counseling intervention for people with lower health literacy who were taking antiretroviral medications. Guided by a theory of health behavior change, health education principles for lower literacy populations, and formative research, the authors designed a two-session plus one booster session nurse-delivered HIV treatment adherence intervention. Results from a pilot test with 30 HIV-positive men and women with lower health literacy showed that the intervention increased HIV/AIDS knowledge, intentions to improve adherence, and self-efficacy for adhering to medications. Participants exposed to the intervention also showed improvement in medication adherence, with reductions in numbers of missed pills and reductions in numbers of doses taken off-schedule. These results suggest that relatively brief behavioral interventions that are tailored for people with lower health literacy may have a significant impact on health-related behaviors.

Adult↗