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PubMed1995

Inadequate functional health literacy among patients at two public hospitals.

OBJECTIVE: To determine the ability of patients to complete successfully basic reading and numeracy tasks required to function adequately in the health care setting. DESIGN: Cross-sectional survey. SETTING: Two urban, public hospitals. PATIENTS: A total of 2659 predominantly indigent and minority patients, 1892 English-speaking and 767 Spanish-speaking, presenting for acute care. MAIN OUTCOME MEASURE: Functional health literacy as measured by the Test of Functional Health Literacy in Adults (TOFHLA), an instrument that measures ability to read and understand medical instructions and health care information presented in prose passages and passages containing numerical information (eg, prescription bottle labels and appointment slips). RESULTS: A high proportion of patients were unable to read and understand written basic medical instructions. Of 2659 patients, 1106 (41.6%) were unable to comprehend directions for taking medication on an empty stomach, 691 (26%) were unable to understand information regarding when a next appointment is scheduled, and 1582 (59.5%) could not understand a standard informed consent document. A total of 665 (35.1%) of 1892 English-speaking patients and 473 (61.7%) of 767 Spanish-speaking patients had inadequate or marginal functional health literacy. The prevalence of inadequate or marginal functional health literacy among the elderly (age > or = 60 years) was 81.3% (187/230) for English-speaking patients and 82.6% (57/69) for Spanish-speaking patients, and was significantly higher (P < .001) than in younger patients. CONCLUSIONS: Many patients at our institutions cannot perform the basic reading tasks required to function in the health care environment. Inadequate health literacy may be an important barrier to patients' understanding of their diagnoses and treatments, and to receiving high-quality care.

Adolescent↗
PubMed1994

The development of precursors to literacy in mentally disabled children.

This study aimed to investigate metalinguistic precursors to literacy in mentally handicapped children, with a view to improve literacy training in this population. Language proficiency and environmental literacy factors were explored, and an analysis was made of proficiency in several metalinguistic tasks (i.e., higher level language awareness skills). Six children who are educable mentally retarted, with mental ages between five and seven years (chronological ages between six and sixteen years) were assessed. Results showed that environmental factors of literacy socialisation and print awareness were adequate, with reasonable exposure to literacy artifacts and events. Language abilities were also adequately developed. Isolated metalinguistic skills (e.g., phonemic segmentation) had developed in those children who had received reading instruction, however, most metalinguistic precursors were not adequately developed for their mental ages and were below a five year level.

Adolescent↗
PubMed2026

Navigating Social Media: Balancing Connectivity With Media Literacy to Combat Misinformation and Protect Mental Well-Being.

BACKGROUND: The pervasive use of social media has created a complex digital ecosystem where high connectivity coexists with significant challenges, including the rapid spread of misinformation, particularly regarding mental health, and documented negative impacts on psychological well-being. Platform architectures designed for engagement maximization have been identified as central factors in both issues. OBJECTIVE: This paper critically analyzes the interconnected relationships between social media use, misinformation dissemination, and mental health impacts, with particular attention to psychiatric misinformation across diagnostic categories (e.g., depression, anxiety, ADHD). A primary objective is to evaluate the potential of advanced critical digital literacy frameworks to serve as protective mechanisms against these dual threats. METHODS: A systematic search was conducted following PRISMA 2020 guidelines across APA PsycInfo, PubMed, JSTOR, and Google Scholar for literature published between January 2018 and March 2026 (updated from the original 2023 search). The search yielded 2672 records. After removing 624 duplicates, 2048 records underwent title and abstract screening, with 1802 excluded. The remaining 246 full-text articles were assessed for eligibility, resulting in 86 studies included in the final qualitative synthesis. Inter-rater reliability was established (Cohen's &#x3ba;&#x2009;=&#x2009;0.82). Quality assessment was conducted using the Joanna Briggs Institute Checklist, AXIS, and CASP tools, with findings weighted by methodological quality. A thematic analysis was undertaken to synthesize findings. RESULTS: The analysis reveals that core architectural features of social media platforms, algorithmic curation and engagement-based metrics, simultaneously foster environments ripe for misinformation spread and contribute to psychological distress, including anxiety, depression, and harmful social comparison. Psychiatric misinformation specifically (e.g., inaccurate claims about treatment effectiveness, diagnostic criteria, and medication side effects) represents a growing concern, particularly on image- and video-based platforms. The findings indicate that conventional media literacy approaches focused solely on fact-checking are insufficient. Instead, a critical digital literacy framework encompassing algorithmic awareness, data literacy, and emotional awareness is essential for building user resilience, with evidence from high-quality systematic reviews supporting this approach. CONCLUSIONS: Navigating the complexities of modern social media requires an integrated approach combining "pedagogies of play" for experiential skill development with advocacy for structural change (e.g., algorithmic transparency, well being by design principles). This dual strategy empowers individual users to critically engage with digital content while advocating for ethical platform design, thereby safeguarding both mental well-being and democratic discourse. Implications for educators, mental health professionals (including competencies for addressing patient encounters with psychiatric misinformation), policymakers, and platform designers are discussed.

Humans↗
PubMed2004

Information literacy-what it is about? Literature review of the concept and the context.

OBJECTIVES: The use of IT in health care has merged advanced knowledge and skills for health care professionals. Former studies indicate that basic skills in computer use are no more than comprehensive competencies to manage electronically stored information in health care. The purpose of this paper is to review the literature focusing on the concept information literacy in the field of health, nursing and medical informatics. The target is to find out how information literacy is defined, in what kind of context it is presented and who are the focus of interest. METHODS: An automated literature search was performed on-line to Medline and by using the EndNote Bibliographic Software. All together the number of papers analyzed was 97 or 78% of the total literature search result. RESULTS: The survey indicates that the concept information literacy does not exist as such in the literature, but it can be found as a synonym to 'computer literacy' or even more obscure concepts such as 'informatics awareness' or 'computer experience'. The definitions of these concepts varied considerably. A variety of descriptions of educational programs were also found, none were based on the IMIA recommendations. CONCLUSIONS: In international cooperation such as that of IMIA WG1, a wide range of efforts still needs to be carried out to compile educational programmes in health informatics to enhance knowledge and skills in computer use among health care professionals.

Computer Literacy↗
PubMedDate not supplied

Computer literacy study: report of qualitative findings.

Computer literacy and information literacy are critical to the future of nursing. The very nature of health care is being transformed in response to environmental drivers such as the demands for cost-effective delivery of high quality services and enhanced patient safety. Facilitating the quality transformation depends on strategic changes such as implementing evidence-based practice (), promoting outcome research (), initiating interdisciplinary care coordination [Zwarenstein, M., Bryant, W. (2004). Interventions to promote collaboration between nurses and doctors. The Cochrane Library(I)], and implementing electronic health records (). Information management serves as a central premise of each of these strategies and is an essential tool to facilitate change. This report of the analysis of qualitative data from a national online survey of baccalaureate nursing education programs describes the current level of integration of the computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students in the United States. The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost-effectiveness, and safety.

Anthropology, Cultural↗
PubMed1993

Does women's literacy affect desired fertility and contraceptive use in rural-urban Pakistan?

The 1984-85 Pakistan Contraceptive Prevalence Survey showed that urban wives had more than twice the literacy rate of rural wives. The present study explored the relationship of the rural-urban gap in female literacy to differences in contraceptive use. In rural areas, literacy did not increase women's perceptions of having reached a 'sufficient' number of living children, although the opposite was true for urban areas. Yet rural women with an 'insufficient' number of living children were more likely to use contraception if they were literate, as did their urban counterparts. Thus, raising the literacy rate in rural Pakistan would not narrow the rural-urban gap in contraception to cease childbearing but would narrow the rural-urban gap in contraception used to space wanted births further apart. Recommendations for government policy are made.

Adolescent↗
PubMed2000

Teaching information literacy skills: an evaluation.

This paper describes an evaluation of a curriculum-integrated information literacy programme in an undergraduate nursing course. The aim of the programme was to provide students with an awareness of the discipline's literature and the skills to locate and retrieve the literature. A multidimensional process for determining nursing students' development was utilised in the evaluation of the programme. Pre- and post-programme questionnaires were distributed to a cohort of students who undertook the programme. A cohort of more senior students who had not undertaken the information literacy programme was utilised as a comparison group. Questionnaire results were analysed using a range of inferential statistics. This paper will focus on two main findings related to objective measures of information literacy skills. These include pre-programme/post-programme change in student performance and differences in student performance between those who undertook the programme and those who did not. The programme demonstrated its effectiveness in developing information literacy skills, however the challenge remains for both academics and students to ensure that these skills are consolidated and extended for effective life-long learning.

Catalogs, Library↗
PubMed2004

Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients.

Clinical information collected directly from patients is critical to the practice of medicine. Past efforts to collect this information using computers have had limited utility because these efforts required users to be facile with the computerized information collecting system. In this paper we describe the design, development, and function of a computer system that uses recent technology to overcome the limitations of previous computer-based data collection tools by adapting the human-computer interface to the native language, reading literacy, and computer skills of the user. Specifically, our system uses a numerical representation of question content, multimedia, and touch screen technology to adapt the computer interface to the native language, reading literacy, and computer literacy of the user. In addition, the system supports health literacy needs throughout the data collection session and provides contextually relevant disease-specific education to users based on their responses to the questions. The system has been successfully used in an academically affiliated family medicine clinic and in an indigent adult medicine clinic.

Computer Literacy↗
PubMed1995

Actual and desired computer literacy among allied health students.

The purpose of this study was to examine the level of computer literacy among allied health students, with specific focus on physical therapy, occupational therapy, and respiratory therapy students, and to investigate the perceived differences between actual computer literacy and desired computer literacy. Two established measurement instruments were used to collect data from a sample of 377 allied health students. T-tests and Pearson product-moment correlations were conducted to analyze the data. Results show that allied health students take very few computer courses, but they are generally aware of the applications of computers in the practice of allied health and they desire a higher level of computer literacy than they currently have.

Adolescent↗
PubMed1995

Evaluating graduate and undergraduate nursing students' computer skills to determine the need to continue teaching computer literacy.

1. INTRODUCTION. This descriptive study examined undergraduate and graduate nursing students' perceptions of their computer literacy skills to determine whether faculty should continue teaching basic computing skills in nursing programs. As in Bryson's study [1] the computer literate nurse is one who understands the concepts of hardware, software, and operating systems; who is able ot use the computer to learn; and who is able ot use such applications as word-processing, spreadsheets, and databases. Zeimer [2] predicted that by 1994 students entering nursing schools would be prepared to use computers and that further teaching of computer skills would not be needed. Some faculty, however, have felt that students are not entering nursing programs prepared to use computers. 2. TOOLS. A Level of Computer Experience (LCE) tool was developed to measure the computer literacy skills of students entering the first of three Masters' level nursing informatics courses over a six-year period. The instrument's 25 items determined experience with: operating systems, hardware, learning tools, applications, and information systems (IS) life cycle (design, selection, implementation, evaluation and project management). The instrument was modified for undergraduate students; this eliminated the items relating to the IS life cycle since these items reflect advanced skills. The resulting instrument was composed of the first 16 items of the original Level of Computer Experience tool. For each item, a four pint Likert scale allowed respondents to choose from the words "none," "some," "moderate," and "extensive" to describe their level of experience. For scoring purposes each word was assigned a numerical value as follows: none = 1, some = 2, moderate = 3, and extensive =4. 3. DATA. The LCE was administered to 65 sophomore nursing students and 74 graduate nursing informatics students. Undergraduate scored 4 items (use of microcomputer, use of IBM type computer, keyboard skills and use of WordPerfect). This score was above the 2 or 'some' experience level. Mean scores for all other items ranged between 1 and 2. Graduate informatics students also had higher mean scores for the 4 items. No mean scores reached the 'moderate' level for either group. One-way analysis of variances showed significant differences between the undergraduate and graduate students on the item concerning use of statistical packages. 4. CONCLUSIONS. In this population, both graduate and undergraduate nursing students continue to possess low levels of computer literacy skills. Since many students come into nursing programs without the capability of using information technology in practice, schools need to continue providing a way for students to obtain computer literacy skills.

Baltimore↗
PubMed1996

A multidimensional evaluation of a nursing information-literacy program.

The goal of an information-literacy program is to develop student skills in locating, evaluating, and applying information for use in critical thinking and problem solving. This paper describes a multidimensional evaluation process for determining nursing students' growth in cognitive and affective domains. Results indicate improvement in student skills as a result of a nursing information-literacy program. Multidimensional evaluation produces a well-rounded picture of student progress based on formal measurement as well as informal feedback. Developing new educational programs can be a time-consuming challenge. It is important, when expending so much effort, to ensure that the goals of the new program are achieved and benefits to students demonstrated. A multidimensional approach to evaluation can help to accomplish those ends. In 1988, The University of Northern Colorado School of Nursing began working with a librarian to integrate an information-literacy component, entitled Pathways to Information Literacy, into the curriculum. This article describes the program and discusses how a multidimensional evaluation process was used to assess program effectiveness. The evaluation process not only helped to measure the effectiveness of the program but also allowed the instructors to use several different approaches to evaluation.

Adolescent↗
PubMed2003

Closing the loop: physician communication with diabetic patients who have low health literacy.

BACKGROUND: Patients recall or comprehend as little as half of what physicians convey during an outpatient encounter. To enhance recall, comprehension, and adherence, it is recommended that physicians elicit patients' comprehension of new concepts and tailor subsequent information, particularly for patients with low functional health literacy. It is not known how frequently physicians apply this interactive educational strategy, or whether it is associated with improved health outcomes. METHODS: We used direct observation to measure the extent to which primary care physicians working in a public hospital assess patient recall and comprehension of new concepts during outpatient encounters, using audiotapes of visits between 38 physicians and 74 English-speaking patients with diabetes mellitus and low functional health literacy. We then examined whether there was an association between physicians' application of this interactive communication strategy and patients' glycemic control using information from clinical and administrative databases. RESULTS: Physicians assessed recall and comprehension of any new concept in 12 (20%) of 61 visits and for 15 (12%) of 124 new concepts. Patients whose physicians assessed recall or comprehension were more likely to have hemoglobin A(1c) levels below the mean (< or = 8.6%) vs patients whose physicians did not (odds ratio, 8.96; 95% confidence interval, 1.1-74.9) (P =.02). After multivariate logistic regression, the 2 variables independently associated with good glycemic control were higher health literacy levels (odds ratio, 3.97; 95% confidence interval, 1.09-14.47) (P =.04) and physicians' application of the interactive communication strategy (odds ratio, 15.15; 95% confidence interval, 2.07-110.78) (P<.01). CONCLUSIONS: Primary care physicians caring for patients with diabetes mellitus and low functional health literacy rarely assessed patient recall or comprehension of new concepts. Overlooking this step in communication reflects a missed opportunity that may have important clinical implications.

Adult↗
PubMed2000

Prescribing books for immigrant children: a pilot study to promote emergent literacy among the children of Hispanic immigrants.

OBJECTIVES: To assess book-sharing activities within first-generation Hispanic immigrant families, and to assess the effect of pediatricians giving books to their patients. DESIGN: Survey. PARTICIPANTS: Convenience sample of 122 predominantly Hispanic immigrant parents of children aged 2 months to 5 years. Of these parents, 56 had received children's books from the pediatrician, and 66 had not. SETTING: House staff continuity clinic at a university children's hospital. MAIN OUTCOME MEASURE: Frequent Book Sharing (FBS) was defined as a parent's reporting more than 3 days per week of sharing books with the child. Main independent variables included the following: (1) exposure to the Reach Out and Read program, defined as having received a children's book from the pediatrician; (2) socioeconomics, as measured by parents' years of education and Medicaid enrollment; (3) acculturation, as defined by 4 questions relating to parents' proficiency with the English language; (4) parent's country of origin; (5) parent literacy, as measured by a parent's reporting more than 3 days per week of reading alone; (6) parent's age; (7) marital status; (8) household size; (9) child's age; (10) child's sex. RESULTS: Ninety percent of the parents were born outside of the United States (71% in Mexico), 85% spoke Spanish in the home, and 63% had completed less than a high-school education. Seventy-five percent of children's medical insurance was provided by Medi-Cal (Medicaid), and 9% of children were uninsured. Sixty-seven percent spoke exclusively Spanish at home, and 84% of parents want their children to learn to read in both English and Spanish. High FBS was reported among parents whose children had received books from the physician when compared with parents whose children had received no books. The odds ratio (OR) was 3.62 (95% confidence interval [CI], 1.40-9.37; P<.05). Also associated with FBS were parents reading frequently to themselves (OR = 9.52; 95% CI, 2.09-43.27; P<.05) and national origin outside Mexico (OR = 5.54; 95% CI, 1.59-19.27; P<.05). These findings were independent of parent's educational level, parent's employment, parent's age, acculturation, and family size. CONCLUSIONS: Pediatricians can promote literacy development among Hispanic immigrant children through the provision of free books at well-child visits. Our findings also suggest the independent effects of adult literacy and child age. Further research is needed to understand the effect of pediatric literacy programs on Hispanic immigrant children, their bilingual environments, and their readiness for school entry. Arch Pediatr Adolesc Med. 2000;154:771-777

Adult↗
PubMed2003

Differences in community mental health literacy in older and younger Australians.

BACKGROUND: Depression has been traditionally considered to increase with age, although that may be due to sampling of those who have presented with depressive conditions. It is now recognised that patients' understanding of depression and beliefs about its appropriate treatment, mental health literacy, influences treatment-seeking behaviour. OBJECTIVES: This study delineates depression, recent use of health services and mental health literacy in a random and representative community sample of younger and older South Australians. METHODS: Depression, health service utilisation and mental health literacy were assessed in a random and representative sample of 2010 South Australians. Results for those aged between 65 and 74 years (n=300) and those aged 15 to 24 years (n=521) were compared. RESULTS: Compared with the younger group, older subjects did not report greater levels of current depression although they were more likely to have seen a medical practitioner in the last 12 months and be taking antidepressants. However, their mental health literacy in terms of recognition of a mental health problem in a vignette was somewhat poorer and fewer recommended treatment from a counsellor, telephone service or psychologist and more considered that a psychiatrist would be harmful. They also more often perceived the clergy as helpful. CONCLUSIONS: Depression was not more common among older than younger members of the community. Despite recognising depression in a vignette less often and perceiving less likelihood of help from several different mental health professionals, those in the older group were more likely to receive antidepressant medication and to have recently consulted a medical practitioner.

Adolescent↗
PubMed1994

Computer speech-based training of literacy skills in neurologically impaired children: a controlled evaluation.

Twenty-two reading-disabled children were randomly assigned to one of four training conditions to evaluate the effectiveness of a computer speech-based system for training literacy skills. The sample included 17 children with significant neurological impairment of various etiologies (including spina bifida and hydrocephalus, seizure disorder, brain tumors, cerebral palsy, and head injury) and five developmental dyslexics. The training employed a "talking" computer system that provides synthesized speech feedback during the course of learning. The training conditions included three word recognition and spelling-training programs and a math-training control program. Three different literacy-training procedures were compared, with the size of the trained print-to-sound unit varying as letter-sound (LSD: train-->t/r/ai/n); onset-rhyme (OR: train-->tr/ain) and whole word units (WW: train-->train). All literacy-training groups made significant gains in word recognition and spelling, with the LSD- and OR-trained subjects making the greatest word recognition gains on the words that could be trained with segmented speech feedback (i.e., words with regular spelling-to-sound patterns). All literacy-training groups demonstrated significant transfer on uninstructed rhymes of instructed regular words, with the greatest degree of transfer achieved by the LSD-trained subjects. These findings suggest that the neurologically impaired children were able to profit from instructional procedures that segment the printed word into units corresponding to onsets, rhymes, and phonemes and that this segmentation training may facilitate transfer-of-training for them.

Analysis of Variance↗
PubMed2007

Medication beliefs as mediators of the health literacy-antiretroviral adherence relationship in HIV-infected individuals.

Identifying modifiable barriers to antiretroviral adherence remains an important aim. We hypothesized that mistaken beliefs regarding taking HIV medications mediated the relation between low literacy and poor adherence. We studied 87 HIV-infected individuals on standard antiretroviral regimens for >or= 3 months. Adherence was assessed using pharmacy refill records. Medication beliefs, including an individual's norm for acceptable adherence, were measured using questions developed by expert panel. Literacy was associated with >or=95% adherence (64% for >or=9th grade level vs. 40% for <9th grade level). Participants with <95% adherence had a lower threshold of acceptable adherence than those with >or=95% adherence [80% adherence (interquartile range 70-90%) vs. 90% adherence (interquartile range 80-90%)]. However, the effect was independent of literacy. No other beliefs assessed were associated with adherence. Although the beliefs assessed do not mediate the relation between literacy and adherence, we identified low adherence norms as a potentially modifiable belief associated with adherence.

Adult↗
PubMed1996

The effect of first written language on the acquisition of English literacy.

The relationship between first and second language literacy was examined by identifying the skills and processes developed in the first language that were transferred to the second language. The performance of 40 university students from The People's Republic of China, Hong Kong, Vietnam and Australia were compared on a series of tasks that assessed phonological awareness and reading and spelling skills in English. The results indicated that the Hong Kong students (with non-alphabetic first language literacy) had limited phonological awareness compared to those students with alphabetic first language literacy. The reading and spelling tasks showed no differences between the groups on real word processing. However, the students from Hong Kong had difficulty processing nonwords because of their poor phonological awareness. The results supported the hypothesis that people learning English as a second language (ESL) transfer their literacy processing skills from their first language to English. When the phonological awareness required in English had not been developed in the first language, ESL students were limited to a whole-word, visual strategy. The findings indicate that students from non-alphabetic written language backgrounds might have difficulties with new, or unfamiliar words when attending universities where English is the medium of instruction.

Adult↗
PubMed2004

The impact of low health literacy on surgical practice.

BACKGROUND: We sought to determine the prevalence of low health literacy (LHL) among patients in a preoperative clinic, the characteristics associated with LHL, and the association between LHL and adherence to preoperative instructions. METHODS: We conducted a cohort study and interviewed patients at a VA preoperative clinic. We administered a health literacy test and collected sociodemographic information. When patients returned for their scheduled surgical procedures, adherence to preoperative instructions was assessed. RESULTS: Of 332 participants, 12% (n = 40) had LHL. Low health literacy was more prevalent among older adults (more than 65 years) compared with those under age 65. Patients with LHL were more likely to be nonadherent to preoperative medication instructions (odds ratio = 1.9; 95% confidence interval: 0.8 to 4.8), but this was of borderline statistical significance. CONCLUSIONS: Low health literacy was common among older patients and appeared to be associated with lower adherence to preoperative medication instructions.

Adolescent↗