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One barrier to participating in clinical research is that patients with low literacy skills (1 in 5 US adults) may struggle to understand the informed consent document (ICD). Writing consents using health literacy and plain language guidelines including simplified syntax and semantics can increase understandability and facilitate inclusivity of research populations with literacy challenges. Our study aim was to evaluate a simplified ICD for understandability while considering factors known to relate to comprehension (reading skills and working memory). We performed an on-line survey of 192 adults ages 18-77 in Georgia. Participants performed significantly better on the simplified ICD test. We built an additional model with all version x measure interactions (i.e., age, sex, race, urbanicity, GMVT, WM). This model did not significantly improve model fit, F < 1.00, suggesting that individual differences did not moderate the effect of simplification. Our findings suggest that using plain language and simplified syntax and semantics in ICD as a universal precaution may reduce cognitive reading burden for adults regardless of differences in reading skill or working memory. Increasing understandability in ICD may help improve targets for clinical trial enrollment., (© 2024. The Author(s).)

Background: Multimedia videos are important tools to inform uptake of the COVID-19 vaccine. Video design using health literacy guidelines may help optimize video usefulness. Many health organizations (HO) (provides information) and health care (HCO) (provides direct health care) organizations have used YouTube to deliver videos about COVID-19 vaccines., Objective: We examined HO and HCO COVID-19 vaccine videos shown on YouTube for health literacy guidelines (quality, understandability and actionability)., Methods: The top 30 most viewed COVID-19 vaccine videos posted by HO and HCO were analyzed using the Global Quality Score (GQS) and the Patient Education Assessment Tool for evaluating audiovisual formats (PEMAT-AV)., Key Results: GQS scores averaged 3.12 (standard deviation [ SD ] .789), which is equivalent to 80%. Using PEMATAV, there was a relationship between actionability and quality ( r (28) = .453, p < .05) for HO; for HCO, there was a relationship between usability and quality ( r (28) = .455, p < .05). Odds ratio analysis showed quality in HO leading to higher odds of actionability (3.573, 95% confidence interval [CI] [1.480-14.569]) and quality in HCO videos leading to higher understandability (4.093, CI [1.203-17.865])., Conclusion: Few organizations applied all health literacy principles to video design. Video creation for mass media health campaigns by HO and HCO should include consideration of evidence-based health literacy measures (quality, understandability, actionability) to ensure intended results across viewers with different health literacy levels including communities who have been disproportionately affected by COVID-19. [ HLRP: Health Literacy Research and Practice . 2023;7(2):e111-e118. ].

Background: How individuals perceive their health literacy may differ based on demographic and individual characteristics., Objective: The purpose of this study was to understand the dispersion of health literacy across demographics in the state of Georgia in 2021 and to determine which factors influence health literacy., Methods: Study participants were age 18 years and older and completed an on-line Health Literacy Questionnaire ( N = 520). The participant pool was stratified to mirror state-wide demographics of geography and race. Results were further collapsed into composite scales reflecting basic, communicative, and critical health literacy. Descriptive statistics, bivariate Pearson's correlations, and multiple regression analyses were used. A two-step cluster analysis was performed with the nine health literacy scales., Key Results: Rural county and no health insurance were negatively related to all three composite scales ( rs = .093-.254, ps < .05). Demographic predictors accounted for 6.7% of the variance in basic (F[6, 439] = 5.287, p < .001), 10% in communicative (F[6, 438] = 8.154, p < .001), and 6% for critical (F[6, 439] = 4.675, p < .0010. In all scales, health insurance status was the strongest primary unique predictor ( βs = .236, .295, .181, ps <.05, respectively). In a two-step cluster analysis only health insurance status differentiated the health literacy level clusters ( X 2 (3) = 9.43, 34.51, ps = 024, <.001 respectively)., Conclusion: Lacking health insurance is the most consistent and largest contributor to low health literacy across the state of Georgia; population demographics are not. Health literacy policies and practices should be developed for universal application and not focus on specific populations. [ HLRP: Health Literacy Research and Practice . 2022;6(3):e182-e190. ] Plain Language Summary: In this study, demographics that are usually associated with low health literacy like age, sex, race, educational attainment, and type of county (rural or urban) were not associated with; the only significant factor was lack of health insurance. This relationship strengthens the case for universal health literacy precautions that go beyond population demographics.

Intercultural competence (ICC) and health literacy (HL) are vital components of patient education. The purpose of this study was to determine if an educational intervention that combined ICC and HL was effective at changing second-year nursing students' self-efficacy, beliefs, and knowledge. A total of 157 second-year nursing students in two different programs participated in pre- and post-surveys consisting of the Transcultural Self-Efficacy Tool and Health Literacy Beliefs and Knowledge survey. Students attended a two-part lecture with a moderated panel on ICC and health literacy and began clinical fieldwork. Results were analyzed using Wilcoxon signed-rank test and Pearson correlation. There was a statistically significant difference in all ICC subscales after an educational intervention and clinical fieldwork (cognitive z = 7.681, p < .001; practical z = 7.319, p < .001; affective z = 6.533, p < .001). HL knowledge and belief measures showed statistically significant difference after the intervention ( z = 3.037, p < .001). There was a statistically significant correlation between intercultural self-efficacy and HL beliefs (Pearson's r = .486, p < .001). Self-efficacy in ICC and beliefs and knowledge in HL increased over time for nursing students, indicating that it may be beneficial to train students about these two constructs simultaneously. [ HLRP: Health Literacy Research and Practice . 2021;5(4):e283-e286.] .

Theoretical Principles: Children with medical complexity experience negative health outcomes despite the high costs associated with their care. There is growing evidence that low parental health literacy is associated with a number of poor child health outcomes, including medication errors. However, less is known about the relationship between parental health literacy and the health outcomes of children with medical complexity, whose care is known to be more complex and demanding of parents., Phenomena Addressed: The challenges faced by parents of children with medical complexity are presented, including those related to communication, care coordination, and medication administration. The historical and theoretical perspectives of health literacy are discussed, and the relationship of parental health literacy to pediatric health outcomes for children with medical complexity is explored., Research Linkages: Remaining knowledge gaps about parental health literacy and its influence on the health of children with medical complexity are outlined. Future research and clinical practice implications of health literacy and its importance to family-centered care are discussed., Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Abstract: For nurses to communicate effectively, they must understand how patients obtain, understand, and use health information to make health decisions, that is, their health literacy (HL) level. A gap in teaching HL communication skills exists in nursing curricula. This study explored nursing students' knowledge and beliefs about HL communication before and after an HL training. Analysis revealed a significant increase in knowledge after training (Mpre = 9.00, Mpost = 9.89), t(36) = 3.75, p < .001. Participants (84.6 percent) used teach-back technique with simulated patients and identified additional training as an aid to skill building., Competing Interests: The authors have declared no conflict of interest., (Copyright © 2020 National League for Nursing.)

Background: Respiratory therapists (RTs) should communicate with patients in a way that leads to patients understanding their discharge plans and medical device instructions. The teach-back method is a patient-centered, health-literate technique that allows health care professionals to confirm patient understanding. The purpose of this mixed-methods pilot study was to measure the use of teach-back by first-year undergraduate RT students in a simulation-center experience after a 1-h teach-back skills training., Methods: First-year RT students' health literacy knowledge and belief in communication skills were measured using a pre- and post- survey about their knowledge and beliefs. A 1-h health literacy and teach-back skills training lecture (ie, intervention) was delivered after the pre-testing. RT students were then assessed for teach-back use during a regularly scheduled simulation center experience. Their experiences were recorded in a semistructured interview immediately after the simulation-center experience., Results: 14 of 20 RT students used teach-back in the simulation center. Knowledge scores increased from 8.278 to 8.944 postintervention, and the median scores for belief increased from 111 to 117 postintervention. There was a statistically significant postintervention increase in knowledge scores ( P < .001) and in communication belief scores ( P = .038). Thematic content analysis revealed 2 primary themes for teach-back use: to confirm patient understanding and to confirm proper use of medical devices. Teach-back was not used due to the discharge scenario used in the simulation center, due to the student forgetting and/or being nervous, due to how engaged the patient was, or due to individual communication style., Conclusions: Results from our pilot study indicate that RT students may benefit from a 1-h health literacy and teach-back skills training. Furthermore, we identified reasons why the teach-back method was not used and determined what communication training students perceived would be helpful. Our findings can be used to help improve and implement communication skills training in the RT curriculum., Competing Interests: Dr Zimmerman presented a version of this paper at the Open Forum of the 2019 AARC Congress, held November 9-12, 2019 in New Orleans, LA. The authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

During the coronavirus pandemic, it was imperative that real-time, rapidly changing guidance on continuously evolving critical health information about COVID-19 be communicated. This case study highlights how understandable and actionable COVID-19 health information was systematically developed and disseminated to support highly vulnerable refugee, immigrant, and migrant (RIM) communities in Clarkston, Georgia. Our approach was grounded in community-based participatory research (CBPR) incorporating Cultural and Linguistically Appropriate Services (CLAS) standards, plain language and health literacy guidelines, and health communication science to improve the understandability and usability of COVID-19 micro-targeted messaging for RIM communities. We followed a centralized systematic approach to materials development and incorporated local needs and existing networks to ensure cultural and linguistic responsiveness as well as understandability for populations with limited literacy skills. Further, iterative development of materials with community members and agencies provided buy-in prior to dissemination. As part of a multi-pronged community-wide effort, effective materials and messaging provided support to community health workers and organizations working to improve vaccination rates among the RIM community. As a result, we saw vaccine rates in Clarkston outpace other similar areas of the county and state due to this community-wide effort. [ABSTRACT FROM AUTHOR]

The gap between how health information is communicated and what people understand and can use to make informed health decisions is called health literacy. This gap was exacerbated by the rapidly changing and excessive volume of information, misinformation, and disinformation during the COVID-19 pandemic. People with lower health literacy may not have understood the importance of COVID-19 vaccination for themselves or for their communities. Our aim was to understand health literacy levels within Fulton County, Georgia, and their relationship to vaccine prevalence. Fulton county residents ages 18 and over (n = 425) completed an on-line Health Literacy Questionnaire. Individual, organizational, functional, interactive, and critical health literacy scales were created. Vaccination prevalence data were collected from the Georgia Vaccine Distribution Dashboard. All data were divided into one of three county areas. There were statistically significant variations in vaccine prevalence χ2(3) = 29.325, p < 0.001 among the three county areas. All levels of health literacy predicted overall county vaccination prevalence F (4,420) = 85.941, p < 0.001, There were significant differences in health literacy levels among two of the three county area pairs; the lowest resourced county area had the lowest vaccination prevalence and health literacy rates. This is the first example of relating direct health literacy measures across a major metropolitan US county with vaccine prevalence data. [ABSTRACT FROM AUTHOR]

Background: The transmission of health information from in-person communication to web-based sources has changed over time. Patients can find, understand, and use their health information without meeting a health care provider and are able to participate more in their health care management. In recent years, the internet has emerged as the primary source of health information, although clinical providers remain the most credible source. The ease of access, anonymity, and busy schedules may be motivating factors to seek health information on the web. Social media has surfaced as a popular source of health information, as it can provide news in real time. The increase in the breadth and depth of health information available on the web has also led to a plethora of misinformation, and individuals are often unable to discern facts from fiction. Competencies in health literacy (HL) can help individuals better understand health information and enhance patient decision-making, as adequate HL is a precursor to positive health information-seeking behaviors (HISBs). Several factors such as age, sex, and socioeconomic status are known to moderate the association between HL and HISBs. Objective: In this study, we aimed to examine the relationship between HL and HISBs in individuals living in a southern state in the United States by considering different demographic factors. Methods: Participants aged =18 years were recruited using Qualtrics Research Services and stratified to match the statewide demographic characteristics of race and age. Demographics and source and frequency of health information were collected. The Health Literacy Questionnaire was used to collect self-reported HL experiences. SPSS (version 27; IBM Corp) was used for the analysis. Results: A total of 520 participants met the criteria and completed the survey (mean age 36.3, SD 12.79 years). The internet was cited as the most used source of health information (mean 2.41, SD 0.93). Females are more likely to seek health information from physicians than males (r=0.121; P=.006). Older individuals are less likely to seek health information from the internet (r=-0.108; P=.02), social media (r=-0.225; P<.001), and friends (r=-0.090; P=.045) than younger individuals. Cluster analysis demonstrated that individuals with higher levels of HISBs were more likely to seek information from multiple sources than those with lower levels of HISBs (mean range 3.05-4.09, SD range 0.57-0.66; P<.001). Conclusions: Age and sex are significantly associated with HISB. Older adults may benefit from web-based resources to monitor their health conditions. Higher levels of HL are significantly associated with greater HISB. Targeted strategies to improve HISB among individuals with lower levels of HL may improve their access, understanding, and use of health information. [ABSTRACT FROM AUTHOR]

Vulnerable refugee communities are disproportionately affected by the ongoing COVID-19 pandemic; existing longstanding health inequity in these communities is exacerbated by ineffective risk communication practices about COVID-19. Culturally and linguistically appropriate health communication following health literacy guidelines is needed to dispel cultural myths, social stigma, misinformation, and disinformation. For refugee communities, the physical, mental, and social-related consequences of displacement further complicate understanding of risk communication practices grounded in a Western cultural ethos. We present a case study of Clarkston, Georgia, the "most diverse square mile in America," where half the population is foreign born and majority refugee. Supporting marginalized communities in times of risk will require a multipronged, systemic approach to health communication including: (1) creating a task force of local leaders and community members to deal with emergent issues; (2) expanding English-language education and support for refugees; (3) including refugee perspectives on risk, health, and wellness into risk communication messaging; (4) improving cultural competence and health literacy training for community leaders and healthcare providers; and (5) supporting community health workers. Finally, better prepared public health programs, including partnerships with trusted community organizations and leadership, can ensure that appropriate and supportive risk communication and health education and promotion are in place long before the next emergency. [ABSTRACT FROM AUTHOR]

Providers of health information like doctors, the CDC, and health systems can help get critical COVID-19 information out to communities by partnering with these trusted sources. As part of our collaboration with the School of Public Health CDC-funded Prevention Research Center at Georgia State University, we have also created a flip book for adults who have low reading skills that addresses many of the COVID-19 related myths that our local refugee communities struggle with. At the Adult Literacy Research Center, we have created a library of high interest/low literacy COVID-19 documents that adult educators, community organizations, and health providers can access to share with adults who are low-skilled readers. Building a Culture of Health Literacy during COVID-19. [Extracted from the article]

Background: The importance of engaging patients in their cancer care cannot be ignored. Health literacy communication skills like Teach-Back may help improve patient engagement by providing patients with accessible, understandable, and usable information and then confirming that patients understand what they are being told, thereby improving patient self-efficacy. Teach-Back is a method in which patients confirm their understanding by responding to questions that are framed by the navigator saying, "I gave you a lot of information, and I want to make sure I was clear." Objective: To evaluate implementation of the Teach-Back method and to measure patient understanding of information and engagement. Methods: We collected data on the number of patient questions using a standard navigator script (N = 65). Navigators were trained on use of Teach-Back, and the navigator script was modified to include Teach- Back language. Patients (n = 55) called in to the navigator center to talk with a navigator who used the modified navigator script. Navigators collected data on each call, identifying which Teach-Back question they used, correctness of patient responses, and types of information Teach-Back by patients. Results: By adding Teach-Back language to standardized navigator scripts, navigators found patients more conversational and more focused in their questions. Conclusions: Teach-Back is an effective method of reinforcing or confirming patient education and will be implemented and measured by the Cancer Center in all standard navigator scripts. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Respiratory therapists (RTs) should communicate with patients in a way that leads to patients understanding their discharge plans and medical device instructions. The teach-back method is a patient-centered, health-literate technique that allows health care professionals to confirm patient understanding. The purpose of this mixed-methods pilot study was to measure the use of teach-back by first-year undergraduate RT students in a simulation-center experience after a 1-h teach-back skills training. METHODS: First-year RT students' health literacy knowledge and belief in communication skills were measured using a pre- and post- survey about their knowledge and beliefs. A 1-h health literacy and teach-back skills training lecture (ie, intervention) was delivered after the pre-testing. RT students were then assessed for teach-back use during a regularly scheduled simulation center experience. Their experiences were recorded in a semistructured interview immediately after the simulation-center experience. RESULTS: 14 of 20 RT students used teach-back in the simulation center. Knowledge scores increased from 8.278 to 8.944 postintervention, and the median scores for belief increased from 111 to 117 postintervention. There was a statistically significant postintervention increase in knowledge scores (P < .001) and in communication belief scores (P = .038). Thematic content analysis revealed 2 primary themes for teach-back use: to confirm patient understanding and to confirm proper use of medical devices. Teach-back was not used due to the discharge scenario used in the simulation center, due to the student forgetting and/or being nervous, due to how engaged the patient was, or due to individual communication style. CONCLUSIONS: Results from our pilot study indicate that RT students may benefit from a 1-h health literacy and teach-back skills training. Furthermore, we identified reasons why the teach-back method was not used and determined what communication training students perceived would be helpful. Our findings can be used to help improve and implement communication skills training in the RT curriculum. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Young children from parents with low income and low-literacy skills are often late in being diagnosed with developmental disabilities. To try to understand this phenomenon, we conducted six focus groups with 17 parents of low income with low-literacy skills living in an urban area who had children between 6 months and 4 years of age. Parents were asked how they access general information about child development and parenting resources. They were also probed about their experiences learning about their specific children's development. Their feedback was also sought on the Centers for Disease Control and Prevention's Learn the Signs Act Early materials. Results highlighted the resourcefulness of the parents to find information and the difficulties they had with printed information. Their focus group responses indicate the need for agencies to think more broadly about where to provide information for parents and the need to utilize easy-to-read printed materials. [ABSTRACT FROM AUTHOR]

The purpose of this research was to analyze oral communication patterns between patients with varying degrees of individual health literacy (how patients access, understand, and use health information) and their health providers. We analyzed a secondary data set of 68 patient–nurse provider audiotaped clinic encounters using REALM (Rapid Estimate of Adult Literacy in Medicine, a health literacy measure), correlations, and quantile regression to look at the use of provider dialogue components: closed-ended questions, open-ended questions, data gathering—biomedical, education/counseling—biomedical, data gathering—lifestyle/psychosocial, education and counseling—lifestyle/psychosocial, and checking for understanding. Patients with lower health literacy levels were asked more closed-ended biomedical and lifestyle/psychosocial questions than those with higher literacy levels. Providers did not check for understanding with patients at any health literacy level. Implications for health literacy and adult education in the medical setting, adult classroom, and community organizations are described. [ABSTRACT FROM AUTHOR]