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The promotion of health literacy was a key public health strategy during the COVID-19 pandemic. However, the role of social networks and relationships for support with health literacy-related tasks in the context of the COVID-19 pandemic is scarcely understood. Moving beyond traditional notions of health literacy, which focus on individual skills and knowledge, this study uses the concept of distributed health literacy to explore how individuals make meaning of and respond to health literacy and make their literacy skills available to others through their relational and socially situated and lived experiences of the COVID-19 pandemic. Drawing on 89 semi-structured interviews conducted in three European countries (Italy, Portugal, and Switzerland) between October and December 2021, we found narratives of stabilization, hybridization, and disruption that show how health literacy concerning COVID-19 is a complex social construct intertwined with emotional, cognitive, and behavioral responses distributed among individuals, communities, and institutions within socioeconomic and political contexts that affect their existence. This paper opens new empirical directions to understand the critical engagement of individuals and communities toward health information aimed at making sense of a complex and prolonged situation of uncertainty in a pandemic. [ABSTRACT FROM AUTHOR]

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Abstract Background Critical thinking about health choices is essential to avoid being misled by unreliable information and to use reliable information appropriately. The aim of this prospective meta-analysis was to synthesize the results of 1-year follow-up data from three cluster-randomized trials of an intervention designed to teach lower secondary school students to think critically about health choices. Only one other randomized trial has evaluated a school-based intervention to teach adolescents to think critically about health choices. That trial compared two teaching strategies to teach statistical reasoning. It did not assess long-term learning-retention. Methods We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included providing a 2–3-day teacher training workshop and digital resources for ten lessons. The intervention focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥ 9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall intervention effects. We calculated learning retention as the test results in the intervention schools after 1 year relative to just after the intervention, adjusted for chance. Results Altogether, 244 schools (11,344 students) took part in the three trials. Follow-up data was collected for 8298 students (73%). The overall odds ratio for the primary outcome after 1 year was 3.6 (95% CI: 1.9–7.1; p = 0.0001) in favor of the intervention, whereas it was 5.5 (95% CI: 3.0–10.2) just after the intervention. This corresponds to 25.6% (95% CI: 21.1–30.0%) more students in the intervention schools passing the test after 1 year versus 33.3% (95% CI: 28.7–37.8%) just after the intervention. Overall, 2273 (52.6%) of 4324 students in intervention schools had a passing score after 1 year compared to 3397 (58.1%) of 5846 students just after the intervention, indicating 88.3% learning retention. Conclusions One year after the intervention, we still found a positive effect on the ability of students to think critically about health choices, but 5.5% fewer students in the intervention schools had a passing score. The certainty of the evidence was also lower due to 27% of students being lost to follow-up. Trial registration The protocol for this prospective meta-analysis was registered with PROSPERO May 31, 2022, ID 336580. The three randomized trials were registered in the Pan African Clinical Trial Registry February 15, 2022, PACTR202203880375077; April 5, 2022, PACTR20220488391731; and April 14, 2022, PACTR202204861458660.

Background: Critical thinking about health choices is essential to avoid being misled by unreliable information and to use reliable information appropriately. The aim of this prospective meta-analysis was to synthesize the results of 1-year follow-up data from three cluster-randomized trials of an intervention designed to teach lower secondary school students to think critically about health choices. Only one other randomized trial has evaluated a school-based intervention to teach adolescents to think critically about health choices. That trial compared two teaching strategies to teach statistical reasoning. It did not assess long-term learning-retention. Methods: We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included providing a 2–3-day teacher training workshop and digital resources for ten lessons. The intervention focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥ 9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall intervention effects. We calculated learning retention as the test results in the intervention schools after 1 year relative to just after the intervention, adjusted for chance. Results: Altogether, 244 schools (11,344 students) took part in the three trials. Follow-up data was collected for 8298 students (73%). The overall odds ratio for the primary outcome after 1 year was 3.6 (95% CI: 1.9–7.1; p = 0.0001) in favor of the intervention, whereas it was 5.5 (95% CI: 3.0–10.2) just after the intervention. This corresponds to 25.6% (95% CI: 21.1–30.0%) more students in the intervention schools passing the test after 1 year versus 33.3% (95% CI: 28.7–37.8%) just after the intervention. Overall, 2273 (52.6%) of 4324 students in intervention schools had a passing score after 1 year compared to 3397 (58.1%) of 5846 students just after the intervention, indicating 88.3% learning retention. Conclusions: One year after the intervention, we still found a positive effect on the ability of students to think critically about health choices, but 5.5% fewer students in the intervention schools had a passing score. The certainty of the evidence was also lower due to 27% of students being lost to follow-up. Trial registration: The protocol for this prospective meta-analysis was registered with PROSPERO May 31, 2022, ID 336580. The three randomized trials were registered in the Pan African Clinical Trial Registry February 15, 2022, PACTR202203880375077; April 5, 2022, PACTR20220488391731; and April 14, 2022, PACTR202204861458660. [ABSTRACT FROM AUTHOR]

Objective: To explore the perspectives and practices of high school health education teachers implementing health literacy with a focus on the social determinants of health within the context of a concern for social justice. Design: Qualitative content analysis was used to assess high school teachers' accounts of the practices used to teach health education in line with their professional preparation, the Texas Essential Knowledge and Skills (TEKS) standards, the textbook(s) used and the district's health education curriculum. Setting: A large urban independent school district in southern Texas, USA. Method: Six high school health education teachers' interviews were analysed using the social ecological framework and a social justice framework to identify themes that aligned with the teaching practices used to facilitate critical health literacy. Results: Although teachers were unfamiliar with the term Social Determinants of Health, they were able to speak to the challenges that their students faced in everyday life. The need for support and the remedying of knowledge deficits were two important themes. Conclusion: Health education teachers often lack the preparation to teach about the social determinants of health in a manner that resonates with students' backgrounds. The current TEKS standards provide insufficient guidance, emphasising kinesiology, diet and movement over a focus on critical health literacy and the social determinants of health, resulting in a limited and inadequate curriculum for high school students. [ABSTRACT FROM AUTHOR]

Background People need critical thinking skills to make well-informed health choices and avoid waste and unnecessary suffering. However, educational interventions can have adverse effects, which is often overlooked. We created a framework of potential harms of interventions to improve critical thinking about health choices. The objective was to identify potential effects and articulate potential mechanisms. We intended to use the framework to inform the development and evaluation of an intervention in Kenya, Rwanda, and Uganda. Methods We created an initial framework drawing on two earlier frameworks. We surveyed external experts using Likert-scale and open-ended items, including researchers, educators, and others, in a variety of relevant fields. We emailed the survey to an international advisory network, and all other experts recommended by respondents. We analyzed the quantitative data using descriptive statistics. We conducted a thematic analysis of the qualitative data. We revised the framework based on those results. To identify any effects missing from the revised framework, we individually interviewed a convenience sample of one teacher from each of Kenya, Rwanda, and Uganda. Results We received responses from 38 of 70 external experts (54%). The quantitative survey data suggested respondents agreed with the initial framework overall. However, the qualitative data led to substantial revisions. The revised framework consists of categories of adverse outcomes; outcomes within each category; sub-outcomes; individuals, groups, and populations that might experience each adverse outcome; beneficial outcomes corresponding with adverse outcomes; and potential mechanisms of adverse effects. There are six categories: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms. In the interviews with teachers, we did not identify any effects missing from the revised framework. Conclusions As far as we know, the framework is the first tool of its kind for education research. It can be improved upon and adapted.

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

In Australia, surveillance data establish that there are higher rates of late HIV diagnoses among heterosexual migrants from Sub-Saharan Africa and new HIV diagnoses among gay and bisexual men (GBM) from Southeast and Northeast Asia and Latin America. Together, these groups are identified as priority migrant communities in current efforts to eliminate HIV transmissions. HIV health literacy is recognised as a key means of improving access to services and health outcomes. This qualitative paper explores critical HIV health literacy among priority migrant communities in Queensland, Australia. To foreground community voices, peer researchers from priority migrant communities participated in the project design, data collection and analysis, with 20 interviews completed. The findings demonstrate how participants' engagement with HIV health information and services is highly relational and situated within the framework of sexual health and wellbeing. Participants strategically selected where to seek information and who they trusted to help them appraise this information. They further demonstrated reflective capacities in identifying the contextual barriers that inhibit the development of their HIV health literacy. The findings highlight the need for HIV health promotion strategies that embrace a sex positive approach, promote cultural change, and involve collaboration with general practitioners (GPs). [ABSTRACT FROM AUTHOR]

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Given the rapid increase in health information available, health literacy is now more important than ever when searching for health information online. Furthermore, health literacy and online health information searching are reported to be associated with support from others. In this study, we examined the associations of health literacy and social support with online health information searching among individuals in their 50s and 60s. Between March and May 2022, an anonymous self-administered questionnaire was administered among 750 middle-aged and older adults (age 50-69) living in northern Japan. The questionnaire items included personal characteristics, frequency of online health information searching, health literacy domains, and social support. A total of 237 respondents answered all the items (response rate: 31.6%). Multiple logistic regression analysis revealed that communicative health literacy was significantly associated with searching for information about illnesses and health promotion, while critical health literacy was significantly associated with searching for information about medical institutions. Controlling for personal characteristics, health literacy, was associated with online health information searching, suggesting that improving health literacy is important in a digital and information society. [ABSTRACT FROM AUTHOR]

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

BACKGROUND: Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA‐Q). METHODS: A cross‐sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13‐15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha. RESULTS: The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability. CONCLUSION: The results indicate acceptable fit of the CHLA‐Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL. [ABSTRACT FROM AUTHOR]

Background: This article details community engagement, design, and implementation strategies for the Raices-Xidid-Roots (RXR) Academy. RXR provided a linguistically accessible and culturally relevant curriculum to residents of Spanish and Somali-speaking immigrant, asylee, and refugee backgrounds. Objectives: This study examined the implementation of the RXR program, including participation and adjustments needed to foster participant engagement and active voice, and explored participant actions to address self-identified aspirations as part of participation. RXR's goal was to empower Morgan County, Colorado, Spanish- and Somalispeaking cohorts of residents from immigrant, asylee, and refugee backgrounds such that they could autonomously plan, create, and sustain programs and organizations to meet their community needs. Methods: The observational study design included process and implementation evaluative approaches, including interview, project team meeting debriefings, and course organizer reflections, to identify and address implementation challenges, learn how the program met participants' needs, and understand keys to maintaining participant engagement. Results: Cultural adaptation of the content was key to maintaining consistent participant engagement, including delivering programming in participant preferred languages and tailoring curriculum to participant cultural practices. Participants indicated that language barriers had previously prevented them from accessing the content provided by the program's curriculum. Adaptations included adjusting meeting logistics, participant compensation, and unit timing. The Two RXR Academy cohorts developed initiatives that addressed community-identified needs. Lessons Learned: Three RXR design elements supported participant engagement and development of community power: 1) language access beyond the language justice model by providing programming in the participants' preferred language, 2) cultural adaptation of programming, and 3) community ownership and active voice Conclusions: The RXR program provided opportunities for skill development among Morgan County's non-native English-speaking residents and led to the design and implementation of resident-driven projects. [ABSTRACT FROM AUTHOR]

Background The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Background The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

The cognitive and social practices associated with critical health literacy, such as critical appraisal of health messages and participation in political processes to address wider determinants of health, are of lifelong benefit. Understanding how and where critical health literacy development can be supported early in the life course may improve health outcomes now and in the future. This scoping review focuses on how critical health literacy in children is conceptualized and the supportive environments available for its development. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines are used in reporting. Evidence retrieved was eligible for inclusion if it contained a substantive conceptual or empirical study of critical health literacy in populations aged 7–11 (middle childhood). From the included 18 peer-reviewed and grey literature sources, schools are identified as the setting most associated with the development of critical health literacy in the target age group. However, the action-oriented dimension of critical health literacy is rarely supported in the school setting. The review concludes that further research is needed to clarify how and where to support children to develop critical health literacy in and outside of school settings. [ABSTRACT FROM AUTHOR]

Aim: There is an overabundance of claims about the advantages and disadvantages of health interventions. People need to be able to appraise the reliability of these claims. The aim of this two‐arm cluster‐randomized trial was to evaluate the Informed Health Choices secondary school intervention designed to teach students to assess claims about the effects of health actions and make informed decisions. Methods: We conducted the trial among students from 80 secondary schools in five subcounties in Kenya. We used stratified randomization to allocate schools to the intervention or control arm. The intervention included a 2‐day teacher training workshop and 10 lessons that addressed nine prioritized key concepts for assessing claims about treatment effects. We did not intervene in the control schools. The primary outcome was the proportion of students with a passing score (≥ 9/18 correct answers) on the Critical Thinking about Health test, which included two multiple‐choice questions for each concept. Results: Between May 11, 2022, and July 8, 2022, we recruited 3362 students and 80 teachers. We allocated 1863 students and 40 teachers to the intervention and 1499 students and 40 teachers to the control arm. In the intervention schools, 1149/1863 (61.7%) of students achieved a passing score compared to 511/1499 (34.1%) in the control schools (odds ratio 3.6 (95% CI 2.5–5.2), p < 0.0001). Conclusions: The intervention had a large effect on students' ability to think critically about health interventions. It is possible to integrate the learning of critical thinking about health within Kenya secondary school curriculum. [ABSTRACT FROM AUTHOR]

Aim: The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices. Methods: We conducted a two‐arm cluster‐randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40‐min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention‐to‐treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts. Results: Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3–17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%–45.0%). Conclusions: The intervention is effective in helping students think critically about health choices. It was possible to improve students' ability to think critically about health in the context of a competence‐based curriculum in Rwanda, despite challenging postpandemic conditions. [ABSTRACT FROM AUTHOR]

Aim: The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students' ability to assess health‐related claims and make informed choices. Methods: In a cluster‐randomized trial, we randomized 80 secondary schools (students aged 13–17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2‐day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple‐choice questions for each concept to evaluate the students' ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly). Results: Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%–39%). Conclusions: The IHC secondary school intervention improved students' ability to think critically and make informed choices. Well‐designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling‐up use of the resources and help to address inequities associated with limited ICT access. [ABSTRACT FROM AUTHOR]

Aim: The aim of this prospective meta‐analysis was to synthesize the results of three cluster‐randomized trials of an intervention designed to teach lower‐secondary school students (age 14–16) to think critically about health choices. Methods: We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2‐ to 3‐day teacher training workshop, digital resources, and ten 40‐min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple‐choice questions answered correctly). We performed random effects meta‐analyses to estimate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers. Results: Altogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0–10.2; p < 0.0001) in favor of the intervention (high certainty evidence). This corresponds to 33% (95% CI: 25–40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 students in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6–40.4; p < 0.0001), corresponding to 32% (95% CI: 6%–57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score. Conclusions: The intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score. [ABSTRACT FROM AUTHOR]

Objective. Patients who trust their physicians have been shown to demonstrate good medication adherence, self-management, and favorable disease outcomes. This study examines how trust in physicians is affected by functional health literacy (HL) and by broader concepts of HL, including communicative HL and critical HL, among patients with systemic lupus erythematosus (SLE). Methods. This was a cross-sectional study using baseline data from the Trust Measurement for Physicians and Patients with SLE (TRUMP2-SLE) study, an ongoing multicenter cohort study conducted at 5 academic centers. The 14-item Functional, Communicative, and Critical Health Literacy Scale assessed the 3 dimensions of HL; each item of the scale was scored on a 4-point Likert scale, ranging from 1 to 4. Outcomes were trust in one’s physician and trust in physicians in general using the 5-item Wake Forest Physician Trust Scale, which ranged from 0 to 100 points. General linear models were fit. Results. A total of 362 patients with SLE were included. Trust in one’s physician increased with higher functional and communicative HL (per 1-point increase: mean difference 3.39, 95% CI 0.39-6.39, and mean difference 5.88, 95% CI 2.04-9.71, respectively). Trust in physicians in general increased with higher communicative HL and decreased with higher critical HL (per 1-point increase: mean difference 7.09, 95% CI 2.34-11.83, and mean difference –6.88, 95% CI –11.72 to –2.04, respectively). Longer internet use was associated with both higher communicative and critical HL. Conclusion. The findings suggest that rheumatologists need to improve their communication to match each patient’s HL, which may foster trust and lead to improved self-management and outcomes in SLE. They also suggest that the formation of the rheumatologist-patient relationship may negate the effect of high critical HL in building trust. [ABSTRACT FROM AUTHOR]

ObjectivesWe aimed to develop and test the feasibility of a critical health literacy (CHL) and science literacy (SL) training course targeting secondary school students in Switzerland.MethodsUsing a community-based participatory approach, we developed a two-block training program, the first centered on argumentation skills and the second on scientific skills. We combined an ex-cathedra and a flipped-classroom approach, providing students with a deep understanding of CHL and SL concepts and the translational capability of implementing theoretical notions to real case scenarios. The feasibility study was designed as a one-group pretest-posttest quasi-experiment. Beyond socio-demographics, questionnaires included measures of CHL, SL, trust in science, and perceived quality of the course.ResultsThe curriculum was feasible and well-accepted by the target groups, teachers, and students. Students convincingly specified their perceived personal benefits associated with a positive change in CHL and SL scores after the training course.ConclusionTraining CHL and SL in secondary school students is feasible and can improve their competencies. Results from present study can inform a large-scale study.

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centered design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Abstract Background Good health decisions depend on one’s ability to think critically about health claims and make informed health choices. Young people can learn these skills through school-based interventions, but learning resources need to be low-cost and built around lessons that can fit into existing curricula. As a first step to developing and evaluating digital learning resources that are feasible to use in Kenyan secondary schools, we conducted a context analysis to explore interest in critical thinking for health, map where critical thinking about health best fits in the curriculum, explore conditions for introducing new learning resources, and describe the information and communication technology (ICT) infrastructure available for teaching and learning. Methods We employed a qualitative descriptive approach. We interviewed 15 key informants, carried out two focus group discussions, observed ICT conditions in five secondary schools, reviewed seven documents, and conducted an online catalog of ICT infrastructure in all schools (n=250) in Kisumu County. Participants included national curriculum developers, national ICT officers, teachers, and national examiners. We used a framework analysis approach to analyze data and report findings. Findings Although critical thinking is a core competence in the curriculum, critical thinking about health is not currently taught in Kenyan secondary schools. Teachers, health officials, and curriculum developers recognized the importance of teaching critical thinking about health in secondary schools. Stakeholders agreed that Informed Health Choices learning resources could be embedded in nine subjects. The National Institute of Curriculum Development regulates resources for learning; the development of new resources requires collaboration and approval from this body. Most schools do not use ICT for teaching, and for those few that do, the use is limited. Implementation of Kenya’s ICT policy framework for schools faces several challenges which include inadequate ICT infrastructure, poor internet connectivity, and teachers’ lack of training and experience. Conclusion Teaching critical thinking about health is possible within the current Kenyan lower secondary school curriculum, but the learning resources will need to be designed for inclusion in and across existing subjects. The National ICT Plan and Vision for 2030 provides an opportunity for scale-up and integration of technology in teaching and learning environments, which can enable future use of digital resources in schools. However, given the current ICT condition in schools in the country, digital learning resources should be designed to function with limited ICT infrastructure, unstable Internet access, and for use by teachers with low levels of experience using digital technology.

BackgroundIn Norway, the introduction of an interdisciplinary subject named Public Health and Life skills has brought about renewed attention to how health is conceptualized and taught within and across school subjects. Physical education (PE) is one subject that has traditionally been linked to health outcomes. However, a narrow focus on increased physical activity as the main outcome of PE could be counterproductive in the pursuit of health. Critical health literacy (CHL) is put forward as a resource for health that can be nurtured in the PE context; this study hypothesizes that academic achievement in PE is positively associated with some aspects of CHL.MethodsThis cross-sectional study included 521 pupils aged 13–15 years old from five lower secondary schools in Norway. Structural equation models were used as the primary statistical analysis to test the hypothesis. The study controlled for parents’ education, leisure physical activity, and participation in sports club activities.ResultsThe results confirm the hypothesis, showing a positive and significant association between PE and CHL. The association remains when controlling for parents’ education, leisure physical activity, and participation in sports club activities (β^PE→CHL−C1 = 0.264, p = 0.001; β^PE→CHL−C2 = 0.351, p

The COVID-19 pandemic presented a teachable moment to empower citizens to assess and apply information to protect their health by promoting critical health literacy. Most Americans took preventive measures, suggesting some overall increase in critical health literacy around infectious disease. Simultaneously, however, a torrent of misinformation, disinformation and malinformation intentionally buried facts, sewed doubt and confusion, promoted lies and conspiracies, and undermined health authorities and institutions. The authors discuss how this 'infodemic' rose from previously localized, unconnected anti-vaccination, anti-government, and anti-science groups galvanized by the pandemic. Prominent politicians seeking political gain lent the power of their offices to the movement, layering a 'polidemic' onto the infodemic and overwhelming inconsistent public health messaging. Even those with strong health literacy skills were challenged. Millions were misled to over-confidently self-manage their risk, revealing the possibility and perils of empowerment in the absence of critical health literacy skills – negative empowerment. The roots of resistance to the government response to COVID-19, and conditions that fostered its influence are examined, followed by recommendations to position health literacy scholars and practitioners to better meet communication challenges and opportunities in future crises. [ABSTRACT FROM AUTHOR]

Abstract Background The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires critical health literacy to discriminate between sources, critically analyse meaning and relevance, and use information for personal health. Adolescents with poor digital health literacy risk using misinformation, with potential negative health outcomes. We aimed to understand adolescents’ contemporary digital health literacy and compared self-efficacy with capability. Methods Adolescents (12–17 years) completed an eHEALS self-report digital health literacy measure, a practical search task using a think-aloud protocol and an interview to capture perceived and actual digital health literacy. eHEALS scores were generated using descriptive statistics, search tasks were analysed using an observation checklist and interviews were thematically analysed based on Social Cognitive Theory, focussing on self-efficacy. Results Twenty-one participants generally had high self-efficacy using online health information but perceived their digital health literacy to be higher than demonstrated. They accessed online health information unintentionally on social media and intentionally via search engines. They appraised information medium, source and content using general internet searching heuristics taught at school. Information on social media was considered less trustworthy than websites, but participants used similar appraisal strategies for both; some search/appraisal heuristics were insufficiently nuanced for digital health information, sometimes resulting in misplaced trust or diminished self-efficacy. Participants felt anxious or relieved after finding online health information, depending on content, understanding and satisfaction. They did not act on information without parental and/or health professional advice. They rarely discussed findings with health professionals but would welcome discussions and learning how to find and appraise online health information. Conclusions Whilst adolescents possess many important digital health literacy skills and generally feel self-efficacious in using them, their critical health literacy needs improving. Adolescents desire increased digital health literacy so they can confidently appraise health information they find online and on social media. Co-designed educational interventions with adolescents and health providers are required.

The purpose of this investigation was to assess the extent to which health literacy and social determinants of health exist together in medical school curricula, and the attitudes and beliefs of medical school educators toward the relevance of these topics taught in the curriculum. The research used a descriptive cross-sectional survey design of institutions that comprised the Accelerating Change in Medical Education (ACE) Consortium of the American Medical Association. The study population was 36 ACE institutions, but only 11 ACE institutions made up the study sample. Results also showed that five health literacy items were taught as curricula topics in medical school education with 100% (n = 10) of the respondents teaching how to use plain language skills for oral communication. Respondents rated the level at which their institution prioritized instructional methods to explicitly teach social determinants of health as a topic in the medical curriculum with three (27.3%) ranking the priority level as extremely high, seven (63.6%) ranking it as high, and one (9.1%) ranking it as low. Medical educators rated five social determinants of health influencing a person’s health status, with “economic stability” and “social and community context” having the first and second highest mean rankings, respectively. Nine (81.5%) medical educators agreed that health literacy is a social determinant of health (M = 8.73) and a predictor of health status (M = 7.82).

Background: Previous studies have revealed that functional health literacy plays a less important role than communicative and critical health literacy (CRHL) and that communicative literacy and CRHL contribute more to better patient self-management. Although improving health literacy has been identified as an approach to fostering community involvement and empowerment, CRHL may be regarded as the neglected domain of health literacy, rarely achieving any focus or interventions that claim to be working toward this outcome. Considering this research background, close scholarly attention needs to be paid to CRHL and its associated factors. Objective: This study aimed to assess CRHL and identify essential factors closely associated with the status of CRHL among Chinese patients and to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We conducted this cross-sectional study, which lasted from April 8, 2022, to September 23, 2022, following the steps below. We first designed a 4-section survey questionnaire and then recruited Mandarin Chinese–speaking patients from Qilu Hospital of Shandong University, China, using randomized sampling. Subsequently, we administered the questionnaire via wenjuanxing, the most popular web-based survey platform in China, between July 20, 2022, and August 19, 2022. Finally, we used latent class modeling to analyze the valid data collected to classify the patient participants and identify the factors potentially associated with different CRHL levels. Results: All data in the 588 returned questionnaires were valid. On the basis of the collected data, we classified the patient participants into 3 latent classes of limited, moderate, and adequate CRHL and identified 4 factors associated with limited CRHL, including middle and old age, male sex, lower educational attainment, and low internal drive to maintain one's health. Conclusions: Using latent class modeling, we identified 3 classes of CRHL and 4 factors associated with limited CRHL among the Chinese study participants. These literacy classes and the predicting factors ascertained in this study can provide some implications for clinical practice, health education, medical research, and health policy making. [ABSTRACT FROM AUTHOR]

This commentary is intended as a response to ongoing concerns expressed about fundamental limitations of current research, policy, and practice surrounding health literacy. These concerns emphasise the individualistic and reductionist approaches which often dominate health literacy work, as well as a neglect of broader structural factors in addressing pressing public health issues. The potential of critical health literacy as a concept and practical approach which responds to these critiques is presented. A case is made that critical health literacy, as a concept that operates at both the community and individual level, offers an opportunity to address and eventually overcome these basic limitations in current health literacy approaches., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background The Informed Health Choices (IHC) project team developed learning resources for primary school children to teach critical thinking about treatments claims and health choices and evaluated their effect in a randomized controlled trial of 120 schools in Uganda. Children taught with these resources showed a better ability to think critically about treatments claims and health choices than children not taught with these resources. Teams in multiple countries are contextualising the IHC resources for use in other languages and settings; in this pilot we describe contextualization for use in Italian primary school. Methods After translating the IHC resources to Italian and holding an introductory workshop with participating schoolteachers, we piloted the resources with two classes of a primary school in Florence over nine lessons. Our aims were: 1) to assess the feasibility of introducing the IHC curriculum in Italian primary school; 2) to evaluate students’ ability to assess health claims and make informed health choices; to explore 3) students’ and 4) teachers’ experiences with the IHC learning resources; 5) to identify barriers and facilitators to implementation of IHC learning resources in Italian primary school. To assess these objectives, we used qualitative and quantitative methods. Results Both qualitative and quantitative analyses consistently showed that the IHC learning resources had a positive impact on the objectives examined. The resources integrated well into the Italian primary school curriculum. Both students and teachers considered these resources comprehensible, appealing in design and content, and stimulating for the development of a critical attitude. The only barrier teachers and students expressed was using the resources in a remote learning context. Conclusions Findings from our contextualisation of IHC learning resources in Italian primary school indicate that these resources are well-suited for Italian teachers and students in a primary school context and compatible with the Italian primary school curriculum.

Background: The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods: For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results: The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions: There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Background: Good health decisions depend on one's ability to think critically about health claims and make informed health choices. Young people can learn these skills through school-based interventions, but learning resources need to be low-cost and built around lessons that can fit into existing curricula. As a first step to developing and evaluating digital learning resources that are feasible to use in Kenyan secondary schools, we conducted a context analysis to explore interest in critical thinking for health, map where critical thinking about health best fits in the curriculum, explore conditions for introducing new learning resources, and describe the information and communication technology (ICT) infrastructure available for teaching and learning. Methods: We employed a qualitative descriptive approach. We interviewed 15 key informants, carried out two focus group discussions, observed ICT conditions in five secondary schools, reviewed seven documents, and conducted an online catalog of ICT infrastructure in all schools (n=250) in Kisumu County. Participants included national curriculum developers, national ICT officers, teachers, and national examiners. We used a framework analysis approach to analyze data and report findings. Findings: Although critical thinking is a core competence in the curriculum, critical thinking about health is not currently taught in Kenyan secondary schools. Teachers, health officials, and curriculum developers recognized the importance of teaching critical thinking about health in secondary schools. Stakeholders agreed that Informed Health Choices learning resources could be embedded in nine subjects. The National Institute of Curriculum Development regulates resources for learning; the development of new resources requires collaboration and approval from this body. Most schools do not use ICT for teaching, and for those few that do, the use is limited. Implementation of Kenya's ICT policy framework for schools faces several challenges which include inadequate ICT infrastructure, poor internet connectivity, and teachers' lack of training and experience. Conclusion: Teaching critical thinking about health is possible within the current Kenyan lower secondary school curriculum, but the learning resources will need to be designed for inclusion in and across existing subjects. The National ICT Plan and Vision for 2030 provides an opportunity for scale-up and integration of technology in teaching and learning environments, which can enable future use of digital resources in schools. However, given the current ICT condition in schools in the country, digital learning resources should be designed to function with limited ICT infrastructure, unstable Internet access, and for use by teachers with low levels of experience using digital technology. [ABSTRACT FROM AUTHOR]

Background The Informed Health Choices (IHC) project team developed learning resources for primary school children to teach critical thinking about treatments claims and health choices and evaluated their effect in a randomized controlled trial of 120 schools in Uganda. Children taught with these resources showed a better ability to think critically about treatments claims and health choices than children not taught with these resources. Teams in multiple countries are contextualising the IHC resources for use in other languages and settings; in this pilot we describe contextualization for use in Italian primary school. Methods After translating the IHC resources to Italian and holding an introductory workshop with participating schoolteachers, we piloted the resources with two classes of a primary school in Florence over nine lessons. Our aims were: 1) to assess the feasibility of introducing the IHC curriculum in Italian primary school; 2) to evaluate students’ ability to assess health claims and make informed health choices; to explore 3) students’ and 4) teachers’ experiences with the IHC learning resources; 5) to identify barriers and facilitators to implementation of IHC learning resources in Italian primary school. To assess these objectives, we used qualitative and quantitative methods. Results Both qualitative and quantitative analyses consistently showed that the IHC learning resources had a positive impact on the objectives examined. The resources integrated well into the Italian primary school curriculum. Both students and teachers considered these resources comprehensible, appealing in design and content, and stimulating for the development of a critical attitude. The only barrier teachers and students expressed was using the resources in a remote learning context. Conclusions Findings from our contextualisation of IHC learning resources in Italian primary school indicate that these resources are well-suited for Italian teachers and students in a primary school context and compatible with the Italian primary school curriculum.

Background: The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods: For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results: The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions: There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Background: The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires critical health literacy to discriminate between sources, critically analyse meaning and relevance, and use information for personal health. Adolescents with poor digital health literacy risk using misinformation, with potential negative health outcomes. We aimed to understand adolescents' contemporary digital health literacy and compared self-efficacy with capability.Methods: Adolescents (12-17 years) completed an eHEALS self-report digital health literacy measure, a practical search task using a think-aloud protocol and an interview to capture perceived and actual digital health literacy. eHEALS scores were generated using descriptive statistics, search tasks were analysed using an observation checklist and interviews were thematically analysed based on Social Cognitive Theory, focussing on self-efficacy.Results: Twenty-one participants generally had high self-efficacy using online health information but perceived their digital health literacy to be higher than demonstrated. They accessed online health information unintentionally on social media and intentionally via search engines. They appraised information medium, source and content using general internet searching heuristics taught at school. Information on social media was considered less trustworthy than websites, but participants used similar appraisal strategies for both; some search/appraisal heuristics were insufficiently nuanced for digital health information, sometimes resulting in misplaced trust or diminished self-efficacy. Participants felt anxious or relieved after finding online health information, depending on content, understanding and satisfaction. They did not act on information without parental and/or health professional advice. They rarely discussed findings with health professionals but would welcome discussions and learning how to find and appraise online health information.Conclusions: Whilst adolescents possess many important digital health literacy skills and generally feel self-efficacious in using them, their critical health literacy needs improving. Adolescents desire increased digital health literacy so they can confidently appraise health information they find online and on social media. Co-designed educational interventions with adolescents and health providers are required. [ABSTRACT FROM AUTHOR]

Abstract Background Diabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM). Diabetes educators are important healthcare professionals for implementing the concept of informed SDM in diabetes care. They need critical health competences (CHC) in order to provide evidence-based information and to support patients in understanding the risks of the disease and also the possible benefits or harm of the healthcare options. Therefore, we surveyed the CHC of diabetes educators. Methods We performed a cross-sectional survey using the validated Critical Health Competences (CHC) Test to measure CHC of certified diabetes educators and trainees in Germany. Diabetes educators were approached via newsletter, mailing lists or in person during the conference of the German Diabetes Association. Trainees were approached during their training sessions. We applied scenario 1 of the CHC test, which comprises 17 items with open-ended and multiple-choice questions. Mean person parameters with a range from 0 to 1000 were calculated to assess the levels of critical health competences and a multiple linear regression analysis was conducted to determine correlations between sociodemographic variables and levels of CHC. Results A total of 325 participants, mean age 38.6 (±11.1) years, completed the CHC test; n = 174 (55.5%) were certified diabetes educators and n = 151 (46.5%) were trainees. The participants achieved a mean score of 409.84 person parameters (±88.10) (scale from 0 to 1000). A statistically significant association was found only between the level of education and the level of CHC (b = 0.221; p-value 0.002). Participants with grammar school education achieved higher mean scores compared to participants with secondary school education (432.88 ± 77.72 vs. 396.45 ± 85.95; mean difference 36.42 ± 9.29; 95%CI 18.15 to 54.71; p

• Health literacy is context-specific and related to cultural differences. • Few studies linked health literacy subdomains to health in the Chinese-speaking context. • Interactive health literacy is a stronger determinant of good self-rated health. • Health promotion actions can focus on improving interactive health literacy. The functional, interactive, and critical domains of health literacy are associated with health. However, studies examining the relationship between health literacy subdomains and health in the Chinese-speaking context are still limited. Thus, we aimed to examine the association of functional, interactive, and critical health literacy with self-rated health among older Taiwanese adults. A total of 1,072 participants aged 60 or older were included in the analysis. Health literacy was measured by the 11-item short-form Mandarin Health Literacy Scale and validated tools. Self-rated health was categorized into good (good/very good), fair, and poor (poor/very poor) status. Multinomial logistic regression revealed that only interactive health literacy was associated with reporting good health status (OR = 2.30; 95% CI = 1.65 to 3.21). Conversely, all health literacy subdomains were not associated with reporting poor health. This study suggested that interactive health literacy was the key determinant of good self-rated health status for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online questionnaires that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four questionnaires was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. The adjusted proportion of Norwegian adults who answered correctly was > 50% for 17 of the 30 Key Concepts. On the other hand, less than half answered correctly for 13 concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices.Future interventions should be tailored to address Key Concepts for which there appears to be a lack of understanding.

Objectives: In the COVID-19 pandemic, critical health literacy (CHL-P) has been proposed as a means of addressing issues of complexity, uncertainty, and urgency. Our study aimed to identify CHL-P clusters among university students in Germany and to analyze associations with potential determinants.Methods: In May 2020, students at four German universities participated in the COVID-19 International Student Well-Being Study, an online survey that yielded a non-probabilistic sample of N = 5,021. CHL-P, COVID-19-related knowledge, worries, risk perception, and adherence to protective measures were measured in an online questionnaire with self-constructed items. We conducted a cluster analysis of the five CHL-P items and performed logistic regression analyses.Results: Two CHL-P clusters were identified: high vs. moderate CHL-P. Belonging to the high-CHL-P cluster (31.2% of students) was significantly associated with older age, female/other gender, advanced education, higher levels of parental education, and moderate importance placed on education. In addition, higher levels of knowledge, risk perception and worries, and adherence to protective measures were associated with high CHL-P cluster membership.Conclusion: Students would benefit from educational measures that promote CHL-P at German universities.

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online questionnaires that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four questionnaires was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. The adjusted proportion of Norwegian adults who answered correctly was > 50% for 17 of the 30 Key Concepts. On the other hand, less than half answered correctly for 13 concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices.Future interventions should be tailored to address Key Concepts for which there appears to be a lack of understanding.

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online tests that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four tests was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. We estimate that at least half of Norwegian adults understand 18 of the 30 Key Concepts (i.e. the adjusted proportion of correct answers was > 50%). On the other hand, less than half understood 13 of the concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices. This can result in poorly informed decisions, underuse of effective interventions, and overuse of ineffective or harmful interventions.

Background: Diabetes associations claim to have a patient-centered approach in diabetes care including shared decision-making (SDM). Diabetes educators are important healthcare professionals for implementing the concept of informed SDM in diabetes care. They need critical health competences (CHC) in order to provide evidence-based information and to support patients in understanding the risks of the disease and also the possible benefits or harm of the healthcare options. Therefore, we surveyed the CHC of diabetes educators. Methods: We performed a cross-sectional survey using the validated Critical Health Competences (CHC) Test to measure CHC of certified diabetes educators and trainees in Germany. Diabetes educators were approached via newsletter, mailing lists or in person during the conference of the German Diabetes Association. Trainees were approached during their training sessions. We applied scenario 1 of the CHC test, which comprises 17 items with open-ended and multiple-choice questions. Mean person parameters with a range from 0 to 1000 were calculated to assess the levels of critical health competences and a multiple linear regression analysis was conducted to determine correlations between sociodemographic variables and levels of CHC. Results: A total of 325 participants, mean age 38.6 (±11.1) years, completed the CHC test; n = 174 (55.5%) were certified diabetes educators and n = 151 (46.5%) were trainees. The participants achieved a mean score of 409.84 person parameters (±88.10) (scale from 0 to 1000). A statistically significant association was found only between the level of education and the level of CHC (b = 0.221; p-value 0.002). Participants with grammar school education achieved higher mean scores compared to participants with secondary school education (432.88 ± 77.72 vs. 396.45 ± 85.95; mean difference 36.42 ± 9.29; 95%CI 18.15 to 54.71; p < 0.0001). Conclusion: Diabetes educators achieved low competence scores and it can be assumed that they do not have sufficient CHC to conduct consultations based on the SDM principles. Poor CHC among healthcare providers are a major barrier for the implementation of SDM. Core concepts of evidence-based medicine should be implemented into the curricula for diabetes educators in order to increase their levels of CHC. [ABSTRACT FROM AUTHOR]

Popular physical culture serves as a site, subject and medium for young people's learning (Sandford & Rich, 2006) and impacts their relationship with physical education, physical activity and the construction of their embodied identities. This paper addresses the potential of scrapbooking as a pedagogical and methodological tool to facilitate physical education researchers and teachers to listen to, and better understand and respond to extend students' existing knowledge of, and critical engagement with popular physical culture. The data draws from a three year Participatory Action Research project that was undertaken in an urban, secondary school and was designed to engage 41 girls (aged 15-19) in understanding, critiquing and transforming aspects of their lives that influenced their perspectives of their bodies and their physical activity and physical education engagement. In this paper the focus is on the engagement of eleven of these girls in a five week popular physical culture unit. The students' scrapbooks, audio-recordings of classes, a guided conversation, and field notes constitute the data sources. Findings suggest scrapbooking has the potential to allow researchers access, understand and respond to students' perspectives on popular physical culture and their lives in a way that other methods may not. Pedagogically, scrapbooking supported students in critically appraising and making meaning of "scraps" of popular physical culture. [ABSTRACT FROM AUTHOR]