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All Relevant Resources for Researchers

Resource: The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy

This document, published by the United States National Center for Education Statistics, is a report on the results of the 2003 National Assessment of Adult Literacy.

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Resource: Bridging the Health Literacy Gap. Health Literacy for Better Public Health [US]

This is the health literacy blog from the Centers for Disease Control and Prevention. The purpose of the blog is to stimulate ideas for new work in public health and health literacy, build relationships and community, and discuss our successes and challenges in real time. A variety of topics are covered including plain language in the emergency room, attributes of a health literate organisation, writing health literate materials, and health literacy around the world. Most entries are written by Cynthia Baur.

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Resource: Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1 – 2014 [US]

Electronic health records provide crucial information to health care providers about a patient’s treatment history and current health status. Recent US legislation places importance on the ‘meaningful use’ of electronic health records. This report (130 pages), from the Institute of Medicine, documents the findings from the first phase of a study into the social determinants of health that influence the meaningful use of electronic health records. The IOM identified a set of domains and measures that capture the social determinants of health. Health literacy is identified as a key measure within the psychological domain. This report briefly summarises the supporting evidence that health literacy influences patient health outcomes and the usefulness of health literacy to health care providers.

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Resource: “Following the Physician’s Recommendations Faithfully and Accurately:” Functional Health Literacy, Compliance, and the Knowledge-Based Economy

This article by Sondra Cuban is a critical analysis of functional health literacy and provides insight into the challenges of health literacy.

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Resource: “Keep it simple”: older African Americans’ preferences for a health literacy intervention in HIV management – 2015 [US]

This study explored the preferences of older African Americans with HIV for a health literacy intervention to promote HIV management. Using patient-centred participatory design methods, semi-structured individual interviews were conducted to determine patient preferences for intervention development and design. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine - Revised (REALM-R). The researchers found that nearly half of the participants had limited health literacy. Four key themes emerged from the interviews. Patients expressed the need to keep health information simple, jargon free and to limit the amount of information given in one session. Patients preferred a team-based approach to health education. Previous research has shown that using medical experts and peer educators with "lived experience" of a condition can increase patient engagement and further improve overall outcomes. Patients expressed a desire to use technology to help self-manage their conditions. Interventions may need to account for digital and eHealth literacy needs. Tailoring teaching strategies to patients' individual needs was a frequent theme. To maximise patient health outcomes and ensure the long term success and sustainability of programs, the researchers recommend that culture, age, gender, mental health and health literacy levels need to be considered when designing educational interventions.

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Resource: “This does my head in”. Ethnographic study of self-management by people with diabetes

This study by Hinder & Greenhalgh (2012) provides a richer understanding of how people live with diabetes and why self-management is challenging for some. They find that self-management of diabetes is physically, intellectually, emotionally and socially demanding, and without support can be a difficult task to undertake.

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Resource: 4th Biennial Wisconsin Health Literacy Summit. April 12 -13, 2011 [US]

Wisconsin Literacy, Inc. and the Wisconsin Research and Education Network (WREN) were pleased to co-present the 4th Biennial Wisconsin Health Literacy Summit on April 12-13, 2011 in Madison, Wisconsin. The theme was: Health literacy as the foundation for health care transformation. This event brought together international voices in the fields of health care, adult literacy and health care policy to address health literacy from an interdisciplinary perspective.

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Resource: 5th Biennial Wisconsin Health Literacy Summit. April 9-10, 2013 [US]

Wisconsin Literacy, Inc. and the Wisconsin Research and Education Network (WREN) were pleased to co-present the 5th Biennial Wisconsin Health Literacy Summit on April 9-10, 2013 in Madison, Wisconsin. The theme was: Changing Systems, Changing Lives. This event brought together nationally important voices in the fields of health care, adult literacy and health care policy to address health literacy from an interdisciplinary perspective.

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Resource: A critical review of population health literacy assessment – 2015 [US]

This review examines currently available health literacy assessment tools to identify how well suited they are in addressing health literacy beyond clinical care settings and beyond the individual. The researchers argue that public health literature continues to focus on the individual rather than on health literacy within the context of families, communities and population groups. This approach fails to reflect societal influences on health knowledge, beliefs and behaviours. The researchers suggest that a different assessment framework is required to adequately address the complexities of community health literacy. A public health approach, founded on health promotion theories provides a useful scaffold to assess the critical health literacy of population groups.

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Resource: A cross sectional study examining social desirability bias in caregiver reporting of children’s oral health behaviors [US]

In previous research Sanzone et al (2013) found a strong association between caregiver oral health literacy and children’s oral health status, but found a weak association between caregiver oral health literacy and oral health behaviours. The authors hypothesize that this weak association may be due to social desirability bias (caregivers over reporting of behaviours considered to be socially desirable and under reporting undesirable ones). This research article compares caregivers’ responses to traditional oral health behaviours items and newer social desirability bias-modulating items, and examines the association of caregiver literacy with oral health behaviours. Sanzone et al (2013) found that caregivers with lower literacy scores were more likely to avoid brushing their children’s teeth. This avoidance was due to frustration around how and why to brush teeth. Sanzone et al (2013) note that for this study, REALD-30 and REALM are not capable of assessing the wide array of skills that comprise health literacy, including health knowledge, numeracy, and receipt of information via other modes of communication.

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Resource: A cross-sectional study of pandemic influenza health literacy and the effect of a public health campaign [Aus]

This study by Jhummon-Mahadnac et al (2012) sought to ascertain the understanding of 2009 pandemic (H1N1) influenza and relevant infection control measures in an emergency department population and to assess the effectiveness of education campaigns in informing the public about the pandemic. This is the first Australian study to correlate the general public’s knowledge of pandemic (H1N1) 2009 influenza with a health department public health campaign. Jhummon-Mahadnac et al (2012) found the knowledge regarding pandemic influenza was high in this emergency department population and positively affected by official campaigns. The authors recommend that pandemic planning should address knowledge gaps and the impression that authorities had exaggerated the public-health threat.

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Resource: A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial – 2010 [Aus]

Patient decision aids are interventions designed to help people make informed choices about their health. This article, by Smith et al (2010), examines whether a decision aid designed for adults with low education and limited literacy can help support informed choices and involvement in decisions around screening for bowel cancer. A paper-based interactive booklet and DVD were given to patients. The study found that tailoring decision support information to the needs of limited literacy patients can be effective in supporting informed choices and greater involvement in decision making without increasing patient anxiety.

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Resource: A Drug by Any Other Name: Patients’ Ability to Identify Medication Regimens and Its Association with Adherence and Health Outcomes – 2013 [US]

In this study, Lenahan et al investigated hypertension patients’ understanding of and familiarity with their drug regimen. The relationship between patients' identification strategies, self-reported adherence, and health outcomes (blood pressure control, hospitalization) was investigated. Lenahan et al found that patients who were dependent on the visual identification of their prescription medicine reported worse adherence. In addition, they had significantly lower rates of blood pressure control and greater risk of hospitalization. The researchers concluded that the ability to identify prescribed medicines by name may be helpful for screening and responding to patients at greater risk of making medication errors or being less engaged with their regimen for adherence purposes This article was published in the Journal of Health Communication: International Perspectives. Special Issue: Promoting Health Literacy Research to Advance the Field (Volume 18, Supplement 1, 2013).

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Resource: A Framework for Health Literacy – 2015 [NZ]

This framework, from the Ministry of Health, outlines expectations for the health system, health organisations and all of the health workforce to take action that: * supports a ‘culture shift’ so that health literacy is core business at all levels of the health system * reduces health literacy demands and recognises that good health literacy practice contributes to improved health outcomes and reduced health costs. This resource accompanies the Ministry's new resource: Health Literacy Review: A guide.

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Resource: A health literacy fable for tomorrow: help the world be healthy with health literacy. Discussion paper – 2014 [US]

This discussion paper (3 pages), by Andrew Pleasant, was written for the Institute of Medicine's Roundtable on Health Literacy. In this paper the author tells the story of an American town that lost health literacy and the health care system went from an emphasis on health care to sick care. The author argues that health literacy can create a path to a happy, healthy future in which good health is not only a human right but also well within everyone’s reach.

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Resource: A health literate approach to the prevention of childhood overweight and obesity – 2013 [US]

Previous studies that have developed enhanced educational materials for low health literate populations have demonstrated moderate improvements in parental behaviors that impact upon child health. This article describes a systematic process to assess the quality of the educational materials written for the Growing Right Onto Wellness (GROW), a behavioral intervention aimed at obesity prevention within a low health literate population. These resources were developed using plain language principles and were informed by the GREENLIGHT toolkit. The resources were reviewed by an expert panel and assessed using the Suitability Assessment of Materials (SAM) tool. Evaluation resulted in adjustments to the literacy demand to a 6th grade reading level and the presentation of materials. Cognitive interviews with the target population were used to assess perceptions of acceptability and feasibility for behavioural change. The researchers found that the GROW resources were appropriate for parents with low health literacy and their preschool children. The researchers recommended that educational resources targeting this population should be developed using this project's systematic methodology and with consideration of the needs of low health literacy audiences.

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Resource: A Maturing Partnership

In this article by Rudd (2002) she traces early innovations in the connection between literacy and health, through some current activities, and provides some suggestions for next steps in the development.

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Resource: A new adaptive testing algorithm for shortening health literacy assessments

This article by Kandula et al (2011) describes the development of a new procedure for testing health literacy levels. They found that by using measurement decision theory (MDT), they were able to create an accurate test for health literacy which was 50% shorter than previous tests.

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Resource: A New Approach to Measurement of Health Literacy

This PowerPoint presentation from Elizabeth Hahn outlines the difficulties of assessment of health literacy and implications for policy, practice and assessment.

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Resource: A pilot study to assess oral health literacy by comparing a word recognition and comprehension tool – 2014 [US]

Oral health literacy is important to oral health outcomes. Very little has been established on comparing word recognition to comprehension in oral health literacy especially in older adults. This pilot study, by Khan et al (2014), aimed to compare methods of measuring oral health literacy in older adults by using the Rapid Estimate of Literacy in Dentistry (REALD-30) tool including word recognition and comprehension and by assessing comprehension of a brochure about dry mouth. This pilot study demonstrated the feasibility of using the REALD-30 and a brochure to assess literacy in a University setting among older adults. Participants had higher scores on the word recognition than on comprehension agreeing with other studies that recognition does not imply understanding.

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