Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy (...) from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy. (shrink)

This paper is particularly concerned with shame, sometimes considered the ‘master emotion’, and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and (...) may lead to discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity. (shrink)

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy (...) from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy. (shrink)

Many families worldwide have at least one member with a behavioral or mental disorder, and yet the majority of the public fails to correctly recognize symptoms of mental illness. Previous research has found that Mental Health Literacy (MHL)—the knowledge and positive beliefs about mental disorders—tends to be higher in European and North American cultures, compared to Asian and African cultures. Nonetheless quantitative research examining the variables that explain this cultural difference remains limited. The purpose of our study was (...) fourfold: (a) to validate measures of MHL cross-culturally, (b) to examine the MHL model quantitatively, (c) to investigate cultural differences in the MHL model, and (d) to examine collectivism as a predictor of MHL. We validated measures of MHL in European American and Indian samples. The results lend strong quantitative support to the MHL model. Recognition of symptoms of mental illness was a central variable: greater recognition predicted greater endorsement of social causes of mental illness and endorsement of professional help-seeking as well as lesser endorsement of lay help-seeking. The MHL model also showed an overwhelming cultural difference; namely, lay help-seeking beliefs played a central role in the Indian sample, and a negligible role in the European American sample. Further, collectivism was positively associated with causal beliefs of mental illness in the European American sample, and with lay help-seeking beliefs in the Indian sample. These findings demonstrate the importance of understanding cultural differences in beliefs about mental illness, particularly in relation to help-seeking beliefs. (shrink)

ObjectiveThe level of health literacy is one of the important factors affecting health outcomes. Family is an important place to shape personality traits, and people with different personalities will adopt different lifestyles, which will lead to variations in health outcomes. Therefore, this article aims to explore the relationship between health literacy and personality and its influencing factors in different family structures.MethodsThis was a cross-sectional study with 1,406 individuals. A questionnaire was utilized to measure (...) class='Hi'>health literacy, personality and demographic variables, including family structure. Canonical correlation analysis and hierarchical multiple regression analysis were used to examine the relation between health literacy and personality traits between two types of family structure.ResultsCCA showed that the canonical correlation coefficients were 0.309 and 0.347, in two-parent family and single-parent family, respectively. The openness of personality traits exhibited the highest correlation with health literacy. Compared with the remaining personality traits, openness yielded the strongest effect in two types of family structure, respectively. Education and monthly income were significantly associated with health literacy.ConclusionOur results support the relation between health literacy and personality traits in two types of family structure. (shrink)

Commentary on Angelo E. Volandes & Michael K. Paasche-Orlow, Health Literacy, Health Inequality and a Just Healthcare System.

Public health professionals recognize the critical role the law plays in determining the success of public health measures. Even before September 11, 2001, public health experience with tobacco use, HIV, industrial pollution and other potent threats to the health of the public demonstrated that laws can assist or thwart public health efforts. The new focus on infectious threats and bioterrorism, starting with the anthrax attacks through the mail and continuing with SARS, has highlighted the important (...) role of law.For lawyers to serve as effective partners in public health, they should have a basic familiarity with public health: how public health professionals see the world and the key issues they tackle. A practical grasp of public health can be acquired, and often is acquired, “on the job.”. (shrink)

Public health professionals recognize the critical role the law plays in determining the success of public health measures. Even before September 11, 2001, public health experience with tobacco use, HIV, industrial pollution and other potent threats to the health of the public demonstrated that laws can assist or thwart public health efforts. The new focus on infectious threats and bioterrorism, starting with the anthrax attacks through the mail and continuing with SARS, has highlighted the important (...) role of law.For lawyers to serve as effective partners in public health, they should have a basic familiarity with public health: how public health professionals see the world and the key issues they tackle. A practical grasp of public health can be acquired, and often is acquired, “on the job.”. (shrink)

BackgroundThe positive component of Mental Health Literacy refers to a person’s awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners.AimTo identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications.MethodsLiterature search and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach.ResultsPositive component of Mental Health Literacy (...) is considered one component of MHL, integrating positive mental health. The concept’s attributes include: competence in problem-solving and self-actualization; personal satisfaction; autonomy; relatedness and interpersonal relationship skills; self-control; and prosocial attitude. Four case scenarios were used to clarify the antecedents and consequences of PMeHL.ConclusionPositive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families. (shrink)

Our article is focused on selected socio-economic aspects of health literacy of poor persons in the South Bohemian Region. In addition to determining the level of health literacy, we test its relationship to income and education level and examine how difficult it is for the target group to pay for medicines and visit a physician if needed. We also focus on the causes of such difficulties. The research was conducted in 2016 on a sample of 254 (...) persons entitled to state material poverty benefits in the South Bohemian Region. A structured interview was used, including the administration of the short form of the standardized Health Literacy questionnaire, with several additional questions on the respondents’ socio-economic situation. The data were statistically processed using SPSS. The results showed the respondents had an insufficient level of health literacy, and that a high proportion had difficulty paying for medicines and visiting their physician when required. Health literacy is not related to income but to education level. (shrink)

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. (...) Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples’ ability to enact moral agency in making such decisions. (shrink)

BackgroundReturning neuroimaging incidental findings may create a challenge to research participants’ health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders (...) involved in disclosing IF.MethodsWe surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined.ResultsAlthough participants reported high health literacy skills, 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings.ConclusionsThe language in clinically useful radiology reports can create a challenge for participants’ health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings. (shrink)

High prevalence of musicians’ physical and mental performance-related health issues (PRHI) has been demonstrated over the last 30 years. To address this, health promotion strategies have been implemented at some post-secondary music institutions around the world, yet the high prevalence of PRHI has persisted. In 2018, an international group of researchers formed the Musicians’ Health Literacy Consortium to determine how best to decrease PRHI, and to examine the relationship between PRHI and health literacy. An (...) outcome of the Consortium was the development of a new health literacy tool for musicians, the MHL-Q19, which drew from the theoretical framework of the European health literacy suite of tools, HLS-EU. The aim of the current study was to evaluate the validity and reliability of the MHL-Q19. Participants completed a battery of questionnaires, including the HLS-EU-Q16 for the assessment of general health literacy; the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM); the RAND-12 quality of life questionnaire; and the General Self-Efficacy scale (GSE). We hypothesized that the MHL-Q19 would have a weak correlation with the HLS-EU-Q16; moderate correlation with the physical component scale and weak correlation with the mental component scale of the RAND-12; moderate correlation with the GSE; and finally, moderate correlation with pain interference and weak correlation with pain intensity of the MPIIQM. A total of 549 post-secondary music students from six English-speaking countries completed the battery of questionnaires, and 328 of these participants provided valid responses to the MHL-Q19 alone 2 weeks later. The tool showed acceptable internal consistency and test–retest reliability. Three of our hypotheses were supported, although the strength of the correlations varied from what we had predicted. The fourth hypothesis was not supported; our findings indicate that lower health literacy scores were weakly related to higher MPIIQM pain intensity and interference scores. The results of this study support the notion that musicians’ health literacy is a distinct construct that cannot be fully evaluated with existing health literacy tools. Given that this is a new instrument, the evidence presented is positive and promising. Further studies will be needed to refine the tool. (shrink)

The Mental Health Literacy Scale is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin’s translation model and tested with a sample of 872 clinical (...) registered nurses. The Jefferson Scale of Empathy-Health Professionals, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-2 were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named “knowledge of mental disorder,” “ability to seek information and help,” “recognition of mental disorder,” and “acceptance of patients with mental illness,” with factor 1-3 were summarized into MHLS-Core and factor 4 as MHLS-SA. The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 and highly positively correlated with JSE-HP. The Cronbach’s α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50th percentile for the MHLS-C was 99, with 50th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended. (shrink)

In this article, we study health literacy as entangled and situated processes of authorisation of pregnant women to become competent caretakers of their own physical activity and health based on the development of the practice of ‘learning to take notice’. Based on our ethnographic fieldwork in a randomised controlled trial on physical activity during pregnancy called FitMum, we develop a processual conceptualisation of health authorisation as multidirectional flows between participants, staff and technologies. Using the concepts of (...) attunement and authorisation from Latour and Despret, we suggest that health literacy is not just something that can be acquired once and for all, but is processual and must be maintained, nurtured and developed through continuous negotiations, adjustments and adaptations to the constantly changing conditions of the health subject. (shrink)

A significant proportion of the U.S. population exhibits low health literacy. Evidence suggests that low health literacy is correlated with higher medical costs and poorer health outcomes. Even more concerning, evidence suggests that low health literacy threatens patients’ and families’ autonomy and exacerbates injustices in patients who are already vulnerable to difficulties navigating the health care system. There is also, however, increasing evidence that health literacy interventions—including initiatives such as plain (...) language practices and teach-back—improve comprehension and usefulness of health care information. I show how health literacy best practices can enhance the work of clinical ethicists in their primary roles of policy, consultation, and education. In the final section, I suggest ways health literacy initiatives may be enhanced with insights from clinical ethicists. (shrink)

Teachers have an important social role, and their mental health literacy is very important to their own abilities as educators and to the growth and development of those they educate. This study explored the mechanism underlying the influence of social support on teachers’ mental health literacy by conducting a questionnaire survey of 573 teachers. The results showed that social support can influence teachers’ mental health literacy not only through the separate effects of life satisfaction (...) and coping tendency but also through the chain mediation effect of life satisfaction and coping tendency; however, the direct effect of social support on the teachers’ mental health literacy is not significant. This study is conducive to understanding the internal mechanism underlying the relationship between social support and mental health literacy. It reminded us that when formulating mental health literacy promotion programs for teachers, we should not only provide adequate social support to improve but also should pay attention to improvements in their coping tendencies and life satisfaction. (shrink)

The current study describes the implementation of an online Future Problem Solving program in the field of Health education and set out to explore its contribution to students' eHealth Literacy identity, by using two levels of teacher guidance: minimal vs. frequent. FPS was employed in two groups of Health students. In the research group, frequent weekly guidance was provided to the students centered on the enhancement of eHealth Literacy skills, whereas in the control group minimal guidance (...) was offered by the lecturer. Data for the analysis were gathered from 113 Israeli undergraduate students of a Management of Health Service Organizations program, of whom 62 comprised the research group. Data were gathered twice, pre- and post-program implementation from both groups. Findings showed significant differences between the tests only for the research group, with increased levels of eHealth Literacy skills detected between the tests. The perception of the FPS program as meaningful contributed to students' perceived eHealth Literacy skills only in the research group whereas non-significant results were shown for the control group. This study mainly shows that the enhancement of skills in online educational environments requires frequent and personalized guidance. Faculty must recognize the role of the instructor as a facilitator of learning and design successful scaffolding strategies to nurture students' lifelong learning skills during distance learning. (shrink)

Health literacy is a contemporary term used in health services, often used to describe individuals requiring additional support to access, understand and implement health service information. It is used as a measure of self‐efficacy in chronic disease models of care such as the nurse navigator service. The aim of the research was to investigate the concept of health literacy in the nurse navigator service, particularly in relation to the defined role objective of person‐centred care. (...) Fairclough's critical discourse analysis was used to analyse the experiential, relational and expressive elements of texts, investigating the hidden truths which are represented in discourse. Texts from a variety of health service micro‐, meso‐ and macro‐hierarchical sources were selected for analysis using the nurse navigator evaluation data set and other associated texts. Health literacy in the nurse navigator service is a technology of government used to increase participation of individuals in their own health and well‐being. The discourse suggests that health literacy responsibilises both individuals and nurses and is discursively formed within a matrix of rational choice. In this context, health literacy contributes to structural vulnerability. (shrink)

This article describes a study that examined the experiences of 27 individuals who frequented an Open Access homeless shelter in Toronto, Canada. The overarching aim of this study was to map the social organisation of health care in Toronto, with particular regards to the ways in which literacy, or the lack of literacy, mediates the experiences of homeless individuals attempting to gain access to health care. While terms such as “literate” or “illiterate” might be seen to (...) reflect an individual’s level of acquired education or competence, critical social theorists argue that such terms instead more accurately reflect an individual’s relative class or position within the social hierarchy. Individuals who possess literacy are able to read into texts for their implicit understandings, directives, and power structures. Furthermore, they are able to translate and decode texts as potential pretexts for coordination or control. This study draws on a Freirean critical standpoint, which acknowledges that knowledge and power are inextricably interconnected. This study asked: How does literacy, or the lack of literacy, facilitate or impede access to health care for homeless individuals? What are the social consequences of illiteracy? (shrink)

ABSTRACT The expansion of health research to low and middle income countries has increased the likelihood of exploitation and undue influence in economically vulnerable populations. In behavioral research, “reasonable availability”, which was originally developed for biomedical research and advocates for the equitable provision of any product developed during the research process, cannot always prevent exploitation. In such cases and settings, the informed consent process may lack cross-cultural validity and therapeutic misconceptions may arise. This article advocates for a mutual learning (...) framework where international researchers can gain cultural competence while training and empowering local partners, increasing community ownership of health research. (shrink)

Mhealth technology is mushrooming world-wide and, in a variety of forms, reaches increasing numbers of users in ever-widening contexts and virtually independent from standard medical evidence assessment. Yet, debate on the broader societal impact including in particular mapping and classification of ethical issues raised has been limited. This article, as part of an ongoing empirically informed ethical research project, provides an overview of ethical issues of mhealth applications with a specific focus on implications on autonomy as a key notion in (...) the debate. A multi-stage model of references to the potential of mhealth use for strengthening some or other form of self-determination will be proposed as a descriptive tool. It illustrates an assumed continuum of enhanced autonomy via mhealth broadly conceived: from patient to user autonomy, to improved health literacy, and finally to the vision of supra-individual empowerment and democratised, participatory health and medicine as a whole. On closer examination, however, these references are frequently ambivalent or vague, perpetuating the at times uncritical use of established autonomy concepts in medical ethics. The article suggests zooming in on the range of autonomy-related aspects against the backdrop of digital innovation and datafied health more generally, and on this basis add to existing frameworks for the ethical evaluation of mhealth more specifically. (shrink)

The proposition that digital innovations can put people in charge of their health has been accompanied by prolific talk of empowerment. In this paper we consider ethical challenges and opportunities of trying to achieve justice and empowerment using digital health initiatives. The language of empowerment can misleadingly suggest that by using technology, people can control their health and take responsibility for health outcomes to a greater degree than is realistic or fair. Also, digital health empowerment (...) often primarily reaches people who already have high technological and health literacy, leaving others behind. We critically investigate whether the concept of health empowerment could be re-engineered to mean something different, namely the process of improving the health literacy and access of those who least possess it, in line with recent proposals for conceptual engineering in the service of justice. We settle on the weaker conclusion that underlying ethical values including justice should be used to interpret the existing concept of empowerment. To conclude, we take a high-level view of various strategies for achieving the ethical value associated with digital health empowerment. (shrink)

Internationally, governments, health and exercise practitioners are struggling with the threat posed by physical inactivity leading to worsening outcomes in health and life expectancy and the associated high economic costs. To meet this challenge it is important to enhance the quality, and quantity, of participation in sports and physical activity throughout the life course to sustain healthy and active lifestyles. This paper supports the need to develop a physically literate population, who meaningfully engage in play and physical activity (...) through the development of functional movement skills in enriched environments. This is a shift away from reductionist approaches to physical activity engagement and maintenance to an ecological dynamics approach that focuses on enrichment to support functional movement skill learning and development. This is an embedded approach to physical literacy that allows learners the space and time to “explore–discover” within environments that will lead to a concomitant self-organization of highly intricate network of co-dependent sub-systems resulting in functional movement solutions for the performance task and enduring positive adaptations to subsystems supporting the physical literacy journey across the life course. “Explore-discover adapt” is at the heart of two contemporary learner-centered pedagogies: Non-linear Pedagogy and the Athletic Skills Model. Both emphasize the importance of enrichment experiences from an early age, and throughout life course, and both appreciate the inherent complexity involved in the learning process and the importance of designing a rich and varied range of athletic, participatory experiences that will support the embedded development of physical literacy leading to ongoing physical activity for all. The final part of this paper will demonstrate the potential of an ecological dynamics approach for supporting the concept of physical literacy by providing a roadmap for a reliable and valid measurement of physical literacy when considered from both an ecological dynamics perspective and the phenomenology understanding of physical literacy. (shrink)

Many different professionals play a key role in maintaining welfare in a welfare society. These professionals engage in moral judgements when using (new) technologies. In doing so, they achieve that radical responsibility towards the other that Levinas describes as being at the very core of ethics. Also, professionals try to assess the possible consequences of the involvement of specific technologies and adjust their actions in order to ensure ethical responsibility. Thus, ethics is necessary in order to obtain and sustain one's (...) professionalism. This presents care institutions with the challenge to design work processes and technology work in ways that include a sense of ‘the Other’ and make moral judgement an indispensable part of professional competence in technology. This article provides new understandings of the way ethics are involved in care institutions. Nurses’ moral judgements are sophisticated with regard to ethical perspectives. In hospitals, nurses combine Latour's notion of symmetry in human/technology relations with an ethics implying ethical priority to human beings over other beings. This combination of ethics is not only sophisticated; it is also paradoxical, as it puts together mutually contradictory ethics. Instead of causing moral confusion, this ethical paradox is employed to produce a particularly refined notion of care situations, allowing nurses’ care to include patients and technology alike. (shrink)

Research has shown that “no use” drug education programs, with the objective of scaring or shaming youth into abstinence, have not been effective in addressing problematic substance use. The ineffectiveness of such scare tactic approaches has led program developers to focus on prevention and harm reduction associated with drug use, or in general, health literacy promotion. While significant ‘discussion-based’ drug education programs have been developed over the past decade and has encouraged students to be expressive and critical thinkers (...) regarding drug use, their effective implementation has been a challenge. This paper introduces Engaged Philosophical Inquiry as a pedagogical approach in order to promote drug literacy. The EPI approach is used both as the content and means of professional development for high school teachers to address the significant role of teachers in these programs. Its goal is to help teachers become aware of and re-evaluate their biases, beliefs and behaviors, before they are able to facilitate a non-stereotyped, open, and thoughtful discussion on drug use related topics. The overall idea of this paper is based on an in-progress research project sponsored by Mitacs organization. It discusses the significance of the project by first presenting the existing methods and theoretical approaches to drug education. On that basis, it shows how EPI can contribute to traditional drug education approaches. It then describes how the methodology and phases of the project are rooted in a dialogical process that aim for a close collaboration with teachers. (shrink)

The concept of suicide literacy is currently used to describe a perceived deficit in public knowledge about suicide that is directly related to specific health actions and outcomes. It thereby fulf...

After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers’ self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in Liberia combining basic (...) neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers’ own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers’ knowledge of students’ social and emotional needs, and promoting educational improvement. (shrink)

Purpose Health misinformation poses severe risks to people’s health decisions and outcomes. A great deal of research in this area has focused on debunking misinformation and found limited effects of correctives after misinformation exposure. The research on prebunking strategies has been inadequate. Most has focused on forewarning and enhancing literacy skills and knowledge to recognize misinformation. Part of the reason for the inadequacy could be due to the challenges in conceptualizing and measuring knowledge. This study intends to (...) fill this gap and examines various types of knowledge, including subjective knowledge, cancer literacy, persuasion knowledge and media literacy. This study aims to understand how knowledge may moderate the effect of misinformation exposure on misbeliefs. Design/methodology/approach An online experiment with a basic experimental design (misinformation exposure: health misinformation vs factual health message) was conducted. The authors measured and tested the moderating role of different types of knowledge (subjective knowledge, cancer literacy, persuasion knowledge and media literacy) separately to improve the understanding of their role in combatting online health misinformation. Findings This study found that a higher level of cancer literacy and persuasion knowledge helped people identify misinformation and prevented them from being persuaded by it. A higher level of subjective knowledge, however, reduced the recognition of misinformation, thereby increasing the likelihood of being persuaded by it. Media literacy did not moderate the mediation path. Originality/value This study differentiates the role different types of knowledge may have played in moderating the influence of health misinformation. It contributes to a strategic development of interventions that better prepare people against the influence of health misinformation. (shrink)

The COVID-19 pandemic poses an unprecedented threat to global human wellbeing, and the proliferation of online misinformation during this critical period amplifies the challenge. This study examines consequences of exposure to online misinformation about COVID-19 preventions. Using a three-wave panel survey involving 1,023 residents in Singapore, the study found that exposure to online misinformation prompts engagement in self-reported misinformed behaviors such as eating more garlic and regularly rinsing nose with saline, while discouraging evidence-based prevention behaviors such as social distancing. This (...) study further identifies information overload and misperception on prevention as important mechanisms that link exposure to online misinformation and these outcomes. The effects of misinformation exposure differ by individuals’ eheath literacy level, suggesting the need for a health literacy education to minimize the counterproductive effects of misinformation online. This study contributes to theory-building in misinformation by addressing potential pathways of and disparity in its possible effects on behavior. (shrink)

In this article, we argue that the scope of bioethical debate concerning justice in health should expand beyond the topic of access to health care and cover such issues as occupational hazards, safe housing, air pollution, water quality, food and drug safety, pest control, public health, childhood nutrition, disaster preparedness, literacy, and many other environmental factors that can cause differences in health. Since society does not have sufficient resources to address all of these environmental factors (...) at one time, it is important to set priorities for bioethical theorizing and policy formation. Two considerations should be used to set these priorities: (1) the impact of the environmental factor on health inequality, and (2) the practicality of addressing the factor. (shrink)

Sri Lanka, once a colony of Britain, gained independence in 1948. However, especially the health sector continues to use English as its main medium of communication. Such language bias leads to marginalization of those less fluent in English, and hinders achieving a higher level of health literacy. Discrimination of people or social groups based on their language is termed linguicism. Tackling linguicism requires an understanding of its historic roots and an exploration of potential links to colonial racial (...) prejudices. Published literature presents evidence that traces linguicism to language policies of the British colonial government. Though an exhaustive survey of historical records is not presented, there is reasonable evidence to suggest a close link. British colonial rule derived its justification from supremacist and racist ideology. As a result, English became the medium in all forms of official communications, a situation that persisted after independence. A similar situation exists in many parts of the worlds. We should recognize language-based discrimination and linguicism as public health issues. They are detrimental to health of vulnerable groups and have the potential to worsen health disparities. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation (...) study. Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Graduate education is a critical period in shaping and fostering graduate students' awareness about the importance of responsible conduct of research and knowledge and skills in doing good science. However, there is a lack of a standard curriculum and assessment framework for graduate students in Taiwan. The aim of this study was to develop a literacy-based research integrity (RI) assessment framework, including five core RI areas: (1) basic concepts in RI, (2) RI considerations in the research procedure, (3) research (...) ethics and research subject protection, (4) publication and authorship, and (5) conflict of interest. The five areas were derived through a comprehensive review of major topics and areas covered in existing research integrity education and training programs and were rated by RI experts with adequate content validity. Test items on the five core areas were developed across three literacy levels: remembering and understanding, applying and analyzing, and evaluating and creating. Seven thousand and eighty-seven graduate-level trainees took an 18-unit RI course covering the five RI areas. Upon finishing the course, trainees completed a computer-based RI assessment randomly selected from 26 RI testing booklets. The design of test items followed the mastery-oriented assessment principles to promote trainees’ learning of RI with adaptive assessment feedback. Results showed that the items in the RI assessment had adequate discrimination and low difficulty level. Thus, the RI assessment can be used to assess a range of trainees’ RI literacy and can provide the most information in identifying trainees in need of more instruction or alternative training. The low guessing parameters also indicated the online RI assessment had an appropriate control of test exposure and cheating prevention. Higher education authorities can use this framework to assess graduate students' RI literacy based on a standard curriculum and prepare them for conversations about the responsible conduct of research for RI culture-building. (shrink)

Background and aimThe postpartum depression literacy of perinatal women is closely related to the occurrence, recognition, and treatment of postpartum depression, therefore valid instruments for evaluating the level of PoDLi are of great significance for both research and clinical practice. This study aimed to cross-culturally adapt the postpartum depression literacy scale into Chinese and to test its psychometric properties among Chinese perinatal women.Materials and methodsA cross-sectional study was conducted from April to May 2022 in a tertiary hospital in (...) Hangzhou, Zhejiang Province, China. 619 out of the 650 perinatal women that were approached via a convenience sampling method completed the Chinese version of the PoDLiS. Content validity [the content validity index of items and scale-level content validity index ] was evaluated by an expert panel. Psychometric properties, including item analysis, structure validity, convergent and discriminant validity, reliability, criterion validity, and floor/ceiling effect were examined.ResultsThe final version of C-PoDLiS is a six-factor structure consisting of 27 items, which explained 61.00% of the total variance. Adequate content validity was ensured by the expert panel. The modified confirmatory factor analysis model revealed that the 6-factor model fitted the data well. The total Cronbach’s α was 0.862, the total McDonald’s ω was 0.869, and the test-retest reliability coefficient was 0.856. Results of convergent validity and discriminant validity provided good or acceptable psychometric support. Significant correlations between scores of the C-PoDLiS and Mental health literacy scale and Attitudes toward seeking professional psychological help short form scale supported good concurrent and predictive validity, respectively. No floor/ceiling effect was found.ConclusionThe C-PoDLiS was demonstrated to be a sound instrument with good reliability and validity for evaluating Chinese perinatal women’s PoDLi levels. Its use in the future can facilitate data aggregation and outcome comparisons across different studies on this topic. (shrink)

Mobile health tools are often said to empower users by providing them with the information they need to exercise control over their health. We aim to bring clarity to this claim, and in doing so explore the relationship between empowerment and autonomy. We have identified three distinct models embedded in the empowerment rhetoric: empowerment as information, empowerment as control, and empowerment as values. Each distinct model of empowerment gives rise to an associated problem. These problems, the Problem of (...) Interpretation, the Value Alignment Problem, and the Priority Problem, show that mobile health tools in their current form are either insufficient for empowerment or are self‐defeating. These digital health technologies encourage users to adopt an individualized conception of autonomy, one that may weaken the doctor–patient relationship and undermine practices in shared decision making, and ultimately may not deliver on improving the health outcomes for those that need it the most. (shrink)

School belonging is of great significance to students' physical and mental health development, especially academic improvement. However, the mechanism of the influence of school belonging on student academic achievement should be further explored, especially reading performance. Based on ecological systems theory and self-determination theory, the present research constructs a multilevel design to examine a moderated mediation model in which school belonging as a level-1 predictor, mastery goal orientation as a level-1 mediator and school disciplinary climate as a level-2 moderator (...) jointly impact reading literacy. Results of the study were based on the questionnaires from 11,364 15-year-olds nested in 332 schools in mainland China that participated in PISA 2018. The cross-sectional analysis indicated that: school belonging had a direct and positive effect on student reading literacy; the relationship between school belonging and reading literacy was prominently mediated by mastery goal orientation; both school disciplinary climate level and strength could negatively moderate the latter half path of “school belonging → mastery goal orientation → reading literacy.” Implications, limitations, and future research directions are discussed. (shrink)