Health literacy (HL) encompasses an individual\'s ability to access, understand, and integrate health-related information. Routine use of functional, critical, and communicative HL screening questionnaires shows promise in identifying those at risk for poor clinical outcomes. Although it is evident that low levels of HL are associated with poor clinical outcomes in end-stage renal disease, it is unclear how varying HL levels are associated with nutrition-specific adherence. Here, we present a summary of literature published between 2018 and 2023 examining relationships between HL and nutrition-related adherence among individuals on hemodialysis. A positive association between higher HL scores and adherence to nutrition-related recommendations was found in this population. Based on these findings, screening for low levels of HL using validated tools should be integrated into standard practice for nutrition assessment. Future studies are warranted to explore the dietitian\'s role in improving HL and to develop a standardized measure for nutrition-related adherence.

Aims/Background Seroma formation is the most common complication following breast surgery. However, there is little evidence on the readability of online patient education materials on this issue. This study aimed to assess the accessibility and readability of the relevant online information. Methods This systematic review of the literature identified 37 relevant websites for further analysis. The readability of each online article was assessed through using a range of readability formulae. Results The average Flesch-Reading Ease score for all patient education materials was 53.9 (± 21.9) and the average Flesch-Kincaid reading grade level was 7.32 (± 3.1), suggesting they were \'fairly difficult\' to read and is higher than the recommended reading level. Conclusion Online patient education materials regarding post-surgery breast seroma are at a higher-than-recommended reading grade level for the public. Improvement would allow all patients, regardless of literacy level, to access such resources to aid decision-making around undergoing breast surgery.

Frequent use of pain relief medications among patients with migraine can result in disease worsening and medication-overuse headache (MOH), a painful and debilitating condition. We sought to conduct a cross-sectional survey among adult patients diagnosed with migraine to determine: 1) their awareness of MOH, and 2) their knowledge of the condition and its prevention, and 3) the association of these factors with actual use of pain relief medications. We recruited and interviewed 200 English-speaking adults with migraine who had a clinic visit with a neurologist or primary care provider within the past month. Patients were identified via an electronic health record query. Almost 40% of participants had never heard of the term \'medication-overuse headache.\' In bivariate analyses, participants who were Black or Hispanic and those with limited health literacy were less likely to have heard of MOH. Participants scored an average of 2.1 (range: 0-3) on a MOH knowledge measure; older participants, those with limited health literacy, lower education, and little or no migraine-related disability demonstrated less knowledge. Almost a third (31.5%) of patients reported overusing pain relief medication and were at risk for MOH. Overuse was not significantly associated with MOH awareness, knowledge, or sociodemographic factors, but was related to greater migraine-related disability. Our findings suggest that patient awareness and knowledge of MOH is suboptimal, particularly among older adults, racial and ethnic minority groups, and those with limited health literacy. Interventions are needed to prevent MOH and better inform patients about risks associated with frequent use of pain relief medications.

BACKGROUND: Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied user-centered design sprint methodology to develop a patient portal intervention empowering patients to address selected diabetes care gaps (eg, no diabetes eye examination in last 12 months).
OBJECTIVE: This study aims to evaluate the effect of our novel diabetes care gap intervention on completion of selected evidence-based diabetes preventive care services and secondary outcomes.
METHODS: We are conducting a pragmatic randomized controlled trial of the effect of the intervention on diabetes care gaps. Adult patients with diabetes mellitus (DM) are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible if they have type 1 or 2 DM, can read in English, are aged 18-75 years, have a current patient portal account, and have reliable access to a mobile device with internet access. We exclude patients with medical conditions that prevent them from using a mobile device, severe difficulty seeing, pregnant women or women who plan to become pregnant during the study period, and patients on dialysis. Participants will be randomly assigned to the intervention or usual care. The primary outcome measure will be the number of diabetes care gaps among 4 DM preventive care services (diabetes eye examination, pneumococcal vaccination, hemoglobin A1c, and urine microalbumin) at 12 months after randomization. Secondary outcomes will include diabetes self-efficacy, confidence managing diabetes in general, understanding of diabetes preventive care, diabetes distress, patient portal satisfaction, and patient-initiated orders at baseline, 3 months, 6 months, and 12 months after randomization. An ordinal logistic regression model will be used to quantify the effect of the intervention on the number of diabetes care gaps at the 12-month follow-up. For dichotomous secondary outcomes, a logistic regression model will be used with random effects for the clinic and provider variables as needed. For continuous secondary outcomes, a regression model will be used.
RESULTS: This study is ongoing. Recruitment was closed in February 2022; a total of 433 patients were randomized. Of those randomized, most (n=288, 66.5%) were non-Hispanic White, 33.5% (n=145) were racial or ethnic minorities, 33.9% (n=147) were aged 65 years or older, and 30.7% (n=133) indicated limited health literacy.
CONCLUSIONS: The study directly tests the hypothesis that a patient portal intervention-alerting patients about selected diabetes care gaps, fostering understanding of their significance, and allowing patients to initiate care-will reduce diabetes care gaps compared with usual care. The insights gained from this study may have broad implications for developing future interventions to address various care gaps, such as gaps in cancer screening, and contribute to the development of effective, scalable, and sustainable approaches to engage patients in chronic disease management and prevention.
BACKGROUND: ClinicalTrials.gov NCT04894903; https://classic.clinicaltrials.gov/ct2/show/NCT04894903.
UNASSIGNED: DERR1-10.2196/56123.

BACKGROUND: The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages.
METHODS: This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator.
RESULTS: The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall\'s coefficient of concordance (Kendall\'s W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults.
CONCLUSIONS: This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults.
UNASSIGNED: Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.

UNASSIGNED: This study developed a causal relationship model of herb use from observational data and analyzed the direct and indirect effects of herb use on health according to the model.
UNASSIGNED: A cross-sectional study was conducted with 400 participants aged 26-59 years, selected through multistage random sampling. The instruments used for data collection included demographic information, herb use, health literacy (HL), perceived social support, societal values, and attitudes toward herb use. The conceptual model, hypothesized based on prior evidence, was tested using confirmatory factor analysis through structural equation modeling. Path coefficients were estimated using the maximum likelihood method.
UNASSIGNED: The final model utilized empirical data, which showed that perceived social support had the most significant impact on herb use. This was followed by HL, positive attitudes toward herbal remedies, and societal values, with coefficients of 0.31, 0.18, and 0.16, respectively. When analyzing variables that indirectly affected herb use, it was clear that positive attitudes, perceived social support, and societal values significantly influenced herb use through HL, with influence coefficients of 0.08, 0.16, and 0.04, respectively. Together, these variables accounted for 68% of the variance in herb use.
UNASSIGNED: The findings from this study can be utilized to develop and implement strategies that guide the use of herbal products, ultimately aiming to improve human health.

BACKGROUND: Mental health literacy is a promising avenue of intervention for addressing the development of psychopathology, as well as its associated consequences, such as a decrease in academic performance. The current study aims to test the effectiveness of such an intervention in high school students, focusing on two main formats of delivery: (1) automated and (2) blended.
METHODS: To achieve this aim, a randomized clinical trial with direct comparisons at three time points between three conditions (automated, blended, and waitlist) was designed. Power analyses yielded a necessary sample size of 264 high school students. The participants will be selected from Romanian high schools.
CONCLUSIONS: The current study aims to contribute to the mental health literacy literature by testing the effectiveness of an educational intervention concerning mental health in terms of its benefits for reducing psychopathology and increasing academic performance. The success of such an intervention bears important implications for addressing mental health in the educational system.
BACKGROUND: Clinicaltrials.gov Identifier: NCT06217744, version 1, 22 January 2024.

BACKGROUND: Despite the importance of health literacy and the self-care skills in improving individual and social health and health costs reduction, scientific evidence indicates women\'s poor awareness of self-care needs and low health literacy concerning reproductive and sexual health in most societies. The present study was conducted to specify the effect of health awareness promotion on self-care needs and reproductive and sexual health literacy of newly married women.
METHODS: This randomized controlled clinical trial was conducted on 64 newly married women aged 15-45 in Tehran, Iran from August 2021 to the end of December 2021. The participants were randomly assigned into the intervention (n = 32) and control (n = 32) groups. The intervention group received four individual health awareness-promotion education sessions. The reproductive and sexual self-care needs, and sexual health literacy questionnaires, were completed before and 4-week after the intervention through interview. The data were analyzed using SPSS26 software. The independent t-tests and ANCOVA were used to comparison the mean scores and a significance level of P < 0.05 was considered.
RESULTS: The results of this study indicated that after counseling, the average overall score of perceived reproductive and sexual self-care needs significantly decreased in the intervention group [Mean (standard deviation(SD)): 125.70 (24.70)] compared to the control group [Mean (SD): 87.1 (23.42)][P = 0.001]. Also, the mean score of sexual and reproductive health literacy significantly increased in the intervention group [Mean (SD): 125.50 (14.09)] compared to the control group [Mean (SD): 97.15 (14.90)] after intervention [P = 0.01].
CONCLUSIONS: The results indicated the positive effect of health promotion awareness educations on reproductive and sexual self-care needs and health literacy among newly married women. Therefore, health promotion interventions should be incorporated in health services provision programs for newly married women in comprehensive health centers to improve the health of women and families.
BACKGROUND: Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N7 Date of registration: 2021-09-21. URL: https://fa.irct.ir/trial/58597 .

Carceral communities face heightened COVID-19-related risks while simultaneously experiencing medical mistrust and limited access to health information and services. Health education programs that incorporate dialogue-based, participatory learning models have been shown to motivate health behavior and increase health knowledge in carceral settings. To increase health literacy and change COVID-19-related health behavior among jail residents in the United States, a local health department developed a dialogue-based education program centered around COVID-19 prevention, misinformation, and navigating health care systems. Dialogue-based health information sessions took place in person in a county jail. Pre- and postsurveys gauged the sessions\' influence on self-reported health literacy and behavior intention. Overall, 595 residents collectively attended 43 facilitated discussions. Key findings indicate that dialogue-based education can temper medical mistrust, influencing COVID-19 preventive behaviors and increasing health literacy in a carceral setting.

BACKGROUND: As ChatGPT becomes a primary information source for college students, its performance in providing dietary advice is under scrutiny. This study assessed ChatGPT\'s performance in providing nutritional guidance to college students.
METHODS: ChatGPT\'s performance on dietary advice was evaluated by 30 experienced dietitians and assessed using an objective nutrition literacy (NL) test. The dietitians were recruited to assess the quality of ChatGPT\'s dietary advice, including its NL achievement and response quality.
RESULTS: The results indicate that ChatGPT\'s performance varies across scenarios and is suboptimal for achieving NL with full achievement rates from 7.50% to 37.56%. While the responses excelled in readability, they lacked understandability, practicality, and completeness. In the NL test, ChatGPT showed an 84.38% accuracy rate, surpassing the NL level of Taiwanese college students. The top concern among the dietitians, cited 52 times in 242 feedback entries, was that the \"response information lacks thoroughness or rigor, leading to misunderstandings or misuse\". Despite the potential of ChatGPT as a supplementary educational tool, significant gaps must be addressed, especially in detailed dietary inquiries.
CONCLUSIONS: This study highlights the need for improved AI educational approaches and suggests the potential for developing ChatGPT teaching guides or usage instructions to train college students and support dietitians.